Older adults' attitudes toward using Euthanasia at the end-of life: cancer vs. Parkinson's disease.

Background: There is a paucity of studies that compare older adults' attitudes toward Euthanasia in two different terminal illnesses. Moreover, these studies did not relate to potentially influencing psycho-social factors. The current study aimed to examine the impact of a diverse range of variables on attitudes among older adults toward Euthanasia in two medical conditions: cancer and Parkinson's disease. Methods: A total of 501 individuals aged 75 and above participated in the study. Attitudes toward Euthanasia were measured using vignettes which described two conditions: an 80-year-old man with metastatic cancer and another man in an advanced stage of Parkinson's disease. The questionnaire included measures of relevant experience (with a close family member or a friend dying from a terminal illness), self-efficacy, will to live, satisfaction with life, will to prolong life, fear of death and dying, social support, and psycho-social characteristics. The data were analyzed using hierarchical linear regression models. Results: A more positive attitude toward Euthanasia was found in the case of cancer compared to Parkinson's disease. Being a woman, having more years of education, lower level of religiosity, greater fear of death and dying and higher self-efficacy contributes to more favorable attitudes toward Euthanasia in both end-of life conditions. Conclusions: The finding that attitudes toward Euthanasia are statistically significantly more positive in the case of cancer compared to Parkinson's disease can be attributed to the greater prevalence of cancer in the population, and to the public's awareness of the suffering associated with each of these medical conditions. Beyond the important role of the socio-demographic characteristics of gender, education, and religiosity, it appears that fear of death and dying and self-efficacy are important psychological factors in explaining attitudes toward Euthanasia in both illnesses among older people. These findings shed light on older adults' attitudes toward Euthanasia in debilitating illnesses.

Social Support and Commitment to Life and Living: Bidirectional Associations in Late Life over Time.

OBJECTIVES: This study aims to enhance the understanding of longitudinal associations between two important facets of well-being in late life: social support and commitment to life and living (CTL). METHODS: Structured home interviews were conducted with 824 Israelis ≥75 years of age, with three annual data collection timepoints. We hypothesized and tested a cross-lagged, longitudinal structural equation model (SEM) in which CTL and social support were assumed to predict each other over time, covarying for previously reported CTL and social support. RESULTS: Social support has a positive, contemporaneous effect, predicting commitment to living at T1 and T3, while CTL predicts social support the following year (i.e., T1-T2 & T2-T3). Satisfaction with relationships significantly contributes to measurement of both latent constructs at each point of data collection. DISCUSSION: Commitment to life and living and social support are intertwined phenomena. Whereas social support has a concomitant effect on CTL, the effect of CTL on social support emerges over time. This suggests that greater social support fosters greater CTL, leading older adults to nurture social networks and relationships; the effect of which is greater social support in the future. The implications of these results warrant further research over longer periods and across cultures.

Social Support and Symptoms of Depression in Late Life: Bidirectional Associations over Time.

Social support functions as an effective buffer against depression, especially among older adults with limited social networks. For the current study, we examined longitudinal bidirectional associations between social support and depression among those 75+ years of age. We recruited and followed a sample of Israeli adults 75+ years of age (N = 824; M = 80.84; range 75-96 years). Structured interviews were conducted in the homes of participants at three annual points of measurement. Participants reported depressive symptoms and emotional and instrumental support received from friends and family. We examined a cross-lagged, longitudinal structural equation model (SEM) in which social support and depressive symptoms predict each other over time, covarying for previously reported social support and depressive symptoms. We found that both depressive symptoms and social support are largely consistent in late life. Depressive symptoms and social support reported at baseline predict levels reported 1 and 2 years thereafter. Cross-over effects emerged over time. Depressive symptoms predicted lower social support in future, and social support at baseline predicted depressive symptoms 2 years later. These findings suggest that associations between depressive symptoms and social support are bidirectional in late life. Further research is needed to replicate findings in other cultures and over longer periods, ideally until end of life.

Elderly Caregivers' Awareness of Caregiving Health Risks.

