A first step toward integrating schema theory in geriatric psychiatry: a Delphi study

2017 ◽  
Vol 29 (7) ◽  
pp. 1069-1076 ◽  
Author(s):  
M. J. H. Legra ◽  
F. R. J. Verhey ◽  
S. P. J. van Alphen
Keyword(s):  
Older Adults ◽  
Life Course ◽  
Delphi Study ◽  
Schema Theory ◽  
Older Individuals ◽  
Multiple Factors ◽  
The Past ◽  
The Life Course ◽  
Full Consensus

ABSTRACTBackground:Schematherapy (ST) is an effective therapy for personality disorders (PD's) in adults, however, empirical research into ST in older adults is limited. The manifestation of schemas over the life course is unclear. Besides, long-term patterns of schemas in old age and whether schemas change during the aging process remain unknown.Methods:We performed a Delphi study involving a group meeting of nine experts in the field of ST in older adults.Results:Full consensus was achieved that schemas vary later in life, and that this is due to biopsychosocial factors. The concepts of schema triggering (the chance that a maladaptive schema is activated) and schema coping (the psychological and behavioral effort a person makes to minimize the stress that comes with the schema) in the past are important in clinical practice. Understanding how schemas are triggered during the life course and how patients deal with their schemas throughout life will help the therapist to complete the diagnostic puzzle in older individuals and to choose appropriate interventions.Conclusion:Schemas are flexible and dynamic constructs that can fade or intensify due to multiple factors. This study is a first step toward advancing the state of knowledge regarding schema theory in an aging population. The results will contribute to improvements in ST in older adults by developing an understanding of the plasticity of schemas during the life course.

scholarly journals Family Member Death and Subjective Life Expectancy Among Black and White Older Adults

2018 ◽  
Vol 32 (3-4) ◽  
pp. 143-153
Author(s):  
Rachel Donnelly ◽  
Debra Umberson ◽  
Tetyana Pudrovska
Keyword(s):  
Older Adults ◽  
Life Expectancy ◽  
Life Course ◽  
Family Member ◽  
Well Being ◽  
White Americans ◽  
Black And White ◽  
Survival Expectations ◽  
The Life Course

Objective: To examine whether exposure to family member deaths throughout the life course is associated with subjective life expectancy—a person’s assessment of their own mortality risk—at age 65, with attention to differences by race. Method: We analyzed 11 waves of data from a study of men and women above age 50 (Health and Retirement Study; n = 13,973). Results: Experiencing the deaths of multiple family members before the respondent is 50 years old is negatively associated with subjective life expectancy at age 65. Discussion: Understanding the life-course predictors of older adults’ subjective life expectancy is particularly important because survival expectations influence long-term planning, health, and longevity. Moreover, Black Americans are exposed to more family member deaths earlier in their life compared with White Americans, with implications for long-term health and well-being.

Abstract 15422: Distribution of 10- and 30-year Predicted Risks for Heart Failure in the United States: NHANES 2015 to 2018

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nilay S Shah ◽  
Hongyan Ning ◽  
Sanjiv J Shah ◽  
Clyde Yancy ◽  
John T Wilkins ◽  
...  
Keyword(s):  
United States ◽  
Heart Failure ◽  
Life Course ◽  
The United States ◽  
Older Individuals ◽  
Middle Aged ◽  
Short And Long Term ◽  
The Life Course ◽  
Predicted Risk

