Nadeeka N. Dissanayaka
Progressive neurological disorders are incurable disorders with gradual deterioration and impacting patients for life. Two common progressive neurological disorders found in late life are Parkinson’s disease (PD) and motor neuron disease (MND). Psychological complications such as depression and anxiety are prevalent in people living with PD and MND, yet they are underdiagnosed and poorly treated.
PD is classified a Movement Disorder and predominantly characterized by motor symptoms such as tremor, bradykinesia, gait problems and postural instability; however, neuropsychiatric complications such as anxiety and depression are common and contribute poorly to quality of life, even more so than motor disability. The average prevalence of depression in PD suggest 35% and anxiety in PD reports 31%. Depression and anxiety often coexist. Symptoms of depression and anxiety overlap with symptoms of PD, making it difficult to recognize. In PD, daily fluctuations in anxiety and mood disturbances are observed with clear synchronized relationships to wearing off of PD medication in some individuals. Such unique characteristics must be addressed when treating PD depression and anxiety. There is an increase in the evidence base for psychotherapeutic approaches such as cognitive behavior therapy to treat depression and anxiety in PD.
Motor neuron disease (MND) is classified a neuromuscular disease and is characterized by progressive degeneration of upper and lower motor neurons is the primary characteristic of MND. The most common form of MND is Amyotrophic lateral sclerosis (ALS) and the terms ALS and MND are simultaneously used in the literature. Given the short life expectancy (average 4 years), rapid deterioration, paralysis, nonmotor dysfunctions, and resulting incapacity, psychological factors clearly play a major role in MND. Depression and suicide are common psychological concerns in persons with MND. While there is an ALS-specific instrument to assess depression, evaluation of anxiety is poorly studied; although emerging studies suggesting that anxiety is highly prevalent in MND. Unfortunately, there is no substantial evidence-base for the treatment of anxiety and depression in MND.
Caregivers play a major role in the management of progressive neurological diseases. Therefore, evaluating caregiver burden and caregiver psychological health are essential to improve quality of care provided to the patient, as well as to improve quality of life for carers. In progressive neurological diseases, caregiving is often provided by family members and spouses, with professional care at advanced disease. Psychological interventions for PD carers addressing unique characteristics of PD and care needs is required. Heterogeneous clinical features, rapid functional decline, and short trajectory of MND suggest a multidisciplinary framework of carer services including psychological interventions to mitigate MND. A Supportive Care Needs Framework has been recently proposed encompassing practical, informational, social, psychological, physical, emotional, and spiritual needs of both MND patients and carers.
Carolyn M. Aldwin and Ritwik Nath
Erythocyte sedimentation rate (ESR) is one of the oldest measures of inflammation. It is used extensively in clinical medicine and has shown some utility in biomedical research. It is a nonspecific inflammation assay, and although it is less sensitive than more modern measures such as C-reactive protein, it is a useful measure in chronic illnesses.
In general, ESR increases with age and appears to be a biomarker of aging in general. It predicts both cardiovascular disease (CVD) and cancer and is elevated in autoimmune disorders such as rheumatoid arthritis. Further, it predicts mortality both in the general population and in those with chronic illnesses such as CVD and cancer, independent of other indicators of illness severity.
Interestingly, ESR is not associated with anxiety or general measures of distress but is consistently associated with measures of depression and suicidal ideation. Further, the effect of depressive symptoms on mortality appears to be mediated through increases in ESR.
Studies of the relationship between stress and ESR have been less consistent, primarily because early studies were largely cross-sectional and in small samples. Studies using more modern, longitudinal analyses in larger samples may show more consistent results, especially if multilevel modeling was used that examined within-person changes in ESR in response to stress. Given that other large, longitudinal studies, such as the Baltimore Longitudinal Study on Aging, the Rotterdam Study, The Reykjavik Cohort Study, and Women’s Healthy Ageing Study have included ESR in their biomedical assays, it should be possible to analyze existing data to examine how psychosocial factors influence inflamm-aging in humans.
