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ObjectivesThe distinction between bipolar I disorder (BD-I) and bipolar II disorder (BD-II) has been a topic of long-lasting debate. This study examined differences between BD-I and BD-II in a large, global sample of OABD, focusing on general functioning, cognition and somatic burden as these domains are often affected in OABD.MethodsCross-sectional analyses were conducted with data from the Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) database. The sample included 963 participants aged ≥50 years (714 BD-I, 249 BD-II). Sociodemographic and clinical factors were compared between BD subtypes including adjustment for study cohort. Multivariable analyses were conducted with generalized linear mixed models (GLMMs) and estimated associations between BD subtype and (1) general functioning (GAF), (2) cognitive performance (g-score) and (3) somatic burden, with study cohort as random intercept.ResultsAfter adjustment for study cohort, BD-II patients more often had a late onset ≥50 years (p=0.008) and more current severe depression (p=0.041). BD-I patients were more likely to have a history of psychiatric hospitalization (p

Objectives To examine whether (a) as people age, accumulation of negative events increases (“sensitizing”) or decreases (“steeling”) the detrimental effects of subsequent events on depressive symptoms, and (b) how particular psychosocial factors are associated with the strength of these steeling or sensitizing effects. Method We used data from 6 measurement waves from 2,069 adults aged 55–84 (M = 68.0) at baseline in the Longitudinal Aging Study Amsterdam, the Netherlands. We included 18 different life events across the life course. Using hybrid multilevel models, we tested whether the effects of proximate life events ( Results Cumulative and proximate life events were independently associated with more depressive symptoms. Interaction effects indicated that the more cumulative life events, the weaker the effects of recent life events, suggesting a “steeling” effect. Unexpectedly, 3-way interaction effects showed that higher mastery and lower neuroticism were associated with weaker steeling effects. These effects were predominantly attributable to within-person changes rather than to fixed between-person differences. Results from analyses with event severity scores were similar. Conclusions As a population, older adults appear to become more resilient against new stressors as they accumulate experience in dealing with negative life events. Findings on mastery tentatively suggest that accepting limits to one’s own control over life circumstances may foster a steeling effect.

BACKGROUND: The impact of the COVID-19 pandemic on mental health in people with pre-existing mental health disorders is unclear. In three psychiatry case-control cohorts, we compared the perceived mental health impact and coping and changes in depressive symptoms, anxiety, worry, and loneliness before and during the COVID-19 pandemic between people with and without lifetime depressive, anxiety, or obsessive-compulsive disorders.METHODS: Between April 1 and May 13, 2020, online questionnaires were distributed among the Netherlands Study of Depression and Anxiety, Netherlands Study of Depression in Older Persons, and Netherlands Obsessive Compulsive Disorder Association cohorts, including people with (n=1181) and without (n=336) depressive, anxiety, or obsessive-compulsive disorders. The questionnaire contained questions on perceived mental health impact, fear of COVID-19, coping, and four validated scales assessing depressive symptoms, anxiety, worry, and loneliness used in previous waves during 2006-16. Number and chronicity of disorders were based on diagnoses in previous waves. Linear regression and mixed models were done.FINDINGS: The number and chronicity of disorders showed a positive graded dose-response relation, with greater perceived impact on mental health, fear, and poorer coping. Although people with depressive, anxiety, or obsessive-compulsive disorders scored higher on all four symptom scales than did individuals without these mental health disorders, both before and during the COVID-19 pandemic, they did not report a greater increase in symptoms during the pandemic. In fact, people without depressive, anxiety, or obsessive-compulsive disorders showed a greater increase in symptoms during the COVID-19 pandemic, whereas individuals with the greatest burden on their mental health tended to show a slight symptom decrease.INTERPRETATION: People with depressive, anxiety, or obsessive-compulsive disorders are experiencing a detrimental impact on their mental health from the COVID-19 pandemic, which requires close monitoring in clinical practice. Yet, the COVID-19 pandemic does not seem to have further increased symptom severity compared with their prepandemic levels.FUNDING: Dutch Research Council.

Objective Competing events are often ignored in epidemiological studies. Conventional methods for the analysis of survival data assume independent or noninformative censoring, which is violated when subjects that experience a competing event are censored. Because many survival studies do not apply competing risk analysis, we explain and illustrate in a nonmathematical way how to analyze and interpret survival data in the presence of competing events. Study Design and Setting Using data from the Longitudinal Aging Study Amsterdam, both marginal analyses (Kaplan–Meier method and Cox proportional-hazards regression) and competing risk analyses (cumulative incidence function [CIF], cause-specific and subdistribution hazard regression) were performed. We analyzed the association between sex and depressive symptoms, in which death before the onset of depression was a competing event. Results The Kaplan–Meier method overestimated the cumulative incidence of depressive symptoms. Instead, the CIF should be used. As the subdistribution hazard model has a one-to-one relation with the CIF, it is recommended for prediction research, whereas the cause-specific hazard model is recommended for etiologic research. Conclusion When competing risks are present, the type of research question guides the choice of the analytical model to be used. In any case, results should be presented for all event types.