The aim of this study was to assess the level of awareness of elderly primary caregivers of being at physical and mental health risk due to their caregiving role, as well as to examine the impact of sociodemographic characteristics, patient care characteristics, and situational variables on caregivers' awareness. Data were collected by interview of a sample of primary caregivers aged 60+. A total of 202 primary caregivers responded positively, representing a response rate of 65% (202/311). We found a low−moderate level of awareness. The final multivariate regression analysis (F (12, 179) = 21.26, p < 0.000) revealed six variables, out of nearly 30, that are associated with a high percentage (59%) of the variability of caregivers' awareness, namely caregiving burden, caregivers' self-rated health, patient's disease severity, caregiver gender, number of children, and familial relation to the patient. Action may be taken to raise caregivers' awareness. Such interventions would possibly contribute to the quality of life and health of caregivers, enable the optimal treatment of the patient, and reduce the costs imposed on the health system and society in general.

Psychological reactions to the coronavirus pandemic: a comparative study of Holocaust survivors and other older adults in Israel.

BACKGROUND: The current study examines psychological reactions to the COVID-19 pandemic among older adults living in Israel. Based on the 'life events, stress, coping and health theory,' we hypothesized that due to their traumatic early life history and dearth of emotional and physical coping resources, Holocaust survivors would be more vulnerable than other older adults to the negative effects of this difficult and prolonged life event on their mental health. METHODS: Based on structured questionnaires with closed questions, we interviewed 306 Holocaust survivors and non-survivors aged 75 + during the COVID-19 pandemic. RESULTS: Univariate data analysis showed that Holocaust survivors had fewer coping resources in terms of health status and educational level than non-survivors. As expected, Holocaust survivors also reported a greater extent of COVID-19-related anxiety, and more depression, which worsened during the pandemic. However, both groups did not differ in their will to live, which is an indicator of general well-being and commitment to continue living. In multivariate analyses conducted to explain COVID-19 anxiety in the entire sample and separately on each of the two groups, the best explanatory variables were other psychological variables especially increased depression. CONCLUSIONS: It seems that Holocaust survivors are more emotionally vulnerable to the pandemic's negative effects than other older adults, in support of the 'life events, stress, coping and health theory,' but despite this, they show resilience in their will to continue living. Policy makers and practitioners are recommended to identify Holocaust survivors and other vulnerable older people and investigate their specific needs. Interventions should include practices for maintaining and boosting resilience and well-being by increasing appropriate emotional and cognitive internal and external coping resources, especially during prolonged periods of hardship.

Care for caregivers- a mission for primary care.

BACKGROUND: The number of elderly people living in the community who are limited in daily activities is increasing worldwide. This generates prolonged care, which usually falls on one family member, the family caregiver. Caregivers are prone to develop psychosocial and physical symptoms. As a result, the World Health Organization (WHO) issued a clear directive to assess and support these caregivers. The main goals of this study were to assess primary care physicians' (PCP) awareness to caregivers' health risks and the extent that they recommended preventive measures to maintain the health of the caregivers. As no suitable instrument existed, a secondary goal was to develop a scale to measure physicians' awareness to caregivers' health and preventive treatment and test it's psychometric properties. METHODS: Data were collected from a convenience sample of 201 PCP interviewed with structured questionnaires. RESULTS: The participants' mean age was 48.5 ± 11.2 years and 53.5% were female. Only 48.5% were Israel medical graduates and 72% were board-certified family physicians. Nearly 34% had been primary caregivers of family members. Most physicians (83.6%) were aware of the primary caregiver's high-risk for morbidity and mortality, and recommended preventive care. On a multivariate regression, PCP's higher level of risk awareness, their country of medical school and board certification were significant for explaining recommendations for preventive care. However, being a primary caregiver for a sick family member neither contributed significantly to the physicians' awareness to caregiving risks nor to their preventive care. CONCLUSION: Although a high percentage of physicians were aware and concerned about caregivers' health, their preventive care activities were relatively passive. PCPs should take a more active and preventive role for maintaining caregivers' health.

Open communication between caregivers' and terminally ill cancer patients about illness and death: The role of gender - A correlational study.

