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Background: Sexual health and function is an important yet understudied aspect of overall health and well-being in older adults. There are limited data on the relative strength of associations between various aspects of sexual health with the physical, emotional, and cognitive function in older adults. Additionally, there is little information on how these associations differ by age and sex., Methods: In this Successful Aging Evaluation (SAGE) study, 606 community-dwelling adults in San Diego County, aged 50-99 years and who had a partner, were included in the analysis. Evaluations included a phone-based cognitive screening followed by a comprehensive mail-in survey including rating scales of sexual health, depression, anxiety, and physical function., Results: The mean age of the sample was 75.2 years. Over 80% of respondents had engaged in sexual activity in the past year, over 70% engaged in sexual activity weekly or more than once a week, and over 60% were somewhat or very satisfied with their sex lives. No sex differences were evident on dimensions of sexual health except for a higher rate of rejection of sexual overtures by women. Depressive symptoms were negatively associated with all assessed aspects of sexual health, even after adjusting for age, physical functioning, anxiety, cognitive ability, or perceived stress in both men and women., Conclusions: In this population-based study older men and women who had a partner reported frequent engagement in and satisfaction with sexual activity. Depressive symptoms were broadly associated with worse sexual health, more so than physical function, anxiety or stress, or age itself., (Copyright © 2015. Published by Elsevier Inc.)

Objectives: Hispanics are the fastest growing ethnic/racial group of the older adult population in the United States, yet little is known about positive mental health in this group. We examined differences in life satisfaction between demographically matched groups of older Hispanics and non-Hispanic Whites, and sought to identify specific factors associated with these differences, Methods: Participants included 126 community-dwelling English-speaking Hispanics aged 50 and older, and 126 age-, gender-, and education-matched non-Hispanic Whites. Participants completed standardized measures of life satisfaction and postulated correlates, including physical, cognitive, emotional and social functioning, as well as positive psychological traits and religiosity/spirituality., Results: Hispanics reported greater life satisfaction than non-Hispanic Whites (p < 0.001). Ethnic groups were comparable on most postulated correlates of life satisfaction, except that Hispanics had lower levels of cognitive performance, and higher levels of daily spiritual experiences, private religious practices and compassion (ps < 0.001). Among these factors, spiritual experiences, religious practices, and compassion were significantly associated with life satisfaction in the overall sample. Multivariable analyses testing the influence of these three factors on the association between ethnicity and life satisfaction showed that higher spirituality among Hispanics accounted for ethnic differences in life satisfaction., Conclusion: English-speaking Hispanics aged 50 and older appeared to be more satisfied with their lives than their non-Hispanic White counterparts, and these differences were primarily driven by higher spirituality among Hispanics. Future studies should examine positive mental health among various Hispanic subgroups, including Spanish speakers, as an important step toward development of culturally sensitive prevention and intervention programs aimed at promoting positive mental health.

Objective: There is growing public health interest in understanding and promoting successful aging. While there has been some exciting empirical work on objective measures of physical health, relatively little published research combines physical, cognitive, and psychological assessments in large, randomly selected, community-based samples to assess self-rated successful aging., Method: In the Successful AGing Evaluation (SAGE) study, the authors used a structured multicohort design to assess successful aging in 1,006 community-dwelling adults in San Diego County, ages 50-99 years, with oversampling of people over 80. A modified version of random-digit dialing was used to recruit subjects. Evaluations included a 25-minute telephone interview followed by a comprehensive mail-in survey of physical, cognitive, and psychological domains, including positive psychological traits and self-rated successful aging, scaled from 1 (lowest) to 10 (highest)., Results: The mean age of the respondents was 77.3 years. Their mean self-rating of successful aging was 8.2, and older age was associated with a higher rating, despite worsening physical and cognitive functioning. The best multiple regression model achieved, using all the potential correlates, accounted for 30% of the variance in the score for self-rated successful aging and included resilience, depression, physical functioning, and age (entering the regression model in that order)., Conclusions: Resilience and depression had significant associations with self-rated successful aging, with effects comparable in size to that for physical health. While no causality can be inferred from cross-sectional data, increasing resilience and reducing depression might have effects on successful aging as strong as that of reducing physical disability, suggesting an important role for psychiatry in promoting successful aging.

Objectives: To determine whether measures of successful aging are associated with sexual activity, satisfaction, and function in older postmenopausal women., Design: Cross-sectional study using self-report surveys; analyses included chi-square and t-tests and multiple linear regression analyses., Setting: Community-dwelling older postmenopausal women in the greater San Diego region., Participants: One thousand two hundred thirty-five community-dwelling women aged 60 to 89 participating at the San Diego site of the Women's Health Initiative., Measurements: Demographic information and self-reported measures of sexual activity, function, and satisfaction and successful aging., Results: Sexual activity and functioning (desire, arousal, vaginal tightness, use of lubricants, and ability to climax) were negatively associated with age, as were physical and mental health. In contrast, sexual satisfaction and self-rated successful aging and quality of life remained unchanged across age groups. Successful aging measures were positively associated with sexual measures, especially self-rated quality of life and sexual satisfaction., Conclusion: Self-rated successful aging, quality of life, and sexual satisfaction appear to be stable in the face of declines in physical health, some cognitive abilities, and sexual activity and function and positively associated with each other from age 60 to 89., (© 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.)