Background and Objectives The disability paradox postulates that some individuals with severe functional limitations demonstrate psychological resilience, that is, good mental health and quality of life. Resilience to disabilities has been linked to psychological (e.g., mastery) and social factors (e.g., social provisions). It is, however, less clear whether cultural factors can provide additional resources for resilience building in older immigrants. We investigated the extent to which sociodemographic, psychosocial, and cultural factors contributed to psychological resilience to disabilities among immigrants of Turkish and Moroccan descent in the Netherlands. Research Design and Method The sample included 478 older immigrants aged 55–65 years. Data were analyzed using latent profile analysis and multinomial logistic regressions. Results Five categories were identified: (a) High physical and emotional functioning; (b) High physical but poor emotional functioning; (c) Low physical but high emotional functioning (resilient); (d) Low physical and emotional functioning; and (e) Low physical and very low emotional functioning. Resilient functioning (reference category) was associated with poorer Dutch language proficiency, lower levels of loneliness, greater mastery, and more religious coping. Discussion and Implications Findings provide support for the disability paradox and highlight social provisions, mastery, and religiosity/spirituality as important resources for psychological resilience in older labor migrants. Poor Dutch language proficiency is discussed as a potential factor contributing to severe functional limitations in the resilient category.

Contains fulltext : 281800.pdf (Publisher’s version ) (Open Access) OBJECTIVES: Discordance between self-reported functional limitations and performance-based physical functioning may have a negative impact in functional independence in older adults. We longitudinally examined baseline apathy- and depressive symptomatology as associates of discordance. METHOD: 469 participants from the multi-site cohort study NESDO were included. Self-reported functional limitations were assessed by two items derived from the WHO-Disability Assessment Schedule. Performance-based physical functioning included walking speed and handgrip-strength. Both measures were rescaled, with final sum-scores ranging from 0 to 6. Discordance-scores were computed by subtracting sum-scores on performance-based measures from self-reported functional limitations. Using latent growth curve analysis, we estimated individual trajectories of discordance at baseline, 2-and 6-years follow-up, consisting of the baseline discordance-score (intercept) and the yearly change of discordance-score (slope). We then estimated associations with apathy and depression indicators. RESULTS: At baseline, persons (mean age 70.48 years, 65% female, 73% depressed) on average overestimated their daily functioning compared to performance tests (b = 0.77, p

Objectives: The ‘disability paradox’ (DP) suggests that most older adults maintain subjective well-being (SWB) despite functional decline. However, this may depend the SWB component: positive affect (PA), negative/depressed affect (NA/DA) or life satisfaction (LS). We assessed trajectories of these components in older adults with substantial functional decline. Methods: Data originated from the Longitudinal Aging Study Amsterdam ( N = 2545) observed during 1992–2008. Using latent class growth analysis, we distinguished a group with substantial functional decline and examined their SWB trajectories and individual characteristics. Results: The DP occurred more frequently for DA (Men:73%, Women:77%) and LS (Men:14%, Women:83%) than for PA (Men:26%, Women:17%). Higher perceived control (mastery) emerged as the most consistent factor associated with higher odds of the DP. Discussion: We provide a nuanced view of the DP, shifting the question from whether it exists to for which dimension of SWB and for whom it is more or less apparent.

The Longitudinal Aging Study Amsterdam (LASA) is a prospective cohort study of older adults in the Netherlands, initially based on a nationally representative sample of people aged 55-84 years. The study has been ongoing since 1992, and focuses on the determinants, trajectories and consequences of physical, cognitive, emotional and social functioning. Strengths of the LASA study include its multidisciplinary character, the availability of over 25 years of follow-up, and the cohort-sequential design that allows investigations of longitudinal changes, cohort differences and time trends in functioning. The findings from LASA have been reported in over 600 publications so far (see www.lasa-vu.nl). This article provides an update of the design of the LASA study and its methods, on the basis of recent developments. We describe additional data collections, such as additional nine-monthly measurements in-between the regular three-yearly waves that have been conducted among the oldest old during 2016-2019, and the inclusion of a cohort of older Turkish and Moroccan migrants.

