Enhancement of individual and community competence: The older adult as community worker

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44012/1/10464_2004_Article_BF00896496.pd

The choice of self-rated health measures matter when predicting mortality: evidence from 10 years follow-up of the Australian longitudinal study of ageing

<p>Abstract</p> <p>Background</p> <p>Self-rated health (SRH) measures with different wording and reference points are often used as equivalent health indicators in public health surveys estimating health outcomes such as healthy life expectancies and mortality for older adults. Whilst the robust relationship between SRH and mortality is well established, it is not known how comparable different SRH items are in their relationship to mortality over time. We used a dynamic evaluation model to investigate the sensitivity of time-varying SRH measures with different reference points to predict mortality in older adults over time.</p> <p>Methods</p> <p>We used seven waves of data from the Australian Longitudinal Study of Ageing (1992 to 2004; N = 1733, 52.6% males). Cox regression analysis was used to evaluate the relationship between three time-varying SRH measures (global, age-comparative and self-comparative reference point) with mortality in older adults (65+ years).</p> <p>Results</p> <p>After accounting for other mortality risk factors, poor global SRH ratings increased mortality risk by 2.83 times compared to excellent ratings. In contrast, the mortality relationship with age-comparative and self-comparative SRH was moderated by age, revealing that these comparative SRH measures did not independently predict mortality for adults over 75 years of age in adjusted models.</p> <p>Conclusions</p> <p>We found that a global measure of SRH not referenced to age or self is the best predictor of mortality, and is the most reliable measure of self-perceived health for longitudinal research and population health estimates of healthy life expectancy in older adults. Findings emphasize that the SRH measures are not equivalent measures of health status.</p

Adjusting to life after treatment: distress and quality of life following treatment for breast cancer

Clinical and anecdotal findings suggest that the completion of cancer treatment may be marked by heightened distress and disrupted adjustment. The present study examined psychological adjustment during the 3 months following treatment among 89 women with stages 0–III breast cancer. Participants completed measures of depression, cancer-related anxiety, cancer concerns, and quality of life at three time points: during treatment, 3 weeks following the end of treatment, and 3 months post-treatment. Post-treatment scores were suggestive of good psychological adjustment among the majority of women. Moreover, distress did not increase following treatment; longitudinal analyses showed no significant changes in depression or recurrence worry, while intrusive thoughts decreased, and quality of life improved. Younger age predicted greater distress across measures. A history of depression or anxiety predicted greater depressive symptomatology, while more extensive treatment predicted greater cancer-related anxiety. Despite the lack of distress endorsed on general depression and anxiety indices, participants reported moderate distress associated with cancer-related concerns, including physical problems, fear of cancer recurrence, and resuming normal life. In sum, while breast cancer survivors demonstrate good adjustment on general distress indices following treatment, some women are at risk for sustained distress. Moreover, significant cancer-related concerns are prevalent and may be important intervention targets

Ageism in the third age

In the developed world, later life has brought more opportunities to contribute to society and pursue personal goals outside the role of paid work, combined with less stigma and greater recognition of the worth of older people. These values do not necessarily extend to the “oldest old” where some people in the fourth age (people 80 years old and over) continue to face increasing stigma and societal stereotypes from those in the third age (people 60–79 years old). Ageism between these two cohorts is rarely discussed in the literature. Potential ageism involves stereotypical perceptions of the oldest old and may prove detrimental to those transitioning from the third to the fourth age if a resultant resistance to maintain their engagement and independence into older age occurs. This chapter explores the subtleties of these inter-cohort ageist discourses particularly from a health and social care perspective and considers the implications for transitions of older people between the third and fourth age. It addresses the challenges and adjustments needed to ensure continuing and inclusive engagement in society, in order to support independence to grow old without the fear of discrimination

Male Microchimerism at High Levels in Peripheral Blood Mononuclear Cells from Women with End Stage Renal Disease before Kidney Transplantation

Patients with end stage renal diseases (ESRD) are generally tested for donor chimerism after kidney transplantation for tolerance mechanism purposes. But, to our knowledge, no data are available on natural and/or iatrogenic microchimerism (Mc), deriving from pregnancy and/or blood transfusion, acquired prior to transplantation. In this context, we tested the prevalence of male Mc using a real time PCR assay for DYS14, a Y-chromosome specific sequence, in peripheral blood mononuclear cells (PBMC) from 55 women with ESRD, prior to their first kidney transplantation, and compared them with results from 82 healthy women. Male Mc was also quantified in 5 native kidney biopsies obtained two to four years prior to blood testing and in PBMC from 8 women collected after female kidney transplantation, several years after the initial blood testing. Women with ESRD showed statistically higher frequencies (62%) and quantities (98 genome equivalent cells per million of host cells, gEq/M) of male Mc in their PBMC than healthy women (16% and 0.3 gEq/M, p<0.00001 and p = 0.0005 respectively). Male Mc was increased in women with ESRD whether they had or not a history of male pregnancy and/or of blood transfusion. Three out of five renal biopsies obtained a few years prior to the blood test also contained Mc, but no correlation could be established between earlier Mc in a kidney and later presence in PBMC. Finally, several years after female kidney transplantation, male Mc was totally cleared from PBMC in all women tested but one. This intriguing and striking initial result of natural and iatrogenic male Mc persistence in peripheral blood from women with ESRD raises several hypotheses for the possible role of these cells in renal diseases. Further studies are needed to elucidate mechanisms of recruitment and persistence of Mc in women with ESRD

Death and the “life review” in Halakhah

Coping with old age involves resolving the task of “integrity versus despair,” which demands a nondefensive confrontation with the inevitability of death. Halakhah (Jewish ethics) also considered this task critical in later years of life, spoke of death's inevitability, and attempted to discourage denial of death. The Jewish approach seems compatible with Butler's concept of “life review” as a reconciliation with death and a reintegration of one's identity that occurs throughout later years. While the Eriksonian goal is confronting old age with a certain capacity for “wisdom,” the rabbis maintained that such wisdom must culminate in the creative act of repentance.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45115/1/10943_2004_Article_BF00996254.pd