Aging, meaning, and well-being: musings of a cultural historian

The social integration and well-being of old people depends in part on a culturally viable ideal of old age. Growing out of widely shared images and social values, an ideal old age legitimates norms and roles appropriate to the last stage of life. This article discusses the "late Calvinist" and "civilized" models of old age that flourished in Protestant, middle-class America between 1800 and 1920. It argues that the growing cultural dominance of science and the accelerating pace of capitalist productivity undercut the essential vision underlying these models: the view of life as a spiritual journey. The result has been a serious weakening of social meaning in aging and old age.     

Quality of life, nutritional status, physical activity, and their interrelationships of elderly living on an underpopulated island in Japan

Background:   The objectives of this study were to assess the quality of life (QOL), nutritional and health status, physical fitness and daily physical activity level (PAL) of elderly residents living on a remote island in Japan and to reveal factors associated with QOL scores and PAL.
Methods:   This was a cross-sectional study that targeted elderly residents dwelling on an island whose population is aging and rapidly decreasing. Fifty-two subjects (20 men and 32 women; mean age, 74 years) were evaluated for anthropometry (nutritional status), blood pressure (health status) and handgrip strength (physical fitness). QOL was investigated using the World Health Organization-QOL questionnaire. In addition, 24-h acceleration monitoring was conducted in eight subjects on 3 consecutive days to determine PAL.
Results:   Women tended to be obese compared with men (BMI, 25.6 vs 23.6 kg/m², P  < 0.05). Of the four QOL domains, the score for "social relationships" was significantly higher in women. Significant correlations were found between handgrip strength and QOL scores. A significant negative relationship was found between BMI and PAL ( r _s =−0.90, P  < 0.005). In contrast, a positive association was observed between handgrip strength and PAL ( r _s = 0.77, P  < 0.05).
Conclusion:   The results suggest that social communication is an important factor for a high QOL of women in the remote island society. The results of the correlation analyses suggest that walking, maintaining an ideal body weight and promoting physical fitness have important roles in maintaining and increasing PAL in the elderly.     

Prevalence of depressive symptoms among the elderly: A longitudinal study

Aim:   Depression is a common psychiatric problem in late life. The purpose of the present study was to assess the prevalence of depressive symptoms among community-dwelling elderly, both cross-sectionally and longitudinally.
Methods:   This study was a part of the community study in a large cohort of elderly people aged 65 and over in Nangai Village, Japan. Data on depressive symptoms from the fifth survey in 2000 were analyzed cross-sectionally and also combined with data from the first survey in 1992 to assess aging and cohort effects. Depressive symptoms were measured by the short form of Geriatric Depression Scale.
Results:   Among 1195 respondents at the fifth survey, the prevalence of depressive symptoms was 22.3%. In 457 subjects who responded at both surveys, mean depression score or prevalence of depressive symptoms tended to be higher at the fifth survey than at the first survey. The difference in prevalence between the first survey and the fifth survey among individuals of the same age groups was significant only in the oldest group (77 years and over).
Conclusion:   Among Japanese community-dwelling elderly people, aging effects on depressive symptoms were found, though marked cohort effects were not confirmed.     

Cognitive function among physically independent very old people in an urban Japanese community

Background:   A study was conducted to clarify the characteristics of cognitive function among physically independent very old people dwelling in an urban community in Japan.
Methods:   Five hundred and thirteen old-old (aged 75–84 years) and 168 oldest-old (aged 85–100 years) adults participated. We carried out the Mini-Mental State Examination (MMSE) for measuring cognitive functions in the elderly. Age-related differences in the total score and subscale scores of the MMSE were analyzed by sex using ancova , controlling for education, vision and hearing problems.
Results:   Mean MMSE scores for old-old and oldest-old men were 27.5 and 25.9, respectively, and those for old-old and oldest-old women were 27.8 and 25.0, respectively. Age-related differences in the MMSE total score between the old-old and oldest-old were observed in both sexes, suggesting that overall cognitive functions continue to decline over time in very old age. Age-related differences between the old-old and oldest-old in items measuring, registration, calculation and delayed recall were observed in both sexes, and also in those assessing time orientation, place orientation, delayed recognition, writing sentences, and copying figures were observed in women.
Conclusion:   These findings suggest that the faculties are those most sensitive to normal aging among very old individuals. There were no age group differences in five items: reverse spelling, naming objects, repeating a sentence, listening and obeying, and reading and obeying.     