Objectives This study examined trajectories of emotional functioning in three domains (depressive symptoms, emotional, and social loneliness) for individuals who experienced spousal bereavement and investigated cross-domain adaptation. We hypothesized that emotional difficulties after bereavement would be more detectable in emotional loneliness than depressive symptoms or social loneliness. Methods Using latent class growth analysis, we modeled changes in depressive symptoms, emotional loneliness, and social loneliness from 12 years pre- to 12 years post-bereavement on data from 686 older adults to identify trajectories indicating adaptive and maladaptive functioning in each domain. Results Most participants reported depressive symptoms below the clinically relevant threshold by showing a resilient (15.5%) or a slightly elevated (53.5%) trajectory post-bereavement. One third (31%) reported clinically relevant depressive symptoms. More than half of the sample reported emotional loneliness post-bereavement, varying form prolonged (17%), increasing and prolonged (28.3%), and chronically high (8.9%) levels. Remaining participants displayed resilience (13.5%) or recovery (32.3%). Social loneliness showed four trajectories: very low and resilient (43.3%), low and resilient (27.5%), increasing (20.2%), and chronically high (9%) levels. One third of participants maintained adaptive, whereas 12% displayed maladaptive, functioning across all domains post-bereavement. Discussion An increase in emotional loneliness was the most commonly observed change after spousal bereavement. This highlights the central role of emotional loneliness in depression after bereavement.

Most research on cognitive performance among individuals with Attention Deficit/Hyperactivity Disorder (ADHD) focuses on younger persons and on cognitive variability within speeded response-time tasks. Dispersion, i.e., variability across a range of cognitive domains, is emerging as a promising indicator of age-related and pathological cognitive impairment. However, there has yet to be an evaluation of differences in dispersion among older adults with and without ADHD. We address this gap by assessing associations of age and ADHD status with dispersion. We hypothesize older adults will exhibit greater dispersion than comparatively younger adults and explore whether individuals with ADHD exhibit greater dispersion than individuals without ADHD. In a sample of 231 adults from the Longitudinal Aging Study Amsterdam (Average age=71.64 years, SD=7.7, 59% female), 23 individuals met DSM-IV criteria for ADHD and 208 were classified as neurotypically functioning. Participants completed 13 tasks spanning domains of attention, fluency, memory, processing speed, and reasoning. Dispersion across the tasks was calculated as an intraindividual standard deviation. We regressed dispersion on age and ADHD status and adjusted for sex. Older age was significantly associated with greater dispersion (Est =0.06, SE=0.03, p=0.01). However, dispersion profiles did not vary as a function of ADHD status (Est.=-0.25, SE=0.67, p>05). Preliminary results suggest that dispersion across cognitive tasks may not be a sensitive marker of ADHD in older adults, although statistical power to detect differences was relatively low in the current study. As expected, age was a significant predictor of increased dispersion, consistent with accounts of age-related changes in neurological integrity.

Objectives: This study compares the associations of two subjective lifetime perspectives, subjective age (SA) and subjective life expectancy (SLE), with physical performance, self-rated health, and depressive symptoms. Methods: 64 91-year-old participants were selected from three waves of the Longitudinal Aging Study Amsterdam (2008/09, 2011/12, 2015/16; n = 1822 participants, n = 3500 observations) that included graphical and numerical measures of SA and SLE. We used generalized estimating equations to examine their associations with health. Results: Associations of SA/SLE with health were weaker for physical performance than for self-rated health and depressive symptoms. The associations of SA and SLE with physical performance were of similar magnitude but with self-rated health depended on the type of measure. Depressive symptoms, instead, showed a stronger association with SA than with SLE. Graphical measures showed weaker associations than numerical measures. Discussion: The way in which subjective lifetime perspectives and health are conceptualized and measured influences the strength of their associations.

"Background: Ethics reflection groups (ERG) or moral case deliberations (MCD) are increasingly used in health care as a form of clinical ethics support (CES). ERGs are often evaluated with a focus on evaluating ERG itself yet not on the impact of or change due to ERGs. Within a larger study implementation and impact of ERG was studied with use of various qualitative and qualitative research methodologies. In this presentation we present findings of the quantitative research. Research question: Are there changes over time after two years of ERG regarding employees’ normative attitudes with respect to the use of coercion, user involvement during the use of coercion, team cooperation and the handling of disagreement? Research methods: Repeated cross-sectional survey at seven wards within three different Norwegian mental health care institutions (T0-T1-T2). Results: In total, 817 surveys were included in the analyses. Of these, only 7.6 % (N= 62) have responded at all three points in time, while 76.8 % (N= 628) responded only once. Over time, adjusted for ward and profession, respondents agreed less that coercion is a form of care or security. Furthermore, respondents thought they involved patients and their family significantly more often in situations of coercion and they reported that the constructive of disagreement within the team significantly improved. More frequent ERG participation seemed associated with a more critical attitude towards the use of coercion and higher scores for user involvement, team cooperation and the constructive handling of disagreement, yet differences between ERG participation were generally small in absolute terms. Conclusion: Structural participation in ERG seems to contribute to changes in attitudes, user involvement and team cooperation. Studying changes over time and trying to find a relationship between CES interventions and outcome is difficult yet important and need to be further developed in future CES evaluation research. "

