Subjective Aging - Measurement Issues, Developmental Consequences, and Malleability in Midlife and Early Old Age

Previous research has established subjective aging as a predictor of a broad range of developmental outcomes, including physical and mental health, cognitive functioning, and longevity. Recent developments in the field include more sophisticated multidimensional approaches to subjective aging that have been proposed as a means to gain a better understanding of the mechanisms and pathways that link subjective aging to developmental outcomes. Moreover, subjective aging researchers have insisted that the manifestations and developmental implications might change as individuals move through different life stages. Finally, given the detrimental long-term effects of a negative view on aging, subjective aging might become an important vehicle within gerontological interventions. However, an informed statement about promising intervention strategies requires more research to examine the potential for short- and long-term intraindividual change in subjective aging and to determine potential risk groups that have a particularly negative view on aging. Related to these open research questions, the four individual studies of this cumulative dissertation address a selected range of three overarching thematic areas: measurement issues, developmental consequences, and malleability of subjective aging phenomena. Research questions related to measurement issues involve the advantages and disadvantages of a domain-specific over global measurement approaches (Chapters 2 & 4); the manifestation of subjective aging phenomena in everyday life (Chapter 2); and the potentially changing meaning of subjective aging across the second half of life (Chapters 3 & 4). In terms of developmental consequences, two studies in this thesis focus on the role of subjective aging as a predictor of different health and well-being dimensions (Chapters 3 & 4). Finally, the malleability of subjective aging phenomena is investigated in terms of longitudinal change trajectories over 12 years (Chapter 4) as well as in terms of the potential short-term manipulation of subjective aging by means of experimentally induced cognitive aging experiences (Chapter 5). Overall, the thesis provides support for the notion that the salience of subjective aging domains changes across the adult life span. Future research should therefore adopt a life-span perspective on subjective aging, which asks for the mechanisms that link subjective aging to developmental outcomes during specific life phases and life contexts. Such a life-span perspective is also considered necessary for the development of tailored subjective aging interventions that take into account life-span specific needs and requirements. Middle-adulthood emerged as a critical time period for interventions, given that the average downturn in Attitude Toward Own Aging across the middle-adult years varied largely between individuals, thus pointing to some extent of plasticity of subjective aging during midlife. However, the results of the experimental study indicate that intervention strategies aiming at creating a greater awareness for age-related gains need to be developed with caution. A promising strategy might be to draw attention to the domains in which older adults themselves indicate to have various gain experiences, such as interpersonal relationships and social-cognitive and social-emotional functioning

The assessment of views on ageing : a review of self-report measures and innovative extensions

This is a review of existing self-report measures for assessing views on ageing. It provides an overview of instruments, for which basic psychometric properties are available and describes them according to the purposes for which they are suitable. Literature search resulted in the inclusion of 89 instruments which were categorised along eight dimensions. The majority of measures focus on explicit cognitions about people’s own age and ageing or other (older) people. A substantial amount of tools account for the multidimensionality and multidirectionality of views on ageing, i.e. the idea that ageing is accompanied by both gains and losses in several different domains. To some extent, measures reflect that ageing is a long-term process and that views on ageing are malleable, rather than just stable traits. Cluster analysis revealed heterogeneity in instruments regarding the dimensions of Ecosystem, Balance, Stability, Dynamics, and Complexity. It becomes apparent, however, that approaches to measure views on ageing should be extended to more specifically target the implicit level as well as affective, physiological, and behavioural manifestations. Additionally, means for capturing views on ageing on the societal level and tools with a distinct time reference are needed. This is particularly important when one wants to account for the lifelong dynamics of views on ageing.publishe

Views on Ageing - A Lifespan Approach

Kornadt A, Kessler E-M, Wurm S, Bowen CE, Gabrian M, Klusmann V. Views on Ageing - A Lifespan Approach. European Journal of Ageing. 2019

Correction to: Views on ageing: a lifespan perspective

Kornadt A, Kessler E-M, Wurm S, Bowen CE, Gabrian M, Klusmann V. Correction to: Views on ageing: a lifespan perspective. European journal of ageing. 2021;18(2):289.[This corrects the article DOI: 10.1007/s10433-019-00535-9.]. © The Author(s) 2021

