Cognitive reserve and depression predict subjective reports of successful aging
Introduction
As the graying population increases, interest in understanding how to attain “successful” aging (SA) has grown. Genetic predisposition determines merely 25–30 % of individual differences in longevity and the remaining majority of variance is attributed to lifestyle and health factors, many of which may be modifiable to promote SA (Eaton et al., 2012). Understanding the factors that underpin SA would result in dramatic social and economic benefits, with implications extending beyond the individual.
SA has been traditionally defined in terms of longevity, marked by cognitive maintenance and absence of chronic disease (Rowe & Kahn, 1997). The Rowe and Kahn model challenged the view that aging consists of unavoidable decline and suggests that age-related loss may be in part due to modifiable factors, and their model of SA later included maintaining physical functioning and actively engaging in life (Rowe & Kahn, 1997). Since the introduction of “successful aging” to gerontology parlance more than half a century ago (Havighurst, 1961), the definitions of SA have proliferated and become increasingly heterogeneous. For example, systematic review papers document 29 definitions in 2006 (Depp & Jeste, 2006) and 105 definitions a mere eight years later (Cosco, Prina, Perales, Stephan, & Brayne, 2013).
Soon after its introduction, the Rowe and Kahn model was subject to empirically-based critiques that called for its expansion. Proposed additions included subjective criteria (Coleman, 1992; Strawbridge, Wallhagen, & Cohen, 2002;), spirituality (Crowther, Parker, Achenbaum, Larimore, & Koenig, 2002), marital status and quality (Ko, Berg, Butner, Uchino, & Smith, 2007), positive as opposed to pathological health characteristics (Kaplan et al., 2008), resilience (Bowling & Iliffe, 2011; Nygren et al., 2005; Wagnild, 2003), leisure activity (Lee, Lan, & Yen, 2011), engagement and life satisfaction (Tze Pin et al., 2009).
Given the disparity between subjective experience and established objective criteria (Strawbridge et al., 2002), integration of the older adult’s own experience into SA definitions is important but often overlooked in empirical studies (Pruchno, Wilson-Genderson, Rose, & Cartwritght, 2010). The subjective experience of aging is often measured through interview (e.g., Reichstadt, Sengupta, Depp, Palinkas, & Jeste, 2010) or standardized questionnaires that elicit specific self-report based on operational definitions (e.g., Cosco, Stephen, & Brayne, 2015). When comparing objective and subjective measures, myriad domains have been proposed to be added to SA: emotional well-being and spirituality (Crowther et al., 2002; Lewis, 2011); comportment and acceptance of change (Rossen, Knafl, & Flood, 2008); self-acceptance and self-contentment (Reichstadt et al., 2010); self-care, accepting the aging process, and financial well-being (Hilton, Gonzalez, Saleh, Maitoza, & Anngela-Cole, 2012); and living with family and receiving emotional care (Hsu, 2007). With the introduction of new domains, including quality of life and relationships, self-report assessment is clearly warranted but subject to typical bias and unreliability (e.g., Ferri, James, & Pruchno, 2009; Mcdowell, 2010). The study of SA invites latent modeling approaches that specify multidimensional constructs, reflecting multiple indicators (Blanco-Molina, Pinazo-Hernandis, & Tomás, 2019; Cosco, Stephan, Brayne, & Muniz, 2017; Kok, Aartsen, Deeg, & Huisman, 2017; Pruchno et al., 2010), and that mitigate bias from the unreliability of individual measures.
Studies that have used multidimensional definitions have identified several early-life correlates of SA. SA is associated with high education, marriage, and no history of incarceration, as well as low incidence of chronic disease indicators (Pruchno et al., 2010). High socioeconomic status, occupational and educational attainment, and leisure activity are also indicators of cognitive reserve—the maintenance of function despite neurological damage—that is a prominent predictor of aging trajectory (Stern, 2009). The relation between subjective cognitive reserve and SA has not been thoroughly examined, but may provide additional insights into the older adult’s experience of aging. Sex differences in SA have been inconsistently observed: some reports identify women as having lower likelihood of SA (e.g., Pruchno et al., 2010) whereas others identify better outcomes among women (e.g., Maccora, Peters, & Anstey, 2018). Depression is negatively associated with SA and cognitive function, especially among women (Paulson, Bowen, & Lichtenberg, 2011; Vahia et al., 2010), and this may partially contribute to observed sex differences. Systematic studies of sex differences identified that income and education differentially predicted SA between Korean men and women (Park, Jang, & Kim, 2010) and poor access to infrastructural resources by Chilean women were predictive of unsuccessful aging (Rotarou & Sakellariou, 2019). Cross-cultural comparisons in SA are challenging due to differences in subjective criteria, socioeconomics and education (Jensen et al., 2018), and therefore studies of subjective SA in different cultures are necessary to inform a valid understanding of the world’s aging population.
The current study addresses the outlined limitations by examining individual differences in SA reflective of subjective psychosocial measures in a sample of older adults from Slovenia. SA was defined by self-reports of sociodemographic data, health status, and life satisfaction and meaning, which were combined as a latent construct. In a structural equation modeling framework, we tested the hypothesis that greater protective factors (cognitive reserve and functional and cognitive capacity) and lower risk factors (health status and depression) would predict high SA scores. Further, we examined possible differences between men and women in the correlates of SA.