Background: Research on the impact of ethics reflection groups (ERG) or moral case deliberations (MCD) is complex and scarce. Within a larger study, ERG has been used as an intervention for stimulating critical ethical reflection and improved team cooperation while observing changes over time.Research question: Are there – during and after two years of ERGs - changes over time regarding employees’ normative attitudes regarding the use of coercion and how employees perceive user involvement, team cooperation and the handling of disagreement in teams?Methods: Repeated cross-sectional survey to multidisciplinary employees at seven wards within three Norwegian mental health care institutions (T0-T1-T2). Changes in normative attitudes over time were estimated using linear mixed models.Results: In total, 817 surveys (from employees that did and did not participate in ERG) were included in the analyses. Of these, 7.6 % (N=62) responded at all three points in time, 15.5% (N=127) at two points, and 76.8 % (N= 628) once. On average, over time, respondents who participated in ERG agreed less that coercion can be seen a form of care or security. ERG participants more often reported that they involved users and that they handled disagreement within the team constructively. Furthermore, more frequent ERG participation was associated with a more critical attitude towards coercion and higher scores for user involvement, the coercion competence of the team and the constructive handling of disagreement within their teams.Conclusions: Structural ERGs or MCDs seem to contribute to employees reporting a more critical attitude towards coercion, more user involvement around coercion and a more constructive handling of disagreement. Differences were generally small in absolute terms possibly due to the low amount of longitudinal data and the relative low frequency of ERG’s during the two years. Studying changes over time in clinical practice and trying to find a relationship between CES interventions and CES outcomes is difficult yet important and needs to be further developed in future CES evaluation studies. This explorative quantitative study may be a first step from qualitative evidence towards more robust quantitative evidence of the contribution of CES to clinical practice and quality of care.

Objective: The objective of this study was to examine correlates of discordance between 13-year trajectories of self-reported functional limitations and performance-based physical functioning in older adults. Method: We included 2,135 participants from the population-based Longitudinal Aging Study Amsterdam, the Netherlands, followed across 1995-2008. Self-reported functional limitations included six (instrumental) activities of daily living. Performance-based functioning was a composite of four tests. We used latent class growth analysis and multinomial logistic regression to examine discordance and its correlates. Results: Patterns of discordance and concordance (41% concordance, 46% “overestimation” of daily functioning, 13% “underestimation”) appeared to be persistent over 13 years. Older age, male sex, cognitive impairment, absence of pain, and light alcohol use were associated with overestimation. Younger age, female sex, and lower self-rated health were associated with underestimation. Discussion: Factors associated with overestimation partly differ from those associated with underestimation. Factors that are highly stable over time are particularly good indicators of persistent discordance.

Background Although the educational expansion is often seen as a mechanism that might reduce health inequalities, socioeconomic inequalities in health (SEIH) have persisted or increased over the past decades. Theories suggest that this persistence could be due to a changing role of education as a ‘gatekeeper’ to access other socioeconomic resources such as occupation and income that are also associated with health outcomes. To test this, we examine whether the mediating role of occupation and income in the education–health relationship differs between three cohorts of 55–64 year old adults. Methods We used cross-sectional data from three cohorts of 988, 1002, and 1023 adults born in 1928/37, 1938/47 and 1948/57 and observed in 1992/93, 2002/03, 2012/13 respectively, who participated in the Longitudinal Aging Study Amsterdam, the Netherlands. We used multigroup structural equation modelling to compare the strength of indirect effects of education via occupational skill level and income to functional limitations and depressive symptoms between cohorts. Results Absolute educational inequalities in functional limitations increased for men and women in later cohorts, and in depressive symptoms only for men. Relative inequalities in functional limitations increased only for women and in depressive symptoms only for men. The indirect effect of education via income on both health outcomes was weaker in the most recent birth cohort compared to the earlier cohorts. In contrast, the indirect effect of education via occupation on functional limitations was stronger in the most recent cohort compared to the earlier cohorts. These differences were mainly due to a decreasing direct effect of education on income and an increasing direct effect of education on occupational skill level, rather than to changes in the direct effects of occupation and income on health. Conclusions The role of education in determining inequalities in health appears to have changed across cohorts. While education became a less important determinant of income, it became a more important determinant of occupational level. This changing role of education in producing health inequalities should be considered in research and policy.