Life satisfaction in older people

Objective:   Factors influencing life satisfaction were studied in a cohort study.
Methods:   Life satisfaction was measured using the Philadelphia Geriatric Center (PGC) morale scale. Two thousand one hundred and fifty-one older people, approximately 99% of all older people (2165 subjects) in a rural town, Tashiro, Akita prefecture responded to the questionnaire and, after eliminating 455 for incomplete answers, 1710 subjects (79% of all older people) were entered into the present study. Approximately 10% were self-care dependent older people.
Results:   Female self-care independent older people showed lower morale scores than men. Morale scores in self-care independent older people decreased with age in both women and men. Morale scores of self-care independent men were higher when they were healthy, had an occupation and took part in social activities in the community; morale scores of self-care independent women were higher when they were healthy and had hobbies. Family composition, self-care dependency, income and habits for health promotion were also factors of morale scores, while education was not.
Conclusions:   Healthy older persons with some gender specific lifestyles had the higher morale scores. With advanced age, lifestyles do not determine the morale scores.     

Age-related changes in antioxidant enzyme activities in the brain and liver of BN/Bi rats: Striking differences from those in F344 rats emphasize the need for "public observations" for generating a general theory of aging

Objective:   Age-related changes in endogenous antioxidant enzyme activities have been widely discussed in relation to mechanisms of organismic aging. However, some discrepancies in this regard can be seen in the published work. The present study aimed to clarify past discrepancies using BN/Bi rats in which no study has been reported in the past.
Methods:   Antioxidant enzyme activities such as superoxide dismutase (SOD) and catalase (CAT) were compared in several brain regions and the liver between young (8–9 months) and old (27–29 months) BN/BiRijHsd rats of both sexes.
Results:   CAT activities in brain regions were quite comparable between young and old rats of both sexes. SOD activity changes with age also were not remarkable, with the exception of significantly lower Mn-SOD activities in substantia nigra and hippocampus of old male rats and significantly higher activities of Cu/Zn-SOD in substantia nigra of old female rats in comparison with respective values in young rats. CAT activities in the liver tended to be lower in old male rats, while in females the opposite was observed. SOD activities in the liver stayed essentially unchanged with age in males, while in females total as well as Cu/Zn-SOD activities were more than twofold higher in old animals.
Conclusion:   These data coupled with previously reported results, indicate that no generalization can be made in terms of age-related changes in antioxidant enzyme activities. These differences emphasize the need of "public observations" in any attempt to generate a theory for mechanisms of aging based on antioxidant enzyme activity changes with age.     

What determines the life satisfaction of the elderly? Comparative study of residential care home and community in Japan

Background:   Increasing lifespan has forced elderly persons and researchers alike to look at life and aging in a new way: at adding life to years rather than years to life. With increasing lifestyle choices for the elderly, the present study was undertaken to determine and compare the factors associated with life satisfaction in elderly living in a residential care home and in the community in Japan.
Methods:   This was a cross-sectional, self-reported, questionnaire-based study. Elderly persons from the residential care home in Kyoto City ( n  = 261, mean age ± SD = 79.6 ± 6.6 years, male : female = 1 : 3.1) and from the town of Urausu, Hokkaido ( n  = 733, mean age ± SD = 74.8 ± 6.8 years, male : female = 1 : 1.3), participated in the study. This represented 95.3% and 89.5% of all eligible elderly ≥ 65 years in the home and town, respectively. Activities of daily living, higher functions, medical and social history, geriatric depression scale and quality of life were studied. Using multiple logistic regression models, factors associated with high satisfaction of life were identified.
Results:   In community-dwelling elderly, relationship with friends, as opposed to relationship with family for elderly in residential care home, were factors related to life satisfaction.
Conclusions:   This study demonstrates the relative importance of social factors versus medical and functional factors as determinants of life of elderly. We have also shown how these factors differ for elderly living in different environments. Understanding these different as well as common determinants of life satisfaction from a whole array of diverse ones allows us to make effective strategy to improve the quality of life of elderly living in different conditions.     

