Terminal change and adaptation of subjective well-being in very old age: The role of physical health and health- and death-related anxieties in the approach of the end of life
Final Report Abstract
This project (acronymed as “LateLine”) was conducted to follow-up a previously established sample of very old individuals (born 1912-1921). The study was driven by three primary research objectives: First, we aimed to examine terminal changes in physical health, functional status, and psychological variables relevant to individual subjective well-being (SWB) in late life, which means to analyze changes of SWB indicators that unfold time-to-death-related as the very old individuals approach their life’s end. This aim is based on the reasoning that at the end of the human lifespan typical changes may be understood in terms of a terminal development driven by internal processes of (biological) degradation. Second, we aimed to examine psychological adaptation to worsening physical function, analyzing changes in psychological SWB indicators linked with changes in physical health and functional status. With respect to theory, this aim was driven by a conceptual understanding of adaptation as an intraindividual dynamic that promotes stability and/or attenuates “responsiveness” of psychological outcomes under continuously worsening health conditions. Third, we aimed to measure the oldest-olds’ health- and death-related anxieties, which so far have rarely been studied longitudinally across the terminal phase of the lifespan. We expected such anxieties to impact on terminal and adaptation processes in very old age. To achieve these goals, we conducted (by now) 6 longitudinal measurement waves, starting 2009 (n = 113), followed-up twice with 1-year intervals 2010 (n = 92) and 2011 (n = 71), and triply with half-year intervals 2011 (n = 61), 2012 (n = 55), and 2012 (n = 51). The project followed-up the German subsample from the so-called ENABLE-AGE project (N = 252 eligible for contact), which was conducted with 2 measurement waves in 2002 and 2003: Altogether, N = 124 “survivors” from this parent sample could be surveyed in any of the LateLine waves. Assessment focused on indicators of psychological functioning (including, amongst others, life satisfaction and affective well-being, depression, hypochondriac concerns, fears and attitudes towards dying and death, and cognitive performance) and physical health (including functional abilities, general health status, self-reported diseases and symptoms, physical performance, and visual acuity). Furthermore, in the summer 2011 and 2012, the participants’ general practitioners were contacted to receive objective information on diagnosed diseases. The LateLine survey also comprised a regular mortality follow-up of the parent sample, which altogether revealed n = 138 deceased since 2003, including n = 47 that have died after the beginning of the LateLine surveys. All individuals deceased have been recorded with their dates of death, as needed for time-to-death-related analyses. Findings from the study comprise evidence of terminal change dynamics in negative – but not positive – affect, suggesting reactivity of the negative affect system to terminal processes in terms of an increase across the years preceding individual death, but also a terminal drop close to death which may signal a general exhaustion of affective arousal. We also found evidence of different developmental dynamics in depressive symptoms, suggesting that stably high clinical depressiveness is about as prevalent as stably good “affective health” in terms of low depressiveness, but that an “at risk” dynamic of increasing depression towards the clinical level may be most prevalent (>40%) in the oldest-old. Moreover, these findings underscore that stable physical functionality is a resource of stable affective health, but loss of physical functionality does not per se predict the onset of the “at risk” dynamic. In general, our analyses so far were focused on intraindividual changes of affective functioning, pointing at overall high interindividual variability of such changes. It seems that loss of functional abilities needed for independent conduct of everyday activities is crucial to constrain the very olds’ experiences of positive affect, but does not increase negative emotional states. Negative affect nevertheless may be a more sensitive marker of internal processes of degradation at the end of life. Our examination of fears and attitudes to dying and death indicate that anxieties about their one’s own dying may be particularly frequent among the oldest old, but not so fears of their own death or low acceptance of their own dying and death. These findings also showed that high anxiety about one’s own dying may significantly impede subjective well-being in oldest-old age and that high acceptance of death and dying go along with positive valuations of life and perceived autonomy. Also, pointing at risk or resilience factors, we found fears of dying and acceptance of death/dying associated with several personality and health indicators. Overall, the LateLine project has generated a longitudinal database unique in terms of its broad range of psychological and health indicators, the number of longitudinal measurement points, and the thorough mortality follow-up, all realized with a sample of oldest-old. Additional resources building on the DFG funding will enable to continue the longitudinal follow-up measurement until all participants have deceased, which will generate complete records of the study variables across the participants’ terminal phase of life. This data allows for in-depth analyses of change in multiple aspects subjective well-being linked with health changes, ongoing in the late and latest phases of the human lifespan.
Publications
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(2010, November). Long term change in subjective well-being, functional status and health symptoms in very old age: Patterns of deterioration, plasticity, and stability. 63nd Annual Scientific Meeting of the Gerontological Society of America, New Orleans, USA
Schilling, O., Wahl, H.-W., Reidick, O., & Oswald, F.
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(2011, July). Survival into very old age: Is affect affected? 12th European Congress of Psychology, Istanbul, Turkey
Schilling, O., Wahl, H.-W., & Oswald, F.
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(2011, September). Im Angesicht des Todes: Gesundheit, Persönlichkeit und Einstellungen gegenüber Sterben und Tod im sehr hohen Alter [In the face of death: Health, personality, and attitudes towards dying and death in very old age]. 20th Meeting of the Section for Developmental Psychology of the German Psychological Society, Erfurt, Germany
Reidick, O., Schilling, O., Wahl, H.-W. & Oswald, F.
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(2012). Affective development in advanced old age: Analyses of terminal change in positive and negative affect. Developmental Psychology
Schilling, O. K., Wahl, H.-W., & Wiegering, S.
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(2012). Hohes Alter. In W. Schneider, U. Lindenberger, R. Oerter & L. Montada (Hrsg.), Entwicklungspsychologie, 7. Aufl. (pp.311-334). Weinheim, Basel: Beltz
Wahl, H.-W. & Schilling, O.
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(2012, November). Age-graded versus terminal changes in positive and negative affect in very old age. 65th Annual Scientific Meeting of the Gerontological Society of America, San Diego, USA
Schilling, O.K. & Wahl, H.-W.
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(2012, November). Prototypical trajectories of depressive symptoms and affect balance in late life: One out of three at risk? 65th Annual Scientific Meeting of the Gerontological Society of America, San Diego, USA
Schilling, O., Wahl, H.-W., & Reidick, O.
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(2013). Trajectories of depressive symptoms in advanced old age: A functional approach concerning the role of physical functioning. GeroPsych, 26, 29-38
Schilling, O.K., Wahl, H.-W., & Reidick, O.