Background The heterogeneity of late-life depression hampers diagnosis and treatment. Data-driven methods have identified several subtypes of depression in older persons, but the longitudinal stability of these subtypes remains unknown. Methods In total 111 older persons with a major depressive disorder both at baseline and 2-year follow-up from the Netherlands Study of Depression in Older persons (NESDO) were included. Latent class analysis was performed to identify subtypes of depression at baseline and at 2-year follow-up, and latent transition analysis was used to examine the stability of these subtypes over time. Transition rates between subtypes and characteristics of groups were examined. Results Two subtypes were identified in both baseline (T0) and follow-up data (T1), including a ‘melancholic’ subtype (prevalence 80.2% (T0) and 62.2% (T1)), and an ‘atypical’ subtype (prevalence 19.8% (T0) and 37.8% (T1)). The melancholic subtype was characterized by decreased appetite and weight and had a stability of 0.86. The atypical subtype was characterized by increased appetite and weight and had a stability of 0.93, although the discriminating power of different symptoms had decreased at T1. Mean age and education differed significantly between stable and transitioning subgroups, other characteristics did not differ between subgroups. Limitations Limited sample size might have hampered the analyses. Conclusions Subtypes of late-life depression are relatively stable, but symptoms of depression (like weight loss) seem to blur with symptoms of (patho)physiological aging. This underlines the clinical relevance of depression subtyping, but also the importance of further research into subtypes and the influence of aging.

Introduction Aging is characterized by a deterioration of health, which often manifests in multiple health domains. Depressive symptoms, cardiovascular morbidity and loneliness are indicators of mental, physical and social health, respectively, and are highly prevalent at old age. The aim of this study was to investigate how these indicators mutually, and longitudinally, influence one another at old age. We hypothesized that depressive symptoms, cardiovascular morbidity and loneliness have risk increasing effects on one another, which would pose opportunities to prevent a downward spiral of health decline and to improve health at old age. Methods Data from 2979 respondents from the Longitudinal Aging Study Amsterdam, aged 55 years and over, including five measurements with approximately three-year intervals (maximum follow-up of 13 years), were analyzed. A score ≥16 points on the Center for Epidemiologic Studies Depression Scale indicated depressive symptoms. A score of ≥3 points on the De Jong Gierveld Loneliness Scale indicated loneliness. Cardiovascular morbidity was measured with a continuous composite measure incorporating the presence and severity of various cardiovascular diseases. Structural equation modelling was used to create a cross-lagged panel model (fig. 1) in which the effects between depressive symptoms, cardiovascular morbidity and loneliness were all modelled as bidirectional. The best fitting model was identified by comparing the model fit of the cross-lagged panel model to the model fit of nine nested models with different sets of temporal effects. Results The full cross-lagged panel model fitted the data best. In this model, depressive symptoms and loneliness had risk increasing effects on each other and cardiovascular morbidity had a risk increasing effect on depressive symptoms. The other cross-lagged effects were not statistically significant, indicating that these effects were likely to be indirect (i.e. the effects pass through the other variables in the model). Conclusions As depressive symptoms, cardiovascular morbidity and loneliness had direct and indirect risk increasing effects on one another over time, the longitudinal relations between these indicators are complex. Implications of our results for psychiatric clinical practice are first that successful treatment of depression is not only important for mental health but may also reduce the risk of future cardiovascular morbidity and loneliness. Second, the co-occurrence of cardiovascular morbidity or loneliness with depressive symptoms may maintain depressive symptoms, because both are associated with an increased risk of depressive symptoms. Treatment of co-occurring cardiovascular morbidity or loneliness may therefore contribute to higher remission rates and lower relapse rates. Thus, as it may be beneficial for prevention of health deterioration across multiple health domains and for short and longer term recovery of depression, our results emphasize the need for an integrative approach to improve health at older age. Funding The Longitudinal Aging Study Amsterdam was funded by the Dutch Ministry of Health, Welfare and Sport. The authors did not receive any funding.

