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Positive Outlook on Aging Helps Seniors Heal
 
 
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Positive Outlook on Aging Helps Seniors Heal

positive age-stereotype group had a significantly slower rate of ADL decline.......Older persons with positive age stereotypes were 44% more likely to fully recover from severe disability than those with negative age stereotypes.

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By Cole Petrochko, Staff Writer, MedPage Today
Published: November 20, 2012

Older patients with positive attitudes on aging may be more likely to fully recover from severe disability compared with those who can't see the bright side of life, researchers found.

A positive stereotype about aging was associated with a 44% greater likelihood of recovery from severe disability versus negative stereotypes (95% CI 1.01 to 2.06, P=0.04), according to Becca Levy, PhD, from the Yale School of Public Health, and colleagues.

Holding positive stereotypes in older age was also significantly associated with a slower rate of decline in activities of daily living (P=0.001), they wrote in a research letter in the Journal of the American Medical Association online.

"Further research is needed to determine whether interventions to promote positive age stereotypes could extend independent living in later life," the authors noted.

The researchers sampled patients through the Precipitating Events Project study and included 598 mostly female patients (63.3%), with an average age of 79, who belonged to a Connecticut health plan. All participants lived in a community, were nondisabled, and experienced at least 1 month of disability from active daily life during the follow-up period.

The participants were interviewed monthly for up to 129 months and filled out home-based assessments every 18 months over 10 years.

The researchers established age stereotypes by asking participants for five terms or phrases they associated with older individuals and coding those descriptors on a five-point scale, with 1 being most negative (such as decrepit) and 5 being most positive (such as spry). The participants scored a mean 2.12 on this scale.

Participants' severity of disability was based on the number of activities of daily living compromised by disability, including bathing, dressing, transferring, and walking. Three or four compromised activities were considered severely disabled; mild to severe disability required assistance with one to two activities, and mild to no disability required no assistance with activities of daily life.

The researchers grouped patients on whether they held positive or negative age stereotypes and compared rates of recovery from severe or mild injury to no or mild disability. Patients between groups were well-matched for age, sex, nonwhite ethnicity, frailty, education, chronic conditions, mental status, depression, and whether or not they lived alone. The nature of the disabling events was not described.

Patients were significantly more likely to recover from any state of injury to either no or mild disability if they fit positive age stereotypes, including from severe disability to no disability, severe disability to mild disability (HR 1.23, 95% CI 1.03 to 1.46, P=0.02), and mild disability to no disability (HR 1.15, 95% CI 1.02 to 1.29, P=0.02).

The researchers also noted that the positive age-stereotyped patients "showed an advantage in the absolute risk increase percentages" in likelihood of recovery, in addition to "a significantly slower rate of [activities of daily life] decline."

Study limitations included recruitment from a single community and an undersampling of black patients.

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JAMA. Nov 21 2012

Association Between Positive Age Stereotypes and Recovery From Disability in Older Persons

Becca R. Levy, PhD; Martin D. Slade, MPH; Terrence E. Murphy, PhD; Thomas M. Gill, MD

To the Editor: Little research has been conducted on factors that account for why some older persons recover from disability and others do not. We considered a new culture-based explanatory factor: age stereotypes (defined as beliefs about old people as a category).1 Positive age stereotypes may promote recovery from disability through several pathways: limiting cardiovascular response to stress,2 improving physical balance,3 enhancing self-efficacy,4 and increasing engagement in healthy behaviors.1,4 We hypothesized that older persons with positive age stereotypes would be more likely to recover from disability than those with negative age stereotypes. Recovery was based on 4 essential activities of daily living (ADLs; bathing, dressing, transferring, and walking) that are strongly associated with use of health care services and longevity.5- 6

METHODS

The sample was drawn from the Precipitating Events Project, a study with high participation (75.2%) and follow-up (95.4%) rates. Participants were recruited from a health plan in greater New Haven, Connecticut, interviewed monthly for up to 129 months, and completed home-based assessments every 18 months from March 1998 through December 2008.5- 6 Inclusion criteria were age of 70 years or older, English-speaking, community-living, nondisabled (ie, independent in the 4 ADLs at baseline), responded to the baseline age-stereotype measure, and experienced at least 1 month of ADL disability during follow-up (117 participants remained nondisabled). The final sample consisted of 598 participants (79.3% of the Precipitating Events Project cohort). The Yale University Human Subjects Committee approved the study; all participants provided verbal informed consent.

Age stereotypes were assessed by asking, "When you think of old persons, what are the first 5 words or phrases that come to mind?"1,4 Responses (coded on a 5-item scale ranging from 1 = most negative [eg, decrepit] to 5 = most positive [eg, spry]) were averaged and dichotomized at the mean of 2.12.1,4 Interrater reliability was 94.0%. This measure has been validated and the stereotypes have been found to be stable across time.1,4 Recovery was assessed by 3 validated ADL-improvement transitions: severe disability (needing assistance in 3 or 4 of the ADLs) to no disability (independent in all 4 ADLs), severe disability to mild disability (needing assistance in 1 or 2 of the ADLs), and mild disability to no disability.6 Covariates related to disability in previous studies5- 6 included age, sex, race, education, living alone, number of physician-diagnosed chronic conditions, Mini-Mental State Examination score, depressive symptoms, and physical frailty (ie, >10 seconds on a rapid-gait test). The latter 5 covariates were updated every 18 months.

A competing risk Cox model for recurrent events6 evaluated the likelihood of the positive age-stereotype group to experience each recovery transition. This model adjusted for time participants spent in each ADL-disability state (severe, mild, or none), whether they recovered or worsened, and number of times and degree to which they recovered or worsened.6 Absolute risk increase percentages were calculated for the positive age-stereotype group. An individual growth model examined the association between age stereotypes and ADL-disability states over the 129 months. All models were adjusted for all covariates. We used SAS version 9.2 (SAS Institute Inc) and considered 2-tailed P values of less than .05 as significant.

RESULTS

Participants in the positive and negative age-stereotype groups were similar at baseline (Table 1).

Relative to the negative age-stereotype group, the positive age-stereotype group had the following hazard ratios for recovery transitions: severe to none, 1.44 (95% CI, 1.01 to 2.06); severe to mild, 1.23 (95% CI, 1.03 to 1.46); and mild to none, 1.15 (95% CI, 1.03 to 1.29). The positive age-stereotype group showed an advantage in the associated absolute risk increase percentages (Table 2). As indicated by the individual growth model,the age-stereotype group x time interaction (ß = -0.0004 [95% CI, -0.0006 to -0.0002]; P = .001) showed that the positive age-stereotype group had a significantly slower rate of ADL decline.

COMMENT

Older persons with positive age stereotypes were 44% more likely to fully recover from severe disability than those with negative age stereotypes. The study was limited by recruitment from 1 community; however, its demography is similar to the US population, except for an underrepresentation of black participants. Further research is needed to determine whether interventions to promote positive age stereotypes could extend independent living in later life
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