Stephen J. Bright
In the 21st century, we have seen a significant increase in the use of alcohol and other drugs (AODs) among older adults in most first world countries. In addition, people are living longer. Consequently, the number of older adults at risk of experiencing alcohol-related harm and substance use disorders (SUDs) is rising. Between 1992 and 2010, men in the United Kingdom aged 65 years or older had increased their drinking from an average 77.6 grams to 97.6 grams per week. Data from Australia show a 17% increase in risky drinking among those 60–69 between 2007 and 2016. Among Australians aged 60 or older, there was a 280% increase in recent cannabis use from 2001 to 2016. In the United States, rates of older people seeking treatment for cocaine, heroin, and methamphetamine have doubled in the past 10 years. This trend is expected to continue.
Despite these alarming statistics, this population has been deemed “hidden,” as older adults often do not present to treatment with the SUD as a primary concern, and many healthcare professionals do not adequately screen for AOD use. With age, changes in physiology impact the way we metabolize alcohol and increase the subjective effects of alcohol. In addition, older adults are prone to increased use of medications and medical comorbidities. As such, drinking patterns that previously would have not been considered hazardous can become dangerous without any increase in alcohol consumption. This highlights the need for age-specific screening of all older patients within all healthcare settings.
The etiology of AOD-related issues among older adults can be different from that of younger adults. For example, as a result of issues more common as one ages (e.g., loss and grief, identity crisis, and boredom), there is a distinct cohort of older adults who develop SUDs later in life despite no history of previous problematic AOD use. For some older adults who might have experimented with drugs in their youth, these age-specific issues precipitate the onset of a SUD. Meanwhile, there is a larger cohort of older adults with an extensive history of SUDs. Consequently, assessments need to be tailored to explore the issues that are unique to older adults who use AODs and can inform the development of age-specific formulations and treatment plans. In doing so, individualized treatments can be delivered to meet the needs of older adults. Such treatments must be tailored to address issues associated with aging (e.g., reduced mobility) and may require multidisciplinary input from medical practitioners and occupational therapists.
Philip Sayegh, David J. Moore, and Pariya Fazeli Wheeler
Since the first cluster of people with HIV was identified in 1981, significant biomedical advances, most notably the development of antiretroviral therapy (ART), have led to considerably increased life expectancy as well as a reduction in the morbidity and mortality associated with HIV/AIDS. As a result, HIV/AIDS is no longer considered a terminal illness, but rather a chronic illness, and many persons living with HIV/AIDS are beginning to enter or have already reached later life. In fact, Americans ages 50 years and older comprise approximately half of all individuals with HIV/AIDS and represent the most rapidly growing subpopulation of persons living with HIV/AIDS in the United States.
Despite significant advances in HIV/AIDS treatment and prognosis, older adults living with HIV (OALH) face a number of unique challenges and circumstances that can lead to exacerbated symptoms and poorer outcomes, despite demonstrating generally better ART adherence than their younger counterparts. These detrimental outcomes are due to both chronological aging and cohort effects as well as social and behavioral factors and long-term ART use. For instance, neurocognitive deficits and neuropsychiatric symptoms, including depression, anxiety, apathy, and fatigue, are often observed among OALH, which can result in feelings of loneliness, social isolation, and reduced social support. Taken together, these factors can lead to elevated levels of problems with everyday functioning (e.g., activities of daily living) among OALH. In addition, sociocultural factors such as race/ethnicity, ageism, sexism, homophobia, transphobia, geographic region, socioeconomic status and financial well-being, systemic barriers and disparities, and cultural values and beliefs play an influential role in determining outcomes.
Notwithstanding the challenges associated with living with HIV/AIDS in later life, many persons living with HIV/AIDS are aging successfully. HIV/AIDS survivor and community mobilization efforts, as well as integrated care models, have resulted in some significant improvements in overall HIV/AIDS patient care. In addition, interventions aimed at improving successful aging outcomes among OALH are being developed in an attempt to effectively reduce the psychological and physical morbidity associated with HIV disease.