Background: This study examined whether smoking cessation in middle age and old age is associated with following a successful trajectory of functional limitations over time in Dutch older adults.Methods: We used 16-year longitudinal data from 645 participants of the Longitudinal Aging Study Amsterdam. Three types of trajectories regarding functional limitations over time were defined: successful (high initial level of functioning and limited decline), late decline (high initial level of functioning and late onset of decline), and early decline (lower initial level of functioning and early onset of decline). Smoking cessation status was self-reported and categorized into: early quitters (stopped in middle age [35-40 years]), late quitters (already smoked in middle age and stopped in old age [≥55 years]), and continued smokers (smoked in middle age and still smoking in old age). Multinomial Logistic Regression Analyses were used to assess the association between smoking cessation and trajectory membership.Results: The sample (55-85 years at baseline) consisted of 20.3% early quitters, 22.9% late quitters, and 56.8% continued smokers. After adjustment for confounders, the model showed that late quitters were less likely to follow an early decline trajectory instead of a successful trajectory compared to continued smokers (odds ratio [OR] = 0.48, 95% confidence interval [CI] = 0.24-0.97). After adjustment for clinically relevant level of depressive symptoms, this association remained substantial but was no longer statistically significant (OR = 0.50, 95% CI = 0.24-1.02).Conclusions: Although not statistically significant in the full model, the observed associations suggest that smoking cessation in old age may have an important impact on daily functioning in old age.

Purpose of the Study : To determine the prevalence and extent of successful aging (SA) when various suggestions proposed in the previous literature for improving models of SA are incorporated into one holistic operational definition. These suggestions include defining and measuring SA as a developmental process, including subjective indicators alongside more objective ones, and expressing SA on a continuum.Design and Methods : Data were used from 2,241 respondents in the Longitudinal Aging Study Amsterdam, a multidisciplinary study in a nationally representative sample of older adults in the Netherlands. Latent class growth analysis was used to identify successful 16-year trajectories within nine indicators of physical, cognitive, emotional, and social functioning. SA was quantified as the number of indicators in which individual respondents showed successful trajectories (range 0-9).Results : Successful trajectories were characterized by stability, limited decline, or even improvement of functioning over time. Of the respondents, 39.6% of men and 29.3% of women were successful in at least seven indicators; 7% of men and 11% of women were successful in less than three indicators. Proportions of successful respondents were largest in life satisfaction (>85%) and smallest in social activity (Implications : Many older adults age relatively successfully, but the character of successful functioning over time varies between indicators, and the combinations of successful indicators vary between individuals.

Stressvolle levensgebeurtenissen zoals echtscheiding van de ouders of een vroege sterfte van de ouders kunnen op hogere leeftijd nog grote gevolgen hebben. De kansen om dergelijke gebeurtenissen mee te maken zijn echter ongelijk verdeeld en verschillen tussen sociaal-economische groepen. Dit kan leiden tot sociaal-economische ongelijkheid in succesvol oud worden. Op basis van de Longitudinal Aging Study Amsterdam (LASA) onderzoeken wij hoe levensgebeurtenissen en sociaal-economische positie (SEP) samenhangen met succesvolle veroudering. We doen hierbij een aantal verrassende constateringen.

Objectives: Building on social stress theory, this study has 2 aims. First, we aim to estimate the effects of stressful life events in childhood and adulthood on Successful Aging (SA). Second, we examine how unequal exposure to such life events between individuals with different socioeconomic position (SEP) contributes to socioeconomic inequalities in SA. Method: We used 16-year longitudinal data from 2,185 respondents aged 55-85 years in 1992 in the Dutch nationally representative Longitudinal Aging Study Amsterdam. Measurement of SA was based on earlier work, in which we integrated trajectories in 9 indicators of functioning into an index of SA. Using path analysis, we investigated direct and indirect effects of parental and adulthood SEP as well as of self-reported childhood and adulthood life events on SA. Results: Almost all included life events had negative direct effects on SA. Parental SEP had no direct effect on SA, whereas adulthood SEP had. Higher Parental SEP increased the likelihood of parental problems and parental death in childhood, resulting in negative indirect effects on SA. Higher adulthood SEP had both positive and negative indirect effects on SA, through increasing the likelihood of divorce and unemployment, but decreasing the likelihood of occupational disability. Discussion: SEP and particular stressful life events are largely, but not entirely independent predictors of SA. We found that high and low SEP may increase exposure to particular events that negatively affect SA. Findings suggest that low (childhood) SEP and stressful life events are interrelated factors that may limit individual opportunities to age successfully.