Introduction: Heart failure (HF) poses a significant health burden with prevalence projected to increase by 46% by 2030 in the United States. Targeted implementation and dissemination of clinical and public health preventive measures across the life course will be informed by describing population distributions of short- and long-term predicted HF risk. Methods: Among nonpregnant middle-aged (30-59 years) adults without prevalent CVD from the National Health and Nutrition Examination Surveys 2015-18, continuous 10-year (10Y) and 30-year (30Y) HF risk estimates were calculated using short- and long-term risk equations derived in the Cardiovascular Lifetime Risk Pooling Project. High estimated 10Y risk was classified as ≥5%, and high 30Y risk as ≥20%. Participants were categorized by combined 10Y and 30Y estimated risk categories overall and stratified by sex, race, age, and body mass index. Distributions were compared using chi-square tests. Results: In 1495 NHANES participants (representing 53,022,413 Americans) with mean age 45 years (SE 0.3), median 10Y risk was 0.8% and 30Y risk was 11%. Approximately 4% of individuals were estimated to have high 10Y predicted risk of HF. Of those who were classified as low 10Y risk, 23% had high 30Y predicted risk. Distributions differed significantly by sex, race, age, and BMI (P<0.01, Figure ). Black males more frequently were classified as high 10Y or 30Y risk compared to other race-sex groups. Older individuals and those with BMI ≥30 kg/m 2 had a higher frequency of low 10Y but high 30Y risk. Conclusions: More than one-fourth of middle-aged U.S. adults have elevated short- or long-term predicted risk for HF. While the majority of middle-aged US adults are at low 10Y risk for HF, a large proportion among this subgroup are at high 30Y HF risk. Application of both short- and long-term HF risk prediction may mitigate the growing morbidity and mortality related to HF and identify strategies to target those at-risk earlier in the life course.

scholarly journals Is Aging Biology Ageist?

2019 ◽  
Vol 75 (9) ◽  
pp. 1653-1655 ◽  
Author(s):  
Alan A Cohen ◽  
Mélanie Levasseur ◽  
Parminder Raina ◽  
Linda P Fried ◽  
Tamàs Fülöp
Keyword(s):  
Older Adults ◽  
Life Course ◽  
Health Priorities ◽  
Older Individuals ◽  
Cultural Assumptions ◽  
Biological Adaptation ◽  
Population Selection ◽  
Trajectories Of Change ◽  
The Life Course ◽  
Scientific Questions

Abstract The scientific questions we pursue are shaped by our cultural assumptions and biases, often in ways we are unaware. Here, we argue that modern biases against older adults (ageism) have unconsciously led aging biologists to assume that traits of older individuals are negative and those of younger individuals positive. We illustrate this bias with the example of how a medieval Chinese scholar might have approached the task of understanding aging biology. In particular, aging biologists have tended to emphasize functional declines during aging, rather than biological adaptation and population selection or composition processes; the reality is certainly that all these processes interact. Failure to make these distinctions could lead to interventions that improve superficial markers of aging while harming underlying health, particularly as the health priorities of older adults (autonomy, function, freedom from suffering, etc.) are often quite different from the goals of aging biologists (reducing disease, prolonging life). One approach to disentangling positive, negative, and neutral changes is to map trajectories of change across the life course of an individual (physiobiography). We emphasize that our goal is not to criticize our colleagues—we have been guilty too—but rather to help us all improve our science.

Older Adults Diagnosed With Schizophrenia in Long-term Care Facilities: Life Course Theory for Holistic Nursing Research and Practice

2021 ◽  
pp. 089801012110253
Author(s):  
Verónica G. Walker ◽  
Elizabeth K. Walker
Keyword(s):  
Older Adults ◽  
Life Course ◽  
Health Beliefs ◽  
Long Term Care ◽  
Life Course Theory ◽  
Nursing Research ◽  
Term Care ◽  
Holistic Nursing ◽  
Care Facilities

Older adults diagnosed with schizophrenia (OADWS) often enter long-term care facilities with unique challenges related to trauma and stress experienced throughout their life course. Health care workers often report that when they work with this population, they feel unprepared due to limited training. In this article, life course theory is presented as a lens for holistic nursing research and as a way for nurses to adapt interventions already used with cognitively impaired older adults (e.g., those diagnosed with Alzheimer's disease) for OADWS in long-term care. It is hoped that these ideas will facilitate discussion of ways to inform training for holistic long-term care of OADWS. Holistic principles of nursing addressed with life course theory as a lens include the following: (a) accounting for strengths and challenges; (b) honoring experiences, values, and health beliefs; (c) viewing interrelationships with the environment; and (d) nurturing of peace, wholeness, and healing.

scholarly journals Long-term Effects of Prenatal and Infancy Nurse Home Visitation on the Life Course of Youths