Effect of exercise, aging and functional capacity on acute secretory immunoglobulin A response in elderly people over 75 years of age

Background:   Age-associated decline in immune function and regulation, referred to as immunosenescence, brings about an increased incidence of infectious diseases in the aged; however, there are few data on the effect of aging and exercise on mucosal immune function in elderly people. Moreover, there is no evidence on whether the change in functional capacity affects mucosal immunity in elderly people. Therefore, the aim of the present study was to examine the effects of exercise, aging and functional capacity on mucosal immune function in elderly people over 75 years of age.
Methods:   The subjects were 92 community-dwelling elderly women aged over 75 years who lived in a rural community in Miyagi Prefecture. The subjects periodically performed approximately 20 min of low intensity exercise. Saliva samples were collected before and after exercise, and saliva flow (SF), secretory immunoglobulin A (SIgA) concentration (SIgA-C) and SIgA secretion rate (SIgA-SR) were determined. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) was used to measure functional capacity.
Results:   In comparison with before exercise, SF, SIgA-C and SIgA-SR were significantly increased after exercise in elderly subjects. In addition, when low and high value groups of resting SIgA levels were compared, acute SIgA responses were observed only in the low value group; however, there was no significant effect of aging and decline in functional capacity on exercise-induced SIgA response.
Conclusion:   These results suggest that resting SIgA levels influence the mucosal immune function response to exercise in elderly people over 75 years of age.     

Continuity of life situation and "successful" aging (author's transl)]

The determinants of "successful" aging have been a main concern in social gerontological research. The Continuity Hypothesis suggests that there is a relationship between an older person's life satisfaction and the similarity of his social life situation in middle adulthood and in old age. The old person is the more likely to score low in life satisfaction the less similar his old age situation to his life situation in middle adulthood. This hypothesis has been tested in summer 1973 in Cologne with a sample of 406 people aged 65 and over. Findings indicate that continuity of life situation may be an important variable accounting for life satisfaction in old age. Moreover, it could be shown that the various negatively experienced life changes since adulthoood formed a complex of interacting variables, thereby increasing the negative effect on the old person's life satisfaction. Health proved to be one of the most important variables. The continuity hypothesis as stated here represents a modified version of activity theory.     

Impact of lifestyle on tuberculosis

Abstract:   Tuberculosis (TB) is well known to be associated with poverty and multiple social factors. However, relatively little attention has been paid to the behavioural factors, apart from those associated with drug abuse, alcoholism and HIV infection. In recent years, the roles of other lifestyle-related factors have been increasingly recognized. In particular, smoking has been associated with excess risks of TB infection, disease and mortality. Only limited evidence is available for the association between TB disease and passive smoking or the use of biomass fuels. Nutrition status also plays an important role. Malnutrition or underweight is associated with increased risk of TB disease, and obesity appears to be protective. On the other hand, diabetes mellitus increases the risk of TB disease, but mainly among those with poor diabetic control. Although the increase in TB risk is only modest for most lifestyle factors, their prevalences are increasing rapidly in some Asian communities. Furthermore, as much as one-third of the world population is thought to be latently infected with the tubercle bacillus. The successful introduction of directly observed therapy—short course (DOTS) might have rapidly reduced the ongoing risk of transmission in many parts of Asia. However DOTS alone is unlikely to eliminate the continuing emergence of infectious tuberculosis cases through endogenous reactivation among the large pool of latently infected subjects in the Asia–Pacific region. With the close interaction between lifestyle, aging population and aging TB epidemic, promotion of healthy lifestyle may help to complement the DOTS strategy in the control of TB.     

Difference in subjective well-being between ethnic Korean and Japanese elderly residents in an urban community in Japan

Background:   The ethnic Korean community in Japan has witnessed the increasing aging of their population structure. The purpose of our study was to clarify the differences in standards of living between elderly ethnic Korean and elderly Japanese populations living in Japan, and to examine whether there is any difference in subjective well-being between the two populations.
Methods:   We conducted a cross-sectional questionnaire-based survey that consisted of items addressing ethnicity, age, gender, literacy, living conditions, mental health, "sense of purpose in life", activities of daily living (ADL), medical history, quality of life (QOL), and receipt of pension benefits and public assistance; the participants were 425 elderly people (ethnic Korean residents in Japan, n  = 204; Japanese, n  = 221) aged 65 and older living in a community in Osaka City. Findings from the two groups were compared using the Student's t -test and the χ² test. We also employed multiple linear regression analysis.
Results:   We found that the ethnic Korean group had less formal education ( P  < 0.001), lower ADL ( P  < 0.05) and QOL ( P  < 0.001), higher illiteracy ( P  < 0.05) and depression rates ( P  < 0.001), and a higher prevalence of hypertension, myocardial infarction and diabetes mellitus than the Japanese group. Ethnicity was a significant variable for subjective well-being in simple linear regression analysis. After adjusting for literacy, absence of sense of purpose in life and mental health in multiple regression analysis, ethnicity remained a significant variable.
Conclusions:   The present findings indicate that ethnic Korean elderly have poor health and social situations compared with the Japanese group, and that there was a difference in subjective well-being between the two ethnic groups.     