Nikos Ntoumanis, Cecile Thørgersen-Ntoumani, Eleanor Quested, and Nikos Chatzisarantis
Compelling evidence worldwide suggests that the number of physically inactive individuals is high, and it is increasing. Given that lack of physical activity has been linked to a number of physical and mental health problems, identifying sustainable, cost-effective, and scalable initiatives to increase physical activity has become a priority for researchers, health practitioners, and policymakers. One way to identify such initiatives is to use knowledge derived from psychological theories of motivation and behavior change. There is a plethora of such theories and models that describe a variety of cognitive, affective, and behavioral mechanisms that can target behavior at a conscious or an unconscious level. Such theories have been applied, with varying degrees of success, to inform exercise and physical activity interventions in different life settings (e.g., schools, hospitals, and workplaces) using both traditional (e.g., face-to-face counseling and printed material) and digital technology platforms (e.g., smartphone applications and customized websites). This work has offered important insights into how to create optimal motivational conditions, both within individuals and in the social environments in which they operate, to facilitate long-term engagement in exercise and physical activity. However, we need to identify overlap and synergies across different theoretical frameworks in an effort to develop more comprehensive, and at the same time more distinct, theoretical accounts of behavior change with reference to physical activity promotion. It is also important that researchers and practitioners utilize such theories in interdisciplinary research endeavors that take into account the enabling or restrictive role of cultural norms, the built environment, and national policies on physical activity.
Nicola D. Ridgers and Samuel K. Lai
Commercially available wearable activity trackers are small, non-invasive electronic devices that are worn on the body for the purposes of monitoring a range of outcomes including steps, energy expenditure, and sleep. These devices utilize sensors to track movement, and these recorded data are provided to the user via a visual display on the device itself and/or by syncing the device with an accompanying app or web-based program. Combined together, these devices and accompanying apps incorporate a broad range of behavior change techniques that are known to change behavior, including self-monitoring, goal setting, and social support. In recent years, wearable activity trackers have become increasingly popular, and the growth in ownership within different populations has occurred at an exponential rate. This growth in appeal has led to researchers and practitioners examining the validity and reliability of wearable activity trackers for measuring a range of outcomes and integrating the results into physical activity promotion strategies. Acceptable validity has been reported for steps and moderate validity for measuring energy expenditure. However, little research has examined whether wearable activity trackers are a feasible and effective method for changing physical activity behaviors in the short- and longer-term, either alone or in combination with additional strategies. Some initial results are promising, though concerns have been raised over longer-term use and impacts on motivation for physical activity. There is a need for research examining the longer-term use of wearable activity trackers in different population groups, and establishing whether this technology has any positive effects on physical activity levels.
Thomas M. Hess, Erica L. O'Brien, and Claire M. Growney
Blood pressure is a frequently used measure in studies of adult development and aging, serving as a biomarker for health, physiological reactivity, and task engagement. Importantly, it has helped elucidate the influence of cardiovascular health on behavioral aspects of the aging process, with research demonstrating the negative effect of chronic high blood pressure on various aspects of cognitive functioning in later life. An important implication of such research is that much of what is considered part and parcel of getting older may actually be reflective of changes in health as opposed to normative aging processes. Research has also demonstrated that situational spikes in blood pressure to emotional stressors (i.e., reactivity) also have implications for health in later life. Although research is still somewhat limited, individual differences in personal traits and living circumstances have been found to moderate the strength of reactive responses, providing promise for the identification of factors that might ameliorate the effects of age-related changes in physiology that lead to normative increases in reactivity. Finally, blood pressure has also been successfully used to assess engagement levels. In this context, recent work on aging has focused on the utility of blood pressure as a reliable indicator of both (a) the costs associated with cognitive engagement and (b) the extent to which variation in these costs might predict both between-individual and age-related normative variation in participation in cognitively demanding—but potentially beneficial—activities. This chapter elaborates on these three approaches and summarizes major research findings along with methodological and interpretational issues.