PURPOSE: Caregivers face severe difficulties in communicating openly with their terminally ill relatives about illness and death. Some studies suggest that females are more likely than males to hold such conversations. We compared level of open communication between male and female spouse-caregivers, and the contribution of personal and situational characteristics to the explanation of open communication level within each gender group. METHODS: The study design was correlational. We interviewed 77 spousal-primary caregivers of terminal cancer patients. Participants were recruited over a 10-month period from the home hospice unit of the central region of Israel's largest Health Maintenance Organization. The questionnaire included measures of open communication, along with caregiver's personal and situational characteristics. RESULTS: Female spouses reported higher levels of open communication about illness and death with their loved ones, compared to male spouses. Among males, duration of care and self-efficacy emerged as significant contributors to open communication level. Among females, self-efficacy and ethnic origin were found to be significant explanatory variables. CONCLUSIONS: This study demonstrates the important role gender plays in level of open communication between spousal caregivers and terminal cancer patients, concerning their illness and approaching death. Self-efficacy, ethnic origin and duration of care are also significant factors explaining open communication of both male and female caregivers. These factors should be considered by nurses and other healthcare professionals when developing intervention programs to increase the level of open communication between family caregivers and their terminally ill relatives.

Factors affecting the will to live among elderly jews living in israel.

Objectives: The aim of this qualitative study was to explore factors that influence older persons' will to live (WTL).Methods: Twenty-five Israeli elders were interviewed about what weakens and/or strengthens their WTL. Elements of the grounded theory method guided the data collection and analysis.Results: Our analysis revealed that the elements that pertain to WTL could potentially both increase and decrease the WTL in elders. These factors included social networks, financial security, religious faith, working and volunteering, and honor versus ageism.Conclusions: Five factors represent different aspects of older persons' lives that influence the WTL. The first four themes including Social Networks, Religious Faith, Honor versus Ageism, and Working and Volunteering are consistent with the findings of the study of Blue Zones. Blue Zones are areas characterized by high life expectancy. Israel shares cultural characteristics with the Blue Zones, being a society with traditional collective characteristics stemming from the Jewish tradition. The last theme of financial security is related to the characteristics of Israel as a society in which the social gaps are large and many elderly are pushed to the social margins, and lack financial security. This study points to the unique cultural characteristics of Israel that affect the WTL among elderly Jews and proposes a hypothesis linking Israeli culture to the high life expectancy in Israel.

Health and Well-Being in Late Life: Gender Differences Worldwide.

Maintaining health and quality of life and decreasing the number of years lived with disabilities in old age are among the main challenges of aging societies worldwide. This paper aims to present current worldwide health-related gender inequalities throughout life, and especially in late life, as well as gender gaps in social and personal resources which affect health, functioning and well-being. This paper also addresses the question of whether gender gaps at younger ages tend to narrow in late life, due to the many biological and social changes that occur in old age. Based on international data regarding these gender gaps and the trends of change in personal resources and health-related lifestyles in the more and less developed nations, conclusions regarding future changes in gender gaps are presented, along with practical implications for future improvements in women's health and well-being.

Relationships Among Self-perception of Aging, Physical Functioning, and Self-efficacy in Late Life.

Objectives: The purpose of the current study was to examine the longitudinal relationship between 2 central concepts in the study of subjective well-being in old age-self-perception of aging (SPA) and physical functioning, and to assess the mediating role of self-efficacy beliefs in this relationship. Methods: Interviews were conducted in the home with 1,216 randomly selected persons aged 75+ years (T1) and repeated with 892 of them 2 years later (T2). We collected data on SPA, physical functioning, self-efficacy, self-rated health, and demographics. Using SEM techniques, we examined cross-lagged autoregressive relationships between SPA and physical functioning and between SPA and self-efficacy, and the mediating effect of self-efficacy. Results: Findings indicated that it was SPA that affected physical functioning and self-efficacy and not vice versa, while controlling for age, gender, education, economic status and self-rated health. Evaluation of a mediation model showed that self-efficacy fully mediated the longitudinal relationship between SPA-T1 and physical functioning -T2. Discussion: Our results indicated a psychological pathway by which SPA affected physical functioning through self-efficacy. SPA also affected self-efficacy, which in turn probably motivated people to use effective coping patterns for maintaining their physical functioning.

Reciprocal relationships between the will-to-live and successful aging.