Successful aging: the contribution of early-life and midlife risk factors

OBJECTIVES: To test whether early-life factors (education, height, father's social position) and midlife social, behavioral, and psychosocial factors were associated with entering older age without disease and with good functioning.
DESIGN: A longitudinal, British civil service–based cohort study. Participants were followed for 17 years to assess successful aging. This was defined as being free of major disease and in the top tertile of physical and cognitive functioning measured in 2002 to 2004.
SETTING: Twenty London-based Civil Service departments.
PARTICIPANTS: Four thousand, one hundred forty men and 1,823 women, free of major disease at baseline in 1985 to 1988 (mean age 44, range 35–55).
MEASUREMENTS: Behavioral, biological, and psychosocial risk factors; physical and cognitive functioning; and disease outcomes.
RESULTS: Five hundred forty eight (12.8%) men and 246 (14.6%) women were successfully aging at follow-up. Midlife socioeconomic position strongly predicted this (age-adjusted odds ratio, highest vs lowest=7.1, 95% CI=3.4–14.6, for men and 7.7, 95% CI=4.9–12.1, for women). Height, education (in men), not smoking, diet, exercise, moderate alcohol (in women), and work support (in men) were related to a favorable older life after adjustment for age and socioeconomic position.
CONCLUSION: Interventions to promote healthy adult behavior may attenuate harmful effects of less-modifiable risk factors and reduce social inequalities.     

Tuberculosis epidemiology in the Asia–Pacific region

Abstract:   The Asia–Pacific region accounts for about 20% of the global burden of tuberculosis (TB). However, there are a wide variety of TB problems between countries and areas. This variety could be described in three dimensions: (i) historical trends of the TB epidemics, closely related to the advent of industrialization or urbanization; (ii) success in modern TB control in the early days; and (iii) expansion of the directly observed therapy, short course (DOTS) strategy during the past 20 years. Moreover, these dimensions have been subject to the 'health infrastructure' based on such social goods as people's education, economic standards, and social security or stability. The Asia–Pacific Region offers very good examples to illustrate the roles of these factors in leading to such a variety of TB problems as seen today. Thus, this region was the first to achieve the global target of DOTS by the end of 2005, that is to detect 70% of patients and to treat them with DOTS, and to successfully cure 85% of those detected.
However, we should remember that we are currently challenged by TB combined with HIV infection and AIDS; TB with drug-resistance, especially multidrug-resistant (MDR) or extensively drug resistant (XDR) forms; TB in people with special risk factors, for example diabetes and senility; and other medical and socioeconomic problems. At the same time, we have to be careful about the premature loss of people's interest in TB, due to illusion or unfounded optimism, especially among medical professionals and the government.     

Successful aging among the young-old,old-old,and oldest-old Chinese

In this study, successful aging was defined by four dimensions including functional status, affective status, cognitive status, and productive involvement status. This study examined successful aging among Hong Kong Chinese old people in three different age cohorts: young-old, old-old, and oldest-old. The respondents were 1106 people aged 60 years or older from a cross-sectional study of a representative community sample of the elderly population in Hong Kong. We found modest associations between four dimensions of successful aging, indicating the relative independence of these four criteria for successful aging. Using multiple regression models, we found that age, gender, years of education, number of close relatives, frequency of contact with friends, financial strain, number of chronic illnesses, self-rated health, hearing impairment, and life satisfaction were associated with the successful aging indicator.     

Self-reported functional ability predicts three-year mobility and mortality in community-dwelling older persons

Background:  A comprehensive evaluation of the functions of community-dwelling older persons was conducted in 1988. Three years after the 1988 study commenced, the relationship between these background factors and changes during the subsequent 3 years were examined.
Methods:  The study was a comprehensive evaluation of the daily functions of community-dwelling elderly people, and encompassed age, gender, mode of living, marital status, financial status, family relationships, basic activities of daily living, visual and hearing impairment, a history of disease, self-related feeling, social role, social support, habits and physical exercise and the relationship between independence and survival for 3 years after the basic study. The subjects were 2274 community-dwelling elderly people who participated in the first survey in July 1998 and who were aged 65 years and over at that time. Unassisted questionnaire sheets were used for the first survey and changes since the first survey.
Results:  Thirty men and 60 women died during the 3 year period. Data were also gathered about the daily activity levels of 1709 persons (75.2%) with 1499 (87.7%) ranking J for independence and 210 persons (12.3%) ranking A to C for dependence. Age, gender, basic activities of daily living (BADL), history of falls, self-related happiness, participation in community events and physical-exercise habits were found to be explanatory variables for independence after three years; as were age, gender, and BADL for survival.
Conclusion:   The explanatory variables relating to independence and prognosis of life of the elderly obtained in this study will be important in future considerations of the issue of care-taking and measures to enable it.     