Scientific understanding of the associations between socio-economic adversity and other domains such as health and psychosocial functioning may be improved by employing extensive, prospective life course data to model inter-individual heterogeneity in socio-economic trajectories. This study applied Latent Class Growth Analysis to derive a typology of trajectories of socio-economic adversity, and compared the psychosocial profiles of the groups based on this typology. Data were used from 2,950 men and women participating in the MRC National Survey of Health and Development in Great Britain, ascertained prospectively since birth in 1946 until age 53. Trajectories of socio-economic adversity were based on indicators of occupational class, overcrowding, housing tenure, household amenities and financial hardship at ages 4, 11, 15, 36, 43 and 53, and education at age 26. Psychosocial factors included parental interest in education, self-management, neuroticism and attitudes towards social class and social mobility. Seven distinct trajectories were identified: persistent high; persistent low; strongly declining; gradually declining; increasing; early childhood; and relapsing high adversity. Key findings include that those with increasing adversity had high parental interest in education but low self-management and high neuroticism; that those with only early childhood adversity had a less favourable psychosocial profile than those with persistent low exposure; and that groups with declining adversity had relatively favourable attitudes towards education. Findings emphasise the need to consider socio-economic and personality mechanisms in the context of one another in order to better understand later life inequality.

BackgroundThere are substantial socioeconomic inequalities in functional limitations in old age. Resilience may offer new insights into these inequalities by identifying constellations of factors that protect some individuals from developing functional limitations despite socioeconomic adversity.MethodsData from 1973 participants in the Medical Research Council National Survey of Health and Development (Great Britain), followed from birth until age 60–64, were used. Functional limitations were defined as reporting difficulty with at least 1 of 16 activities at age 60–64. Lifetime socioeconomic adversity was based on socioeconomic trajectories, categorised into three adversity levels. Analysis of covariance and regression models were used to compare psychosocial factors and health-related behaviours between a ‘Resilient’ group (high adversity but no functional limitations) and five groups with other combinations of adversity and limitations.ResultsPrevalence of functional limitations in high, intermediate and low adversity groups was 44%, 30% and 23% in men, and 61%, 55% and 49% in women, respectively. Compared with the other high adversity group, the resilient group had a lower prevalence of childhood illness (12% vs 19%) and obesity throughout ages 43–64 (70% vs 55%). Partially adjusted models also showed higher adolescent self-management, lower neuroticism, higher prevalence of volunteer work and physical activity (age 60–64) and lower prevalence of smoking (age 43) in the resilient. Marital status and contact frequency were not associated with resilience.ConclusionResults suggest protection against childhood illness, health-behavioural factors and self-regulation as targets for interventions across life that may particularly benefit those with long-term exposure to socioeconomic adversity.

Context:As a result of increases in life expectancy and decreases in fertility, the proportion of the population entering later life has increased dramatically in recent decades. When faced with age-related challenges, some older adults respond more positively to adversity than would be expected given the level of adversity that they have experienced, demonstrating ‘resilience’. Objectives:Having a clear conceptual framework for resilience is a prerequisite to operationalising resilience in a research context. Methods:Here we compare and contrast several approaches to the operationalisation of resilience: psychometric-driven and data-driven (variable-centred and individual-centred) methods. Results:Psychometric-driven methods involve the administration of established questionnaires aimed at quantifying resilience. Data-driven techniques use statistical procedures to examine and/or operationalise resilience and can be broadly categorised into variable-centred methods, i.e. interaction and residuals, and individual-centred methods, i.e. categorical and latent class. Conclusions:The specific question(s) driving the research and the nature of the variables a researcher intends to use in their adversity-outcome dyad will largely dictate which methods are more (or less) appropriate in that circumstance. A measured approach to the ways in which resilience is investigated is warranted in order to facilitate the most useful application of this burgeoning field of research.

We investigated changes in emotional and social loneliness among older adults 12 years before and after spousal bereavement. Using growth mixture modelling, five resilience-related trajectories were identified in emotional loneliness. Most participants showed increased levels of emotional loneliness at the time of bereavement, which slowly recovered to baseline. Two groups were characterized by prolonged emotional loneliness post-bereavement. A resilient group emerged displaying low levels of emotional loneliness pre- and post-bereavement. A group with chronically high pre- and post-bereavement levels was also present. Experiences of social isolation were less affected by bereavement. Most participants reported low or very low levels of social isolation with no change over time. A smaller proportion displayed gradually increasing levels of social isolation unrelated to bereavement. The fourth group showed patterns of chronically high social isolation, which slightly declined at the time of bereavement. Resilience to spousal bereavement was detectable in emotional, but not social, loneliness.