Objectives: The search for concomitants and predictors of successful aging is of theoretical and practical importance. In this study, we assessed the reciprocal relationships between the will-to-live (WTL) and both objective and subjective successful aging (SA) among older adults. Methods: Interviews were conducted with 1,216 randomly selected persons aged 75+ years (T1) and repeated with 1,019 of these participants one year later (T2). At each session, we collected data on WTL, subjective SA, and objective SA (medical conditions, disability, pain symptoms), and demographics. Using SEM techniques, we examined cross-lagged autoregressive relationships between WTL and both objective and subjective SA. Results: Significant reciprocal relationships were found among WTL, objective SA, and subjective SA. Higher WTL at T1 predicted higher objective and subjective SA at T2 (i.e., fewer medical conditions, less disability, less pain symptoms and higher ratings of subjective SA). Higher objective and subjective SA at T1 predicted higher WTL at T2. Comparison of the bidirectional temporal relationship between WTL and SA showed that the effect of WTL on objective SA was as strong as the reverse effect, but the influence of WTL on subjective SA was stronger than the reverse effect. Finally, objective SA at T1 predicted subjective SA at T2, but the reverse effect was not significant. Conclusion: WTL is an important precursor for both objective and subjective SA. It may also be maintained and further strengthened by successful aging. Policy makers and practitioners should consider WTL in their efforts to help older adults enhance and preserve SA.

Is a Decline in Will to Live a Consequence or Predictor of Depression in Late Life?

OBJECTIVES: To assess the causal directions of interaction between depression and decline in will to live (WTL) over 2 years in community-dwelling older adults. DESIGN: Community-based longitudinal study. SETTING: Three large cities in Israel. PARTICIPANTS: Individuals aged 75 and older (N=870). MEASUREMENTS: We tested a cross-lagged structural equation model in which WTL and depressive symptoms (DS) were tested as latent variables at each of three annual points of measurement. RESULTS: Of the health and sociodemographic covariates examined, only self-rated health predicted WTL and DS, and age predicted WTL. WTL predicted DS at each point of measurement. In addition to these cross-sectional effects, WTL also predicted DS 12 months later at the second and third year. In other words, the direction of prediction was exclusively from WTL to DS, concomitantly and over time. CONCLUSION: Our results indicate that WTL predicts DS rather than vice versa, suggesting that decline in WTL contributes and leads to depression at present and in future. Health strategies designed to promote WTL in older adults may help forestall depression. Moreover, psychotherapeutic interventions targeting WTL might be effective in the treatment of depression.

The Paradox of Well-Being and Holocaust Survivors.

BACKGROUND: Life satisfaction is a core component of well-being. Across age groups, satisfaction with life was found to be integral to individual mental and physical health. Surprisingly, there appears to be little or no association between age and life satisfaction. Recent longitudinal research suggests that life satisfaction may even increase in late life. This is known as the paradox of well-being. OBJECTIVE: To compare levels of life satisfaction reported by Israeli Holocaust survivors (HS) vis-à-vis other older Israelis and older Canadians. DESIGN: We interviewed 295 HS, 205 other older Israelis, and 335 older Canadians each of whom completed the Life Satisfaction Scale with items measuring both concurrent and retrospective aspects. Separate confirmatory factor analytic models were computed for each group. RESULTS: Overall, levels of life satisfaction were indistinguishable across groups. Both concurrent and retrospective items contributed significantly to measurement of a single latent construct. Yet differences between groups in the latent structure of response to certain scale items emerged. CONCLUSIONS: It may be that HS report high life satisfaction not despite, but because of, experiencing early life trauma, juxtaposing early years with the comparatively good conditions of their lives today.

Does early life trauma affect how depression is experienced by Holocaust survivors in late life?