Christiane A. Hoppmann, Theresa Pauly, Victoria I. Michalowski, and Urs M. Nater
Everyday salivary cortisol is a popular biomarker that is uniquely suited to address key lifespan developmental questions. Specifically, it can be used to shed light on the time-varying situational characteristics that elicit acute stress responses as individuals navigate their everyday lives across the adult lifespan (intraindividual variability). It is also well suited to identify more stable personal characteristics that shape the way that individuals appraise and approach the stressors they encounter across different life phases (interindividual differences). And it is a useful tool to disentangle the mechanisms governing the complex interplay between situational and person-level processes involving multiple systems (gain-loss dynamics). Applications of this biomarker in areas of functioning that are core to lifespan developmental research include emotional experiences, social contextual factors, and cognition. Methodological considerations need to involve careful thought regarding sampling frames, potential confounding variables, and data screening procedures that are tailored to the research question at hand.
Trent A. Petrie
Although the specific prevalence rates may vary, eating disorders (ED) affect male and female athletes regardless of sport type and competitive level. Generally, rates of subclinical disorders are much higher than clinical ones, with the most frequent clinical classification being Eating Disorders Not Otherwise Specified. Further, EDs occur not only among active athletes, but are also found in samples of retired athletes as well. Existing research on the prevalence of EDs in athletes, however, has been limited due to its reliance on out-of-date diagnostic criteria, sometimes small samples, and a focus on point prevalence to the exclusion of examining how rates might change over time. Central to prevalence research and clinical assessments is the ability to accurately assess EDs in athletes. Although structured clinical interviews represent the most valid approach, they are time consuming and not often used in determining prevalence. Researchers have relied on self-report measures instead. Such measures include those developed initially in nonathletes, but used to study athletes (e.g., Questionnaire for Eating Disorder Diagnosis; Mintz, O’Halloran, Mulholland, & Schneider, 1997), and those specifically for athletes (e.g., Athletic Milieu Direct Questionnaire; Nagel, Black, Leverenz, & Coster, 2000). Most of these measures, though having adequate psychometric properties, are based on diagnostic criteria that are no longer in use, so additional research that employs prevalence measures that reflect DSM-5 criteria is needed with athletes. Most ED research in sport has used samples of active athletes; few studies have considered how the transition out of sport might affect athletes’ perceptions of their bodies, their relationship to food, and their approaches to exercise and being physically active. Retirement from sport generally is considered to be a developmental stressor and thus may exacerbate ED symptoms and body image concerns in some athletes. Yet, for other athletes, retirement may represent a positive transition in which they emerge from a sport culture, focused on weight and appearance, to reclaim themselves and their bodies. Initial qualitative findings appear to support each hypothesis in part, though longitudinal quantitative studies that track athletes from active competition through retirement are needed to understand the changes athletes experience in relation to their bodies, food, and exercise, and when such changes are most likely to occur.
Diane M. Wiese-Bjornstal
The sociocultural aspects of sport injury and recovery include the broad landscape of social beliefs, climates, processes, cultures, institutions, and societies that surround the full chronological spectrum of sport injury outcomes, ranging from risk through to rehabilitation and retirement. A social ecological view of research on this topic demonstrates that sociocultural influences affect sport injury outcomes via interrelated sport systems extending from the intrasystem (i.e., within sports persons) through the microsystem (i.e., sport relationships), mesosystem (i.e., sport organizations), exosystem (i.e., sport governing bodies), and macrosystem (i.e., sport cultures). Affected sport injury outcomes include sport injury risks and responses during rehabilitation, return to play, and retirement from sport.
Some specific examples of sociocultural themes evident in research literature include personal conformity to the cultural expectation to play hurt, social conventions of behavior when sport injuries occur, institutional character or ethics when making return to play decisions, guidelines for the care of athletes prescribed by sport governing bodies, and the economic costs to society for sport injuries. Many elements of sport injury are affected by these sociocultural influences, such as the risk of injuries, rehabilitation processes, and career terminations. Continuing debates and discussions include advocacy for sport rule changes, bans on dangerous sports, institutional responsibility, and global sport safety efforts. These form the basis for recommendations about sociocultural interventions designed to reduce sport injury risks and optimize effective injury recoveries through social and cultural best practices.