Measuring wellbeing in active seniors

1
Measuring well-being in active seniors

• Active Seniors Group of the Health Network

2
What is well-being?
Well-being is multi -dimensional Well-being is
more than being well
Schickler, 2005
3
Well-being is subjective

• Well-being means that I have hopes and goals.
  
• I have self-esteem, authenticity and confidence.
  I can be creative and spiritual.
• I have energy and vitality which flows freely. I
  am relaxed and at ease.
• It is about being content with life, accepting
  myself, knowing my limitations and the reality
  and risks of life.
• Only I know how I feel when I have a sense of
  well-being and it is hard for me to tell if
  someone else feels that way

Schickler, 2005
4
Well-being is not be the same as health but
well-being can promote health and healthy living

• Evidence shows that people with positive
  well-being
• Live longer
• Have less coronary heart disease
• Are more likely to survive cancer
• Show faster wound healing times
• Are less likely to succumb to a standard dose of
  virus

Summary of multiple studies
5
A diverse range of factors can affect well-being
e.g.

• Lifestyle factors (e.g. diet, exercise, drug use,
  sleep)
• Self-concept
• Relationships
• Integration into community
• Control
• Goals
• Environment
• Mental activity
• Positive emotions/thoughts

6
Why evaluate?

• Evidence of effectiveness of interventions
• Proof of value for money
• Feedback on the process enables refinement of the
  effective elements

7
Evaluative strategies

• Subjective measures
• Structured questionnaires
• Qualitative research
• Objective measures
• Lifestyle change e.g. reductions in smoking,
  illicit drug use, unplanned pregnancies
  increased participation in sports, school
  attendance, support groups, screening programmes
  etc.
• Health outcomes e.g. reduction if hospital
  visits, heart attacks etc. These are long-term
  measures not always suitable for short to
  medium term evaluation
• Pre-clinical biological markers of well-being
  that can be used for shorter-term objective
  evaluations?

8
Our bodies are in harmony with the 24-hour light
dark cycle
9
Circadian (24hour) rhythms

• Wake/sleep
• Body temperature
• Balance of immune system
• Volume of urination
• Sensitivity to certain drugs
• Frequency of eating drinking
• Secretion of hormones that are sensitive to light
  and dark orchestrate rhythms around the 24hour
  cycle and thus ensure optimal functioning

10
Diurnal (12 hour) variation in hormone secretion
Edwards et al., 2001
11
Cortisol tells the rest of our body when it is
night and day
12
The cortisol profile has a powerful regulatory
influence on the immune system
The awakening cortisol response
The cortisol day profile
CORTISOL
The oscillating nature of the immune system
Night time cell mediated immunity
Night time cell mediated immunity
Daytime humoral immunity
13
The problem is threat also causes cortisol
secretion and disturbs the 24 hour rhythm
Brain
Pituitary
Adrenal glands
Everywhere in body 15 minutes
Cortisol
14
In humans threat is usually psychological not
physical
Lack of control
Novelty
Cortisol
Lack of social support
Unpredictable events
Anticipation
Threat to self esteem
Physical illness
15
High overall levels of cortisol associated with
poor physical health
Stroke, depression, high blood pressure, angina,
heart attack, allergy, diabetes, slow wound
healing, osteoporosis, increased infections,
accelerated cancer progression, accelerated HIV
progression
16
Increased risk
Stress
Depression
Genetics
CV disease
Allergy
Hidden predisposition
Development
Diet
Diabetes
Infections
Smoking
Life's rich tapestry!
Slow healing
Stroke
Exercise
17
Unpredictable life events or stressors
The predictable light/dark cycle
Adrenal cortex
Measurable cortisol
Frequent
Basal levels or circadian patterns
Stress responses
Changes in feedback regulation
18
Two groups of breast cancer patients
characterised by the nature of their diurnal
cortisol cycle
Sephton et al., 2000
19
A powerful predictor of survival
20
Mean levels of salivary cortisol associated with
levels of support in cancer patients
Turner-Cobb et al, 2000 (n 103)
21
Interventions such as cognitive behavioural
therapy and meditation lower cortisol levels over
the course of 5 weeks
(p0.012)
Bullen et al, in press
22
The diurnal decline can be attenuated by
stressful events - in this case low frequency
noise
Person-Waye et al, 2002
23
Conversely the 12-hour mean salivary cortisol
concentration was inversely related to positive
mood
Steptoe et al, 2005
24
A multidimensional approach

• Demographic variables Age, sex, medications,
  marital status, children, living arrangements,
  social support, socio-economic status, ethnicity,
  smoking/drinking status, pet ownership, length of
  retirement and activities, hobbies and
  commitments.
• Subjective measures The General Health
  Questionnaire the Perceived Health, Wellbeing and
  Financial status, The Subjective Socio-Economic
  Status Ladder The Life Satisfaction Index,
  Perceived Wellness scale, Control, Autonomy,
  Self-realisation and Pleasure scale CASP-19, The
  Vulnerable Attachment Style Questionnaire VASQ,
  Rosenberg Self-Esteem the Short-Form- 36
• Objective measuresCortisol secretion over a 48
  hour period wrist watch activity level (measure
  the day-night activity and activity variability
  over the day). Cognitive test

25
The cortisol profile can be measured in saliva
samples collected by participants in their own
home
Convenient and hygienic saliva collection devices

26
Saliva sampling design
Awakening Samples
Diurnal Samples
First awakening sample followed by a further 3
samples at 15 min intervals
3 hours after waking
6 hours after waking
8 saliva samples on 2 days, synchronized to time
of waking. Nil-by-mouth for 30 min prior to each
sample except water
9 hours after waking
12 hours after waking
27
Participants

• Participants recruited via community groups (e.g.
  pensioners groups, University of the 3rd Age)
• All active and living within their own homes
• Age 60-91 mean 74 years
• 16 males and 34 females
• The study took place in their own home
  ecological validity

28
Salivary Cortisol
Cortisol concentration collected over two
consecutive days
29
Salivary Cortisol
Negative well-being (CGHQ)
Positive well-being (CGHQ)
CGHQ (F(1,38)5.873, p0.020)
POS-GHQ (F(1,39)6.133, p0.018)
30
Demographics?

• The study found no relationship between positive
  and negative well-being with age or gender.

31
Where to next?

• To refine and identify an objective measure of
  well-being in older people
• Use our pooled expertise to provide a
  consultative service in evaluating well-being in
  older people
• Provide interventions which have the potential to
  improve health and well-being in seniors e.g.
  stress reduction, use of complementary therapies,
  environmental change

32
How To Contact Us

• Professor Angela Clow clowa_at_wmin.ac.uk
• Denise Forte dforte_at_hscs.sgul.ac.uk
• Participating Institutions
• Kingston University, Westminster University,
  Royal Holloway University of London

http//www.ageing-well.org.uk/AgeingWell/Home_14.a
spx
33
Prof. Angela Clow Denise Forte Prof. Frank
Hucklebridge, Cathrine Fredhoi, Liz Aitcheson,
Prof Phil Evans, Dr Catherine
Loveday, Catherine Jacobs