This study aimed to identify factors that protect individuals exposed to lifelong socioeconomic adversity from developing functional limitations in old age. Data from 1,973 participants in the MRC National Survey of Health and Development (United Kingdom) were used. Functional Limitations was defined as experiencing difficulty with any daily activity. Socioeconomic adversity had three levels based on life course trajectories. We compared psychosocial factors and health-related behaviours between a “resilient” group (high adversity but no functional limitations) and five groups with other combinations of adversity and limitations. Compared to other individuals with high adversity, resilient individuals had higher adolescent self-management, a lower likelihood of smoking, obesity, and childhood illness, and were more often physically active. Marital status and contact frequency were not associated with resilience. Results suggest that a combination of psychological and behavioural characteristics across life is required to be physically resilient in the face of socioeconomic adversity.

Iedereen wordt anders oud. Om deze diversiteit in ouder worden inzichtelijk te maken, gebruiken we gegevens uit de Longitudinal Aging Study Amsterdam om trajecten van veroudering over een periode van 16 jaar in negen (kern) uitkomsten van ouder worden op het vlak van fysiek, cognitief, emotioneel en sociaal functioneren te beschrijven. Uit deze trajecten stellen we vier profielen samen die in principe al beleidsrelevant moeten zijn.

Background The use of coercion is morally problematic and requires an ongoing critical reflection. We wondered if not knowing or being uncertain whether coercion is morally right or justified (i.e. experiencing moral doubt) is related to professionals’ normative attitudes regarding the use of coercion. Methods This paper describes an explorative statistical analysis based on a cross-sectional survey across seven wards in three Norwegian mental health care institutions. Results Descriptive analyses showed that in general the 379 respondents a) were not so sure whether coercion should be seen as offending, b) agreed with the viewpoint that coercion is needed for care and security, and c) slightly disagreed that coercion could be seen as treatment. Staff did not report high rates of moral doubt related to the use of coercion, although most of them agreed there will never be a single answer to the question ‘What is the right thing to do?’. Bivariate analyses showed that the more they experienced general moral doubt and relative doubt, the more one thought that coercion is offending. Especially psychologists were critical towards coercion. We found significant differences among ward types. Respondents with decisional responsibility for coercion and leadership responsibility saw coercion less as treatment. Frequent experience with coercion was related to seeing coercion more as care and security. Conclusions This study showed that experiencing moral doubt is related to some one’s normative attitude towards coercion. Future research could investigate whether moral case deliberation increases professionals’ experience of moral doubt and whether this will evoke more critical thinking and increase staff’s curiosity for alternatives to coercion.

The healthy immigrant effect postulates that immigrants have additional cultural resources that can be mobilized to cope with adverse life events. We investigated sociodemographic, personal, social, and cultural factors associated with resilience to disabilities in young-old Turkish and Moroccan immigrants from the Longitudinal Ageing Study of Amsterdam. Using latent class analysis, five resilient-related groups were identified: 1) High physical and emotional functioning; 2) High physical but emotional vulnerability; 3) Physical impairment but good emotional functioning; 4) Physical and emotional impairment; and 5) Physical and extreme emotional impairment. Multinomial regression analysis indicated loneliness, mastery and lack of belonging as the strongest predictors of resilience. Compared to the resilient group, non-resilient participants were lonelier, displayed lower levels of mastery, and were more likely to report feelings of loss regarding their home country. Results indicate feelings of loss as an additional risk factor for older immigrants.

Background This study examines to what extent education, occupation and income are associated with the multidimensional process of successful ageing, encompassing trajectories of physical, mental and social functioning in old age. Methods We employed 16-year longitudinal data from 2095 participants aged 55–85 years at baseline in the Dutch, nationally representative Longitudinal Aging Study Amsterdam. For 9 indicators of successful ageing, separate Latent Class Growth models were used to identify subgroups of older adults with a ‘successful’ trajectory. A ‘Successful Aging Index’ expressed the number of indicators for which individual respondents had a successful trajectory (range 0–9). Using multivariate regression models, we investigated associations between socioeconomic position and the Successful Ageing Index, and with separate indicators of successful ageing. Results Higher education, occupational skill level and income were independently associated with higher numbers of successful trajectories. Education (β=0.09) was a slightly stronger correlate of successful ageing than income (β=0.08). Analyses of separate indicators of successful ageing showed that cognitive functioning, functional limitations and emotional support given were associated with all three components of socioeconomic position, while other indicators were associated with only one (eg, life satisfaction) or none (eg, social loneliness). For some indicators of successful ageing, socioeconomic inequalities were present at baseline, and also increased or decreased during follow-up. Conclusions Education, occupation and income represent distinct socioeconomic life course factors, each of which contribute in a specific way to inequalities in successful ageing. Physical and cognitive functioning were associated more strongly with socioeconomic position than social and emotional functioning.