Later Life Transitions

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Later Life Transitions

• Ken Laidlaw, PhD
• Consultant Clinical Psychologist/Senior Lecturer

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Later Life Transitions

• Health is a state of complete physical, mental
  and social well-being and not merely the absence
  of disease or infirmity. (WHO, 1948)
• Increasing longevity across societies in the
  developed and developing world is a major
  societal achievement, and a challenge (WHO,
  2001).

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Later Life Transitions

• Active ageing is the process of optimizing
  opportunities for health participation and
  security in order to enhance quality of life as
  people age.
• The new paradigm suggested by active ageing is
  that older people are active participants in an
  age-integrated society and are valued and active
  contributors to society, not just recipients.
• It is Rights Based rather than Needs Based.

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Later Life Transitions

• Profound, Global and Irreversible demographic
  shift (UN, 2007)
• People are living longer and healthier
• Ageing is about how we become our own person
• Ageing is not a defeat but a victory not a
  punishment but a privilege.
• Ethel Percy-Andrus

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Later Life Transitions

• By 2050, 1 in 3 residents will be aged 65 years
  and older in Austria, Greece, Italy, Japan,
  Slovenia and Spain (UN, 2002).
• When considering the proportion of people aged 60
  years all of the worlds top 30 oldest
  countries are European, with the exception of
  Japan (1st oldest)

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Later Life Transitions

• Between 2000-2050 life expectancy at age 80 is
  expected to increase by 27
• Life expectancy in 1931 for men was 58 years and
  for women it was 62 years.
• Using 2006 stats, a man aged 65 years could
  expect to live for another 17 years and a woman
  aged 65 years could expect to live for another 20
  years.

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Later Life Transitions

• There can be many transitions to be achieved in
  later life
• Retirement Adjustment
• Challenges to Physical Health Status
• Challenges to Social Capital
• Challenges to Mental Health and Wellbeing
• Attitudes may be important

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Later Life Transitions

• Successful transition from one state to another
  is probably important for determining a persons
  mental health, well-being and quality of life.
• Often problems develop when people try to use
  outmoded strategies when circumstances have
  changed.
• Thus people get stuck. This sort of difficulty in
  negotiating a transition can often be the reason
  a person seeks help

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Later Life Transitions Retirement

• Retirement has been called one of the most
  important late life transition (van Solinge
  Henkens, 2007).
• Evidence for the impact of retirement on health
  and wellbeing is mixed (Kim Moen, 2002).
• Retirement is now becoming more individualised
  and less governed by statutory factors
  (Vickerstaff, 2006)
• How a person manages retirement may depend upon
  the choice they exercised in the decision.
• Choice may be determined by income, gender,
  health and organisation
• Health may be a retrospective reason

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Later Life Transitions Retirement

• Retirement is more likely a process than a state.
  There are gender differences in retirement.
• Mens morale appears to improve as move into
  retirement
• Pre-existing vulnerabilities important in
  relationship between depression retirement
• Sense of personal control is important for both
  genders
• Women tend to have the greater difficulty
  adjusting to retirement
• Health is relatively small in terms of impact on
  adjustment.
• Retirement is a couple phenomenon
• Interdependence People may retire because their
  spouse is ill.
• Premorbid nature of relationship is important
• Context and Psychological factors important for
  successful transition (van Solinge Henkens,
  2005).

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Later Life Transitions Physical Health

• Loss and change is a universal experience
  (Boerner Jopp, 2007).
• While people are living longer they are living
  healthier (WHO, 2002) with a restriction of
  disability to the final years of life (Baltes
  Smith, 2002).
• As well as objective losses in later life there
  may be unwelcome symbolic changes that suggest
  transitions may take place over a very long
  period of time.
• Chronic illness is common in later life with 50
  of people over age 65 experiencing at least one
  illness.

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Later Life Transitions Social Capital

• Our social embeddedness becomes more, not less,
  important as we grow older. From the cradle to
  the grave we all need others (Takahashi, 2005).
• There is a long and complicated association
  between social relations and health and
  well-being (Antonucci et al, 2002).
• Social relations may mean many things, such as
  network or support. It may be that quality of
  support may be more important than quantity of
  support. The subjective perception of support may
  also be an important factor.