2010 ◽  
Vol 164 (1) ◽  
Author(s):  
John Eckenrode ◽  
Mary Campa ◽  
Dennis W. Luckey ◽  
Charles R. Henderson ◽  
Robert Cole ◽  
...  
Keyword(s):  
Life Course ◽  
Home Visitation ◽  
Long Term Effects ◽  
Nurse Home ◽  
The Life Course

Abstract 14677: Distribution of 10- and 30-year Predicted Risks for Atherosclerotic Cardiovascular Disease in the United States: NHANES 2015 to 2018

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nilay S Shah ◽  
Hongyan Ning ◽  
Amanda Perak ◽  
Norrina B Allen ◽  
John T Wilkins ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Life Course ◽  
Risk Model ◽  
The United States ◽  
Atherosclerotic Cardiovascular Disease ◽  
Middle Aged ◽  
Ascvd Risk ◽  
The Life Course ◽  
Predicted Risk

Introduction: Premature fatal cardiovascular disease rates have plateaued in the US. Identifying population distributions of short- and long-term predicted risk for atherosclerotic cardiovascular disease (ASCVD) can inform interventions and policy to improve cardiovascular health over the life course. Methods: Among nonpregnant participants age 30-59 years without prevalent CVD from the National Health and Nutrition Examination Surveys 2015-18, continuous 10 year (10Y) and 30 year (30Y) predicted ASCVD risk were assigned using the Pooled Cohort Equations and a 30-year competing risk model, respectively. Intermediate/high 10Y risk was defined as ≥7.5%, and high 30Y risk was chosen a priori as ≥20%, based on 2019 guideline levels for risk stratification. Participants were combined into low 10Y/low 30Y, low 10Y/high 30Y, and intermediate/high 10Y categories. We calculated and compared risk distributions overall and across race-sex, age, body mass index (BMI), and education using chi-square tests. Results: In 1495 NHANES participants age 30-59 years (representing 53,022,413 Americans), median 10Y risk was 2.3% and 30Y risk was 15.5%. Approximately 12% of individuals were already estimated to have intermediate/high 10Y risk. Of those at low 10Y risk, 30% had high 30Y predicted risk. Distributions differed significantly by sex, race, age, BMI, and education (P<0.01, Figure ). Black males more frequently had high 10Y risk compared with other race-sex groups. Older individuals, those with BMI ≥30 kg/m 2 , and with ≤high school education had a higher frequency of low 10Y/high 30Y risk. Conclusions: More than one-third of middle-aged U.S. adults have elevated short- or long-term predicted risk for ASCVD. While the majority of middle-aged US adults are at low 10Y risk, a large proportion among this subgroup are at high 30Y ASCVD risk, indicating a substantial need for enhanced clinical and population level prevention earlier in the life course.

scholarly journals Association between Lifetime Tobacco Use and Alcohol Consumption Trajectories and Cardiovascular and Chronic Respiratory Diseases among Older People

2021 ◽  
Vol 18 (21) ◽  
pp. 11275
Author(s):  
Ignacio Madero-Cabib ◽  
Claudia Bambs
Keyword(s):  
Alcohol Consumption ◽  
Older People ◽  
Life Course ◽  
Tobacco Use ◽  
Respiratory Diseases ◽  
Chronic Respiratory Diseases ◽  
Logistic Regression Models ◽  
Improved Design ◽  
The Life Course

Background: We identify representative types of simultaneous tobacco use and alcohol consumption trajectories across the life course and estimate their association with cardiovascular and chronic respiratory diseases (CVDs and CRDs) among older people in Chile. Methods: We used data from a population-representative, face-to-face and longitudinal-retrospective survey focused on people aged 65–75 (N = 802). To reconstruct trajectory types, we employed weighted multichannel sequence analysis. Then, we estimated their associations with CVDs and CRDs through weighted logistic regression models. Results: Long-term exposure to tobacco use and alcohol consumption across life are associated with the highest CVD and CRD risks. Long-term nonsmokers and nondrinkers do not necessarily show the lowest CVDs and CRDs risks if these patterns are accompanied by health risk factors such as obesity or social disadvantages such as lower educational levels. Additionally, trajectories showing regular consumption in one domain but only in specific periods of life, whether early or late, while maintaining little or no consumption across life in the other domain, lead to lower CVDs or CRDs risks than trajectories indicating permanent consumption in both domains. Conclusions: A policy approach that considers CVDs and CRDs as conditions that strongly depend on previous individual experiences in diverse life domains can contribute to the improved design and evaluation of preventive strategies of tobacco use and alcohol consumption across the life course.