Factors associated with ADL dependence: A comparative study of residential care home and community-dwelling elderly in Japan

Background:   Since the start of Long Term Nursing Insurance in Japan in April 2000, there has been much discussion about and emphasis on leading healthy and active twilight years, without ever being bedridden if possible. In an attempt to address some of these concerns, this comparative study examines the factors associated with dependence in the activities of daily living (ADL) in two samples of elderly people living in two different environments.
Methods:   In this cross-sectional, self-reported study, 262 and 968 elderly people from a residential care home and Yogo town completed a 65-item questionnaire. Questions pertaining to ADL, medical and social history, quality of life (QOL) and the 15-item Geriatric Depression Scale were included in the questionnaire. Using logistic regression model, factors associated with ADL dependence were determined.
Results:   In the residential care home group, age, female gender, instrumental ADL, communication-related ability, history of falls, stroke, and osteoarthropathy, depressive tendency and low satisfaction with life emerged as the factors associated with ADL dependence, after multivariate logistic regression. The corresponding factors in the community-dwelling elderly group were age, depressive tendency, history of osteoarthropathy, and low sense of health.
Conclusion:   Age and female gender were the two non-modifiable risk factors associated with ADL dependence. Stroke, followed by osteoarthropathy and falls were the main medical conditions predisposing to functional dependence. Dependence in instrumental ADL, independence in communication-related ADL, depressive tendency and components of QOL were factors associated with ADL dependence. Awareness of these factors not only helps to identify at-risk patients, to initiate preventive measures and to promote disability-delaying activities, but also helps in the holistic management of geriatric patients.     

Thesen zur kritischen Gerontologie aus sozialwissenschaftlicher Sicht

This contribution formulates several key statements concerning a critical gerontology and is intended as a starting point for further thought and discussion from the perspective of critical social sciences. In terms of scientific theory, it follows a concept of normative universalism, distinguishing itself from a mere “science of order”, which would be restricted to social self-observation. The assumptions focus on dealing with the social construct of age(ing) under the conditions of modern capitalist societies and on putting age(ing) into context with neo-liberal economic and social politics. This contribution explains some aspects of restructuring the German welfare state into an “activating state”, a process accompanied by the casualisation of many older people’s life circumstances. Moreover, some cultural perspectives of self-determined life in old age are demonstrated, which invariably should also be seen as a learning task. In this way, the complex interactions between gerontology and social and political practice in terms of praxeological and critical research are covered in their totality. At the same time, critical gerontology is oriented towards what is humanly possible and attempts to identify restrictions to a fulfilling life in old age and to suggest perspectives of how such restrictions can be overcome. The aim is to reflect on our own professional behaviour, to make it more compatible theoretically with critical scientific discourses on ageing and thus contribute to the emancipation of older people from discourses of dominance.     

Combined effect of factors associated with burdens on primary caregiver

Background:   It is argued that a multidimensional approach is necessary for burden assessment. Reducing caregiver burden is a social problem in the ageing Japan society. We examined the combined effect of factors affecting the care burden among community-dwelling handicapped people and their caregivers.
Methods:   The participants were 49 handicapped people (aged 53–104 years) who received home-visit rehabilitation, and their 49 caregivers (age 42–85 years). Caregivers were provided questionnaires consisting of questions on social support, subjective well-being, self-efficacy with regard to care continuation, the Motor Fitness Scale and caregiver burden. Care recipients were assessed using the Bedside Mobility Scale and the Barthel Index.
Results:   We prepared the hypothesis model using structural equation modeling with the bootstrap method within outcome measures. The hypothesis model did not fit the data well. The impact of the Motor Fitness Scale was shifted from the caregiver burden to care self-efficacy and well-being, having a cooperator for care and variable of spouse caregiver or others associated with caregiver well-being in the revised model. The fit of the revised model was acceptable (goodness of fit index, 0.903; comparative fit index, 0.998; root mean square error of approximation, 0.017). In the revised model, the care recipients' disabled state was associated with caregiver burden. In addition, higher burden and poor motor fitness of caregivers might lead to lower care self-efficacy in providing continuous care and lower caregiver well-being.
Conclusion:   These findings suggested that the program to reduce caregiver burden should focus on aspects of the care recipients' disabled state, the caregivers' well-being, fitness, and care self-efficacy.