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Later Life Transitions Social Capital

• Older people will have multiple close
  relationships with others in order to maximise
  well-being. There will be different roles and
  functions to each of the relationships.
• Convoy Model (Antonucci, 1986) suggests that
  individuals are distinguished by how important
  they are to the person. Healthy adults normally
  nominate 10 people in their social networks
  (Takahashi, 2005).
• Usually there is an inner circle of 3 or 4 people
  who provide most critical supports (confidant,
  reassurance, sickness care, talk when sick). The
  outer circle mainly provides respect.

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Later Life Transitions Social Capital

• Differences in social networks are evident as
  people age. As different responsibilities may be
  evident at different ages.
• There are gender differences in social networks
  (Ajrouch et al, 2005).
• Women have larger more diverse social networks
  with more people considered close.
• Men may experience greater continuity in social
  networks as they age
• With age, women experience reductions in network
  availability and resources.
• Carstensen Colleagues have developed
  Socio-emotional Selectivity Theory. Older people
  motivated by limited time horizons to selectively
  focus on intimate social relations. Well-being is
  linked to maintaining intimate social ties.

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Later Life Transitions Mental Health

• Mental Health and Well-Being
• One of the biggest challenges to well-being is
  depression.
• Depression is not an outcome of old age
• Depression is an illness that can and should be
  treated

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Later Life Transitions Mental Health

• Schaie (2008)  notes that it is a common
  assumption that universal cognitive decline is an
  outcome of age.
• In reality, a few unfortunately experience
  decline and dementia, but many do not, and a
  lucky few may even go on to achieve selective
  gains in later life.
• When people are depressed the expectation that
  ageing will be distressing leads people to accept
  inadequate treatment.

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Late Life Transitions Attitudes to Ageing

• Attitudes may be crucial in how we manage late
  life transitions.
• Levy (2002) talks of an internalized negative age
  stereotype
• When individuals reach old age, the ageing
  stereotypes internalized in childhood, and then
  reinforced for decades, become self-stereotypes.
• But there is also the paradox of ageing that
  seems to contradict this idea.
• When people become depressed these attitudes
  change and people become more negative.

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Late Life Transitions Attitudes to Ageing

• Attitudes to Ageing questionnaire (Laidlaw et al,
  2007) developed in 15-20 countries worldwide.
• Provided a new way of measuring attitudes to
  ageing both in terms of personal and general
  attitudes
• Three different scores possible
• Psychosocial Loss
• Physical change
• Psychological growth

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Late Life Transitions Attitudes to Ageing

• The majority of participants (71.5) rated their
  health as good and 18.2 reported that they were
  dissatisfied or very dissatisfied with their
  health.
• 69.8 of people rated the quality of life as good
  or very good with 89.5 of people stating that
  they were satisfied or very satisfied with their
  health.

There were no significant differences in health
or life satisfaction between young-old and
old-old participants
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Late Life Transitions Attitudes to Ageing

• Very Preliminary Exploration at level of items
• Gender (2227 men 3160 women) Using P lt.001
• Old age is a time of Loneliness - w (ES .32)
• Capacities and abilities decline with age - m (ES
  .08)
• Old age mainly a time of loss - w (ES .09)
• Personal beliefs mean more as I grow older - w
  (ES 0.21) ?SST
• Unhappy with changes in my appearance - w (ES
  .30)
• GDS 1 (gt4400 said yes)Depression has big impact
  on AAQ scores. On all items except personal
  beliefs p lt .0005 differences
• Subjective health status has same impact on all
  items except wisdom p lt .0005 differences

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Late Life Transitions Attitudes to Ageing

• Chachamovich et al., (2008) reports that
  consistent with the WHOQOL-Old, the AAQ scores
  are progressively influenced by increasing levels
  of GDS depression scores.
• This phenomenon occurs not just with depressed
  but also the subsyndromal subsample.
• Classifying someone as depressed/not depressed
  may fail to capture significant challenges to the
  experience of ageing and QoL.

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Late Life Transitions

• Is it too simple to say it is all in the mind?
  Maybe, chronological age is the least important
  factor in understanding how people manage late
  life transitions?
• "To be young is to be fresh, lively, eager, quick
  to learn to be mature is to be done, complete,
  sedate, tired.
• What if we consider a different perspective? To
  be young is to be unripe, unfinished, raw,
  awkward, unskilled, inept to be mature is to be
  ready, whole, adept, wise."
• Making the transition means valuing our years of
  experience and keeping our intellectual, and
  emotional growth going so that we can gain wisdom
  and not just years