scholarly journals Harmonisation and Between-Country Differences of the Lifetime of Experiences Questionnaire in Older Adults

2021 ◽  
Vol 13 ◽  
Author(s):  
Valentin Ourry ◽  
Natalie L. Marchant ◽  
Ann-Katrin Schild ◽  
Nina Coll-Padros ◽  
Olga M. Klimecki ◽  
...  
Keyword(s):  
Older Adults ◽  
Life Course ◽  
Cognitive Reserve ◽  
Leisure Activities ◽  
International Comparisons ◽  
Education Systems ◽  
Promising Tool ◽  
Behavioural Determinants ◽  
Country Differences ◽  
The Life Course

Background: The Lifetime of Experiences Questionnaire (LEQ) assesses complex mental activity across the life-course and has been associated with brain and cognitive health. The different education systems and occupation classifications across countries represent a challenge for international comparisons. The objectives of this study were four-fold: to adapt and harmonise the LEQ across four European countries, assess its validity across countries, explore its association with brain and cognition and begin to investigate between-country differences in life-course mental activities.Method: The LEQ was administered to 359 cognitively unimpaired older adults (mean age and education: 71.2, 13.2 years) from IMAP and EU-funded Medit-Ageing projects. Education systems, classification of occupations and scoring guidelines were adapted to allow comparisons between France, Germany, Spain and United Kingdom. We assessed the LEQ's (i) concurrent validity with a similar instrument (cognitive activities questionnaire - CAQ) and its structural validity by testing the factors' structure across countries, (ii) we investigated its association with cognition and neuroimaging, and (iii) compared its scores between countries.Results: The LEQ showed moderate to strong positive associations with the CAQ and revealed a stable multidimensional structure across countries that was similar to the original LEQ. The LEQ was positively associated with global cognition. Between-country differences were observed in leisure activities across the life-course.Conclusions: The LEQ is a promising tool for assessing the multidimensional construct of cognitive reserve and can be used to measure socio-behavioural determinants of cognitive reserve in older adults across countries. Longitudinal studies are warranted to test further its clinical utility.

scholarly journals Early-life circumstances and the risk of function-limiting long-term conditions in later life

2020 ◽  
Vol 11 (2) ◽  
pp. 157-180
Author(s):  
Matthew H. Iveson ◽  
Chris Dibben ◽  
Ian J. Deary
Keyword(s):  
Life Course ◽  
Cognitive Ability ◽  
Early Life ◽  
Economic Status ◽  
Functional Limitation ◽  
Later Life ◽  
Socio Economic Status ◽  
Childhood Cognitive Ability ◽  
The Life Course

Older adults are particularly prone to function-limiting health issues that adversely affect their well-being. Previous work has identified factors from across the life course –childhood socio-economic status, childhood cognitive ability and education – that predict later-life functional outcomes. However, the independence of these contributions is unclear as later-in-the-life-course predictors are themselves affected by earlier ones. The present study capitalised on the recent linkage of the Scottish Mental Survey 1947 with the Scottish Longitudinal Study, using path analyses to examine the direct and indirect associations between life-course predictors and the risk of functional limitation at ages 55 (N = 2,374), 65 (N = 1,971) and 75 (N = 1,534). The odds of reporting a function-limiting long-term condition increased across later life. At age 55, reporting a functional limitation was significantly less likely in those with higher childhood socio-economic status, higher childhood cognitive ability and higher educational attainment; these associations were only partly mediated by other predictors. At age 65, adult socio-economic status emerged as a mediator of several associations, although direct associations with childhood socio-economic status and childhood cognitive ability were still observed. At age 75, only childhood socio-economic status and adult socio-economic status directly predicted the risk of a functional limitation, particularly those associated with disease or illness. A consistent pattern and direction of associations was observed with self-rated health more generally. These results demonstrate that early-life and adult circumstances are associated with functional limitations later in life, but that these associations are partly a product of complex mediation between life-course factors.

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