OBJECTIVES: Existing research indicates that early life trauma increases the likelihood of depression in later life. This includes children who survived the Nazi Holocaust living in Israel today. For this study, we set out to examine whether early life trauma affects both levels of depression symptomatology and the relative prominence of certain facets of depression as compared to other older adults in Israel and Canada. METHOD: For this study we recruited 295 Holocaust survivors (HS), 205 other Israelis and 335 older Canadians each of whom completed Radloff's (1977) Center for Epidemiological Studies - Depression Scale (CES-D). The CES-D measures four distinct factors: Depressive affect, absence of well-being, somatic symptoms, and interpersonal rejection. Israeli and Canadian comparison participants were screened to ensure they had not experienced early life trauma. RESULTS: As anticipated, levels of depressive symptoms reported by HS were significantly greater than other Israelis and older Canadians. Moreover, the latent structure of depression as measured by the CES-D differs for HS. Depressive affect and the absence of well-being appear to distinguish depression among HS. Somatic symptoms do not differ, however, and interpersonal rejection seems less germane to depression as experienced by HS compared to both comparison samples. CONCLUSION: Findings support our assertion that early life trauma affects not only levels of depressive symptoms but also that these survivors of genocide experience depression differently than other Israelis and older Canadians. We discuss the implications of early life trauma for mental health in later life.

Subjective well-being of visually impaired older adults living in the community.

OBJECTIVES: Vision impairment is one of the most common disabilities among older adults, and it has a substantial impact on well-being. The present study constructs an integrative model to identify which variables derived from four dimensions of life (physical/functional, social, psychological and environmental) combined with sociodemographic variables explain the overall subjective well-being (SWB) visually impaired older adults living in the community. METHOD: A total of 121 severe visually impaired persons, aged 60 and over (M = 77.4, range 60-95), participated in the study. Personal, face-to-face interviews were conducted with participants at social centers or at their homes. Research tools consisted of valid and reliable questionnaires. RESULTS: Five variables explained the older adults' variability in SWB: self-rated health, sense of meaning in life, functional independence in activity of daily living (ADL), sense of control of one's environment (Mastery) and the participant's age. The explained variance percentage was found to be high (61%). In contrast to expectations, social-environmental variables proved to be only of secondary significance in explaining SWB variability. DISCUSSION: Variables derived from the psychological dimension appear more significant than the social-environmental variables in explaining SWB among visually impaired older adults. These variables should be considered when developing intervention programs intended to increase SWB within this unique population group.

Translation and validation of the Hebrew version of the SHALOM Spiritual questionnaire.

INTRODUCTION: The SHALOM questionnaire is based on a multidimensional perception of spirituality. This study examines the psychometric properties and factorial structure of the Hebrew version of Fisher's SHALOM questionnaire. METHODS: The study included 341 participants. Tools included the SHALOM questionnaire and measures for evaluation of well-being. The factorial structure of the SHALOM was evaluated using exploratory factor analysis (EFA). Concurrent validity was also tested. RESULTS: EFA supported the four-dimensional structure of the questionnaire. Internal consistency of the four dimensions ranges from adequate to excellent (0.72 < α < 0.96). Concurrent validity was supported by the positive associations between SHALOM and indices of life satisfaction, will to live, and participant's health perception and by negative association with depressive symptoms and fear of dying. CONCLUSION: These findings suggest that responses to the Hebrew version of the SHALOM questionnaire are valid and reliable, and can be used as an efficient tool for evaluation of spiritual well-being.

Subjective well-being: gender differences in Holocaust survivors-specific and cross-national effects.

OBJECTIVES: Subjective well-being (SWB) has become an important concept in evaluating older adults' quality of life. The cognitive and emotional evaluations which are used to appraise it differ in structure, characteristics, and effects on life. The purpose of this study was to support hypotheses regarding expected Holocaust survivors-specific effects and cross-cultural differences on three indicators of SWB. METHOD: We recruited samples of 50 male and female Israeli Holocaust survivors, other older Israelis, and older Canadians (N = 300) for allowing us to distinguish survivors-specific effects from cross-national differences. State anxiety, depressive symptoms, and life-satisfaction were compared across groups of men and women. Where univariate differences were detected, post hoc comparisons were computed to determine which of the groups significantly differed. RESULTS: In general, a higher level of SWB was found among Canadians in comparison to both comparative Israeli groups. Level of depressive symptoms was significantly higher among women survivors than in the other two groups. Both groups of Israeli women had higher scores on anxiety than Canadian Women; less apparent were differences across groups of men. Life-satisfaction did not differ among the groups. CONCLUSIONS: Our findings regarding depression support the survivor-specific effect hypothesis for women, and a national effect on anxiety, but not any effect on life-satisfaction. These findings suggest significant differences in impacts of traumatic life events on cognitive versus emotional indicators of SWB. This issue should be further investigated due to its practical implications in use of various measures of SWB with people who experienced traumatic events.

