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.
Gerben J. Westerhof and Susanne Wurm
Aging is often associated with inevitable biological decline. Yet research suggests that subjective aging—the views that people have about their own age and aging—contributes to how long and healthy lives they will have. Subjective age and self-perceptions of aging are the two most studied aspects of subjective aging. Both have somewhat different theoretical origins, but they can be measured reliably. A total of 41 studies have been conducted that examined the longitudinal health effects of subjective age and self-perceptions of aging. Across a wide range of health indicators, these studies provide evidence for the longitudinal relation of subjective aging with health and longevity. Three pathways might explain this relation: physiological, behavioral, and psychological pathways. The evidence for behavioral pathways, particularly for health behaviors, is strongest, whereas only a few studies have examined physiological pathways. Studies focusing on psychological pathways have included a variety of mechanisms, ranging from control and developmental regulation to mental health. Given the increase in the number of older people worldwide, even a small positive change in subjective aging might come with a considerable societal impact in terms of health gains.
Alison Chasteen, Maria Iankilevitch, Jordana Schiralli, and Veronica Bergstrom
In 2016, Statistics Canada released the results of the most recent census. For the first time ever, the proportion of Canadians aged 65-plus years surpassed the proportion aged 15 and under. The increase in the proportion of older adults was viewed as further evidence of the faster rate of aging of Canada’s population. Such demographic shifts are not unique to Canada; many industrialized nations around the world are experiencing similar changes in their populations. Increases in the older adult population in many countries might produce beneficial outcomes by increasing the potential for intergenerational contact and exposure to exemplars of successful aging. Such positive intergenerational contact could counter prevailing age stereotypes and improve intergenerational relations. On the other hand, such increases in the number of older adults could be viewed as a strain and potential threat to resources shared with younger age groups. The possibility of increased intergenerational conflict makes it more important than ever before to understand how older adults are stereotyped, how those stereotypes can produce different kinds of biased behavior toward them, and what the impact of those stereotypes are on older adults themselves.
Social-cognitive age representations are complex and multifaceted. A common stereotype applied to older people is one of warmth but incompetence, often resulting in paternalistic prejudice toward them. However, such benevolent prejudice, characterized by warm overtones, can change to hostile bias if older adults are perceived to violate prescriptive norms about age-appropriate behavior. In addition to coping with age prejudice, older adults also have to deal with the deleterious effects of negative age stereotypes on their day-to-day function. Exposure to negative aging stereotypes can worsen older adults’ cognitive performance in a number of contexts. As well, age stereotypes can be incorporated into older adults’ own views of aging, also leading to poorer outcomes for them in a variety of domains. A number of interventions to counteract the effects of negative aging stereotypes appear promising, but more work remains to be done to reduce the impact of negative aging stereotypes on daily function in later life.
There is no doubt that exercise, a vital health-promoting activity, regardless of health status, produces numerous well-established physical, functional, and mental health benefits. Many people, however, do not adhere to medical recommendations to exercise consistently, especially if they have chronic illnesses. Put forth to explain this conundrum are numerous potential explanatory factors. Among these are mental health correlates such as anxiety, fear, fatigue, pain, motivation, and depression, as well as various self-efficacy perceptions related to exercise behaviors, which may be important factors to identify and intervene upon in the context of promoting adherence to physical activity recommendations along with efforts to reduce the cumulative health and economic burden of exercise non-adherence among the chronically ill and those at risk for chronic illnesses.