Views on Ageing - A Lifespan Approach

Views on ageing (VoA) have special relevance for the ageing process by influencing health, well-being, and longevity. Although VoA form early in life, so far, most research has concentrated on how VoA affect later middle-aged and older adults. In this theoretical article, we argue that a lifespan approach is needed in order to more fully understand the origins of VoA, how they change over ontogenetic time, and how they shape development across the full breadth of the lifespan. We begin by explicitly linking VoA to fundamental principles of lifespan development. We review existing theories of VoA and discuss their respective contributions and limitations. We then outline a lifespan approach to VoA that integrates existing theories and addresses some of their limitations. We elaborate on three core propositions of a lifespan approach to VoA: (1) VoA develop as the result of a dynamic, ongoing, and complex interaction between biological-evolutionary, psychological, and social-contextual factors; however, the relative importance of different sources changes across the lifespan; (2) VoA impact development across the whole lifespan; however, different outcomes, mechanisms, and time frames need to be considered in order to describe and understand their effects; and (3) VoA are multidimensional, multidirectional, and multifunctional throughout life, but their complexity, meaning, and adaptivity change across the lifespan. We conclude with recommendations for future lifespan research on VoA.publishe

Views on ageing : a lifespan perspective

Views on ageing (VoA) have special relevance for the ageing process by influencing health, well-being, and longevity. Although VoA form early in life, so far, most research has concentrated on how VoA affect later middle-aged and older adults. In this theoretical article, we argue that a lifespan approach is needed in order to more fully understand the origins of VoA, how they change over ontogenetic time, and how they shape development across the full breadth of the lifespan. We begin by explicitly linking VoA to fundamental principles of lifespan development. We review existing theories of VoA and discuss their respective contributions and limitations. We then outline a lifespan approach to VoA that integrates existing theories and addresses some of their limitations. We elaborate on three core propositions of a lifespan approach to VoA: (1) VoA develop as the result of a dynamic, ongoing, and complex interaction between biological-evolutionary, psychological, and social-contextual factors; however, the relative importance of different sources changes across the lifespan; (2) VoA impact development across the whole lifespan; however, different outcomes, mechanisms, and time frames need to be considered in order to describe and understand their effects; and (3) VoA are multidimensional, multidirectional, and multifunctional throughout life, but their complexity, meaning, and adaptivity change across the lifespan. We conclude with recommendations for future lifespan research on VoA.publishe

Dual guidance structure for evaluation of patients with unclear diagnosis in centers for rare diseases (ZSE-DUO): study protocol for a controlled multi-center cohort study

Background: In individuals suffering from a rare disease the diagnostic process and the confirmation of a final diagnosis often extends over many years. Factors contributing to delayed diagnosis include health care professionals' limited knowledge of rare diseases and frequent (co-)occurrence of mental disorders that may complicate and delay the diagnostic process. The ZSE-DUO study aims to assess the benefits of a combination of a physician focusing on somatic aspects with a mental health expert working side by side as a tandem in the diagnostic process. Study design: This multi-center, prospective controlled study has a two-phase cohort design. Methods: Two cohorts of 682 patients each are sequentially recruited from 11 university-based German Centers for Rare Diseases (CRD): the standard care cohort (control, somatic expertise only) and the innovative care cohort (experimental, combined somatic and mental health expertise). Individuals aged 12 years and older presenting with symptoms and signs which are not explained by current diagnoses will be included. Data will be collected prior to the first visit to the CRD's outpatient clinic (T0), at the first visit (T1) and 12 months thereafter (T2). Outcomes: Primary outcome is the percentage of patients with one or more confirmed diagnoses covering the symptomatic spectrum presented. Sample size is calculated to detect a 10 percent increase from 30% in standard care to 40% in the innovative dual expert cohort. Secondary outcomes are (a) time to diagnosis/diagnoses explaining the symptomatology; (b) proportion of patients successfully referred from CRD to standard care; (c) costs of diagnosis including incremental cost effectiveness ratios; (d) predictive value of screening instruments administered at T0 to identify patients with mental disorders; (e) patients' quality of life and evaluation of care; and f) physicians' satisfaction with the innovative care approach. Conclusions: This is the first multi-center study to investigate the effects of a mental health specialist working in tandem with a somatic expert physician in CRDs. If this innovative approach proves successful, it will be made available on a larger scale nationally and promoted internationally. In the best case, ZSE-DUO can significantly shorten the time to diagnosis for a suspected rare disease