Background: Resilience, the ability to adapt positively to adversity, may be an important factor in successful aging. However, the assessment and correlates of resilience in elderly individuals have not received adequate attention., Method: A total of 1395 community-dwelling women over age 60 who were participants at the San Diego Clinical Center of the Women's Health Initiative completed the Connor-Davidson Resilience Scale (CD-RISC), along with other scales pertinent to successful cognitive aging. Internal consistency and predictors of the CD-RISC were examined, as well as the consistency of its factor structure with published reports., Results: The mean age of the cohort was 73 (7.2) years and 14% were Hispanic, 76% were non-Hispanic white, and nearly all had completed a high school education (98%). The mean total score on the CD-RISC was 75.7 (sd=13.0). This scale showed high internal consistency (Cronbach's alpha=0.92). Exploratory factor analysis yielded four factors (somewhat different from those previously reported among younger adults) that reflected items involving: (1) personal control and goal orientation, (2) adaptation and tolerance for negative affect, (3) leadership and trust in instincts, and (4) spiritual coping. The strongest predictors of CD-RISC scores in this study were higher emotional well-being, optimism, self-rated successful aging, social engagement, and fewer cognitive complaints., Conclusions: Our study suggests that the CD-RISC is an internally consistent scale for assessing resilience among older women, and that greater resilience as assessed by the CD-RISC related positively to key components of successful aging.

Objective: The purpose of this study was to solicit the opinions of older adults about factors related to successful aging using focus group methods., Methods: Twelve focus groups were conducted with an average of six individuals per group. Participants included 72 community-dwelling older adults (age range: 60-99 years) recruited primarily from retirement communities in San Diego County, California. Interview transcripts were analyzed using a grounded theory framework of "Coding Consensus, Co-occurrence, and Comparison.", Results: A total of 33 factors were identified, out of which four major themes emerged: attitude/adaptation, security/stability, health/wellness, and engagement/stimulation. Every focus group emphasized the need for a positive attitude, realistic perspective, and the ability to adapt to change. Security and stability encapsulated one's living environment, social support, and financial resources. General physical health and wellness were frequently mentioned, with mixed opinions on their necessity for successful aging. Finally, a sense of engagement, reflected in pursuit of continued stimulation, learning, feeling a sense of purpose in life, and being useful to others and to society, was considered a prominent aspect of successful aging. All four themes appeared to be interrelated such that engagement required a foundation of security and stability while positive attitude and adaptation strategies often compensated for impaired physical health., Conclusion: Older adults place greater emphasis on psychosocial factors as being key to successful aging, with less emphasis on factors such as longevity, genetics, absence of disease/disability, function, and independence.

Objective: There is no consensus on how to define successful aging. The authors sought to determine the correlates of self-rated successful aging as well as its correspondence with major researcher-defined criteria., Methods: Participants were 205 community-dwelling adults over age 60. A questionnaire survey asked the participants to rate their own degree of successful aging and inquired about demographic characteristics, medical history, activity levels, resilience, daily functioning, and health-related quality of life (Medical Outcomes study 36-item Short-Form [MOS-SF-36]). Participants' subjective ratings of successful aging were contrasted with sets of researcher-defined criteria, and correlates of subjectively rated successful aging were examined., Results: Ninety-two percent of the participants rated themselves as aging successfully. A majority of them also met other research criteria for successful aging such as independent living, mastery/growth, and positive adaptation but not those requiring an absence of chronic medical illness or physical disability. Higher SF-36 scores as compared with a published sample indirectly corroborated participants' subjectively rated successful aging. Subjective ratings of successful aging were significantly correlated with higher scores on health-related quality of life as well as resilience, greater activity, and number of close friends but not with several demographic characteristics., Conclusion: Most community-dwelling older adults viewed themselves as aging successfully despite having chronic physical illnesses and some disability. Longitudinal studies of the reliability and validity of subjective ratings of successful aging are warranted.

Objective: The authors assessed the need for mental health services among older adults in San Diego County, California, by determining what needs were not being addressed by existing services, what services were necessary to address these needs, and how much consensus there was among different stakeholders with respect to the problems and solutions related to service delivery. Methods: Semistructured interviews were conducted with 23 health care and social service providers and administrators, 16 services consumers and other older adults (55 years of age and older), and 19 caregivers/family members and patient/client advocates This was followed by four focus groups comprised of 18 providers and administrators, six focus groups comprised of 50 consumers and other older adults, and five focus groups comprised of 39 caregivers (family members and advocates). Results: The unmet needs fell into three categories: mental health services, physical health services, and social services. Two interrelated themes were identified by participants: 1) the need for age-appropriate and culturally appropriate services to overcome barriers to mental health services access, use, and quality; and 2) the interrelations between unmet needs that address prevention as well as treatment of mental illness, including socialization and social support, transportation, housing, and physical health care. Differences in stakeholder assessment of unmet needs were associated with respective roles in delivery and use of mental health services Conclusion: Age-appropriate and culturally appropriate solutions that address both prevention and treatment may represent the best strategies for addressing the challenges of mental illness and are most likely to be endorsed by all three groups of stakeholders. [ABSTRACT FROM AUTHOR]

Schizophrenia and aging are both risk factors for deficits in independent functioning, yet relatively few studies have examined the level and predictors of functional status of older outpatients with schizophrenia. We compared employment history, current living situation, and driving status of 83 middle-aged and elderly outpatients with schizophrenia (mean age 59 years), and 46 demographically equivalent normal comparison subjects. We also examined the relationships of neuropsychological functioning and psychiatric symptoms to these aspects of everyday functioning. The schizophrenia patient group had consistently worse functional status than the normal comparison group, but 30% of the patients were employed at least 50% of the time during their post-schizophrenia-onset adult lives, 73% were living in a house or apartment and responsible for meeting most of their own daily needs, and 43% were current drivers. Severity of negative symptoms (but not that of positive symptoms) was inversely correlated with functional status. Worse performance on a neuropsychological battery was generally associated with worse functional status. These findings counter notions that functional impairment is inevitable in older schizophrenia patients, and highlight the importance of assessment of functional skills and possibly targeting them as a treatment focus. [Copyright &y& Elsevier]