Why Do Holocaust Survivors Remember What They Remember?

Purpose of the Study: The ability to integrate traumatic memories into a coherent life narrative is one factor associated with the mental health and well-being of Holocaust survivors. In the present study, reminiscences reported by survivors in Israel were collected to identify themes arising in positive and negative memories and experience. Design and Methods: Participants (M = 80.4 years; SD = 6.87) were asked to describe memories that typify a reminiscence function in which they frequently or very frequently engage. Open-ended responses were collected from 269 Holocaust survivors and thematic analyses were conducted in English (translated) and Hebrew. Results: Thematic analyses of these data suggest three overarching themes related to bridging the past and present, rebuilding families and the Jewish state, and the duty to share. These suggest how integral endurance, survival, and resilience were to participants during the war and how these themes defined their choices and understanding of their lives. Implications: The results of this study demonstrate how reminiscence serves many functions. Participants appear to have integrated memories of horror and loss as part of coherent life narratives. Resilience and memory are ongoing and intertwined processes whereby survivors juxtapose their early lives to the present.

Health, coping and subjective well-being: results of a longitudinal study of elderly Israelis.

OBJECTIVES: The aim of this study was to test a conceptual model designed to promote the understanding of factors influencing subjective well-being (SWB) in old age. Within this framework, we evaluated the relative influences on elderly Israelis' SWB of health and/or function, personal resources, coping behaviors (reactive and proactive), and changes in all of these factors over time. METHOD: At baseline, 1216 randomly selected elderly persons (75+) were interviewed at home (T1) and 1019 one year later (T2). The conceptual model was evaluated by Structural Equation Modeling (SEM) analysis using AMOS 18. RESULTS: After one year, a relatively high percentage of participants reported decline in health/function (DHF) and in personal resources. The effects of the study variables on T2-SWB were evaluated by a SEM analysis, resulting in a satisfying fit: χ2 = 279.5 (df = 102), p < .001, CFI = .970, NFI = .954, TLI = .955, RMSEA = .046. In addition to significant direct effects of health/function on T2-SWB, health/function was found to indirectly influence T2-SWB. Our analysis showed that health/function had a negative influence on the positive effects of personal resources (function self-efficacy, social support) and the diverse effects of the coping patterns (goal-reengagement - positive; expectations for future care needs - negative; having concrete plans for future care - positive). CONCLUSION: Personal resources and use of appropriate coping behaviors enable elderly people to control their well-being even in the presence of DHF. Evidence-based interventions can help older people to acquire and/or strengthen effective personal resources and coping patterns, thus, promoting their SWB.

The will-to-live scale: development, validation, and significance for elderly people.

OBJECTIVES: In old age, the will-to-live (WTL) is one of the most important indicators of subjective well-being (SWB). However, few studies to date have focused on WTL. In these studies, WTL has mainly been evaluated via indirect questions concerning factors that may influence peoples' WTL, or by measures directed to patients with specific diseases. The current study describes the development and psychometric properties of a new WTL scale. METHOD: The five-item WTL scale was developed on the basis of previous qualitative and quantitative research, and was evaluated in a longitudinal study of a random sample of 868 adults, aged 75+. RESULTS: Confirmatory factor analytic (CFA) models were computed showing that each of the five items contributed significantly to measurement of a single WTL latent factor. Goodness-of-fit statistics were in ideal parameters for these CFA models at each point of data collection. Moreover, temporal analyses indicated that the relative contribution to measurement for each item was equivalent across time, attesting to reliability of measurement and the construct validity of WTL measurement. Concurrent validity was supported by significant positive correlations between WTL and life satisfaction, happiness, self-rated health, morale, self-rated aging, and, as expected, by inverse associations of WTL with depression and loneliness. CONCLUSION: The results of these analyses indicate that the WTL scale is a valid and reliable instrument. Considering the importance of the WTL concept in late life, and the psychometric properties of the WTL scale, we recommend it for use in research and practice related to older adults' SWB and end-of-life care.