Section snippets
Participants
A convenience sample of 213 adults, aged 60 years and older, who lived in Slovenia were enrolled in the study. Data were collected over a 10-month period, from November 2015 to August 2016. Older people who lived independently and who were able to communicate verbally in Slovene language were approached and invited to participate. We recruited participants through community agencies and programs for older adults—e.g., pensioners’ associations and Stari za stare. We recruited 222 adults who met
Sample univariate descriptions and bivariate correlations
The Pearson correlation coefficients between all scale self-evaluations are presented in Table 1. Testing possible group differences identified that the indicators of SA were comparable between men and women (all t = -0.50 – 0.18, all p’s > 0.25). Women (M = 67.74, SD = 5.54) were on average younger than men (M = 69.77, SD = 6.57) in this sample (t (210) = -2.17, p = 0.03). Women reported lower Functional Capacity (M = 10.5, SD = 2.4 vs. M = 11.4, SD = 3.3; t (205) = -2.10, p = 0.04) and
Discussion
The present study examined subjective evaluation of SA on a continuum and identified risk and protective factors that were associated with individual differences therein. Across older Slovenian individuals, high SA was associated with low depression ratings and a non-significant trend with high self-report of cognitive reserve. Although men in this sample reported higher depression symptoms than women, the linear relation with SA was similar between sexes. Self-evaluations of functional
Declaration of Competing Interest
The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in
CRediT authorship contribution statement
Klara Golja: Conceptualization, Methodology, Data curation, Writing - original draft. Ana M. Daugherty: Formal analysis, Writing - review & editing. Voyko Kavcic: Conceptualization, Methodology, Visualization, Investigation, Supervision, Validation.
Acknowledgments
This research did not receive any financial support. The data, analyses and materials published in this manuscript will be made available upon written request to the corresponding author.
References (73)
- et al.
Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation
Clinical Psychology Review
(1988) - et al.
Subjective well-being key elements of Successful Aging: A study with Lifelong Learners older adults from Costa Rica and Spain
Archives of Gerontology and Geriatrics Research
(2019) - et al.
Depression, anxiety and cognition in community-dwelling adults aged 70 years and over
Journal of Psychiatric Research
(2012) - et al.
Definitions and predictors of successful aging: A comprehensive review of larger quantitative studies
American Journal of Geriatric Psychiatry
(2006) Measures of self-perceived well-being
Journal of Psychosomatic Research
(2010)- et al.
Older adults’ perspectives on successful aging: Qualitative interviews
American Journal of Geriatric Psychiatry
(2010) Cognitive reserve
Neuropsychologia
(2009)- et al.
Subthreshold depression and successful aging in older women
American Journal of Geriatric Psychiatry
(2010) - et al.
The relationship between cognitive reserve and math abilities
Frontiers in Aging Neuroscience
(2017) - et al.
Psychological perspectives on successful aging: The model of selective optimization with compensation
Manual for the Beck D Beck depression Inventory-II
Depression in late life: Review and commentary
Journal of Gerontology Medical Sciences
What is successful ageing and who should define it?
British Medical Journal (Clinical Research Ed)
Psychological approach to successful ageing predicts future quality of life in older adults
Health and Quality of Life Outcomes
Personal adjustment in late life: Successful aging
Reviews in Clinical Gerontology
The relationships between cognitive reserve and creativity. A study on American aging population
Frontiers in Psychology
Operational definitions of successful aging: A systematic review
International Journal of Psychogeriatrics
Validation of an a priori, index model of successful aging in a population-based cohort study: The successful aging index
International Journal of Psychogeriatrics
Education and successful aging trajectories: A longitudinal population-based latent variable modelling analysis
Canadian Journal on Aging = La Revue Canadienne Du Vieillissement
An experimental study in existentialism: The psychometric approach to Frankl’s concept of noogenic neurosis
Journal of Clinical Psychology
Rowe and Kahn’s model of successful aging revisited: Positive spirituality — The forgotten factor
The Gerontologist
Prevalence and predictors of depression in populations of elderly: A review
Acta Psychiatrica Scandinavica
Genes, environments, personality, and successful aging: toward a comprehensive developmental model in later life
Journals of Gerontology Series A Biomedical Sciences and Medical Sciences
Self-transcendence and depression in middle-age adults
Western Journal of Nursing Research
Successful aging: Definitions and subjective assessment according to older adults
Clinical Gerontologist: The Journal of Aging and Mental Health
Depression, cognitive impairment and dementia: Why should clinicians care about the web of causation?
Indian Journal of Psychiatry
Successful aging
The Gerontologist
Perceptions of successful aging among older Latinos, in cross-cultural context
Journal of Cross-cultural Gerontology
Gender disparity of successful aging in Taiwan. Women &
health
Exploring elderly people’s perspectives on successful ageing in Taiwan
Ageing and Society
Successful aging: Cross-cultural comparison of older adults’ lay perspectives
Innovation in Aging
Successful cognitive and emotional aging
World Psychiatry : Official Journal of the World Psychiatric Association (WPA)
Association between older age and more successful aging: Critical role of resilience and depression
The American Journal of Psychiatry
How could lay perspectives on successful aging complement scientific theory? Findings from a U.S. and a German life-span sample
The Gerontologist
Prevalence and factors associated with thriving in older adulthood: A 10-year population based study
The Journals of Gerontology Series A, Biological Sciences and Medical Sciences
Early impact of depression symptoms on the decline in activities of daily living among older Japanese: Y-HALE cohort study
Environmental Health and Preventive Medicine
Cited by (11)
Relationship between social participation and life satisfaction in community-dwelling older adults: Multiple mediating roles of depression and cognitive function
2024, Archives of Gerontology and GeriatricsThe relationship between purpose in life and depression and anxiety: A meta-analysis
2023, Journal of Clinical PsychologyIs the Sardinian Blue Zone the New Shangri-La for mental health? Evidence on depressive symptoms and its correlates in late adult life span
2022, Aging Clinical and Experimental ResearchAssociations between migration experience and perceived mental health in optimal ageing: Evidence from the Sardinian Blue Zone
2022, International Journal of Psychology