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The role of social relations and Internet use on quality of life amongst older adults in Brazil

What factors can provide better conditions for older people? Is it possible to change the quality of life (QoL) for older people? While some perceive this time as the end stage, others point out that age itself is almost irrelevant for QoL. In our study we aimed to investigate the association of changes in social relations, such as family arrangements, paid work, use of the Internet, participation in social groups, and physical activity on QoL among older adults living in the city of Florianópolis, Santa Catarina State, Brazil, between 2009/2010 and 2013/2014.

This cross-sectional study is part of a population and home based study, called EpiFloripa Elderly Cohort Study. It was conducted with residents aged over 60 years, living in Florianópolis/SC, Southern of Brazil. The analysis consisted of multiple linear regression adjusting each variable of change in social relations and physical activity (from both waves), by demographic, socioeconomic and probable cognitive deficit, in order to estimate their effect on QoL score. The QoL was measured with CASP-16 Brazil at the second wave of data collection.

In the sample as a whole (N=1,131) the mean QoL score was 37.6 (95%CI: 37.2; 38.1), from a possible range of 0 to 48 (with 48 being the highest QoL). Older adults who remained living with their family had a lower QoL score compared to those who continued living alone. The perception of age as being related to fragility means that the older adults can still be excluded from certain activities, which contribute to their autonomy or control and are therefore important for their QoL. This may explain the lower QoL score for those who are living with family, while those who live alone may have more autonomy. Another factor can be the role often played by the family at times of illness or need, which can be stressful and provide a sense of dependence, reducing self-esteem and consequently have a negative effect on QoL.

Those older adults who started working between the waves of the study demonstrated a greater improvement in their QoL scores compared to those who remained without work. Retirement can be faced in different ways, and is a heterogeneous process. Historically, it has been associated with financial and physical decline. More recently however it has been seen as an opportunity to engage in other activities that older adults enjoy. Returning to the labor market may be consistent with the desire to remain active and feel socially important. The study shows that improved QoL can be attained through the domains of control, self-realization and pleasure. In additional, unpublished analysis revealed there was no predominance of low income among those who started working.

Regarding the use of technology, the study indicated participants who kept using the Internet showed a significant increase in their QoL score. The use of computer and Internet can contribute to well-being and generate a greater sense of capability and self-realization. It positively affects interpersonal relationships, stimulates cognitive function and contributes to the elderly’s independence.

In the EpiFloripa Study, those who had begun to participate in religious or lifestyle groups between the waves, showed improvements in their QoL scores. At this age, informal activity groups, such as education, art, music and physical activity groups, significantly contribute to better QoL. This membership may be related to socio-emotional selectivity, whereby they develop a strategy to engage primarily in activities that give them pleasure and satisfaction.

The study also reaffirms the importance of physical activity. As expected those who remained active had higher QoL scores. However, even those who were no longer active had a significantly higher QoL compared to those who remained insufficiently active.

Many important events affect the trajectory QoL in later life, and this study pointed out some changes that can improve QoL at this time of life. For this aged group QoL relates to the ability to adapt to difficulties that may arise. Some of the factors that contribute were: to encourage participation in social activities; to return to work; to use the Internet and to practice physical activity. The use of CASP-16 is recent, and further studies are required to evaluate its structural properties. It is, nonetheless, an excellent tool for population surveys, it has good psychometric properties and comparability with other countries.

 Reference

Marques, Larissa Pruner, Schneider, Ione Jayce Ceola, & d’Orsi, Eleonora. (2016). Quality of life and its association with work, the Internet, participation in groups and physical activity among the elderly from the EpiFloripa survey, Florianópolis, Santa Catarina State, Brazil. Cadernos de Saúde Pública32(12), e00143615.https://dx.doi.org/10.1590/0102-311×00143615

Guest blogger: PhD Student Larissa Pruner Marques, Federal University of Santa Catarina

Quality of life increases for older individuals who switch from organisational employment to self-employment

Policymakers advocate the promotion of business start-ups by people aged 50 or over as a means of tackling the grand challenge of population ageing. The principal societal benefit is extension of working careers: research shows that self-employed individuals tend to retire later than their employed counterparts, which generates savings in public pensions and the prolonged deployment of those individuals’ human capital in the economy. However, to date, we do not know whether taking up self-employment in late career improves ageing workers’ quality of life.

This study utilises data from the first five biennial waves (2002-2011) of the English Longitudinal Study of Ageing to examine whether switching from paid employment to self-employment affects the individual’s quality of life. The measure of quality of life is CASP-19.

We used propensity score matching to create quasi-experimental scenarios involving individuals who are very similar at the baseline (t) but who followed different career paths in the following two years (t+2). We compared individuals who switched to self-employment (‘treatment group’) with i) those who remained in their original employment and ii) those who switched to another organisational job (‘control groups’). In addition to changes in quality of life, we also examined changes in the level of income.

Our results show that on average, older workers who switch to self-employment experience a significant increase in quality of life. The increase in quality of life is also significantly greater than that experienced by individuals who switch to another organisational job. At the same time, individuals who switch to self-employment experience a significant average reduction in income.

Our further analyses suggest that switching to self-employment in late career is not about a phased withdrawal from career employment into retirement with the objective of working less. In fact, the improvement in quality of life as a result of switching to self-employment is greatest among individuals who increase their weekly working hours. Instead, our analyses point to the important role of the pursuit of self-realisation in improving quality of life through self-employment.

From a policy perspective, our findings suggest that promoting late-career switches to self-employment can be socially sustainable because older workers undertaking such transitions are, on average, better off. Hence, the promotion of late-career business start-ups can provide an attractive opportunity for societies to move from ageing models that emphasise economic inactivity and dependence on pension benefits towards active ageing models that are better suited to address the personal needs of ageing individuals.

Reference

Kautonen, Teemu, Kibler Ewald, & Minniti, Maria (2017). Late-career entrepreneurship, income and quality of life. Journal of Business Venturing, 32(3), 318-333. https://doi.org/10.1016/j.jbusvent.2017.02.005

Dr Teemu Kautonen, Aalto University School of Business

Validating the Spanish CASP-12

Current studies have shown that older people´s Quality of Life (QoL) is more associated to individual´s sense of happiness and subjective life satisfaction than to objective problems, such as physical functioning. In this regard, CASP scale conceptualizes QoL based in a psycho-sociological perspective.

Originally it consisted of 19 items grouped by four factors: control, autonomy, self-realization and pleasure. Later, Wiggins, Netuvelli, Hyde, Higgs and Blane (2008) proposed a shorter version including 12 items and three factors (control combined with autonomy, pleasure and self-realization). Regarding these discrepancies in the CASP factor structure, there was a lack of studies comparing which model works better for Spanish population.

Although life expectancy has increased in the past decades, it is also surprising that several studies using CASP scale to assess older people´s QoL have included people younger than 60 years old, such as the SHARE project, in which people aged 50 years old and over participated. The consideration of people aged 60 and over is especially important in order to assess adequately older people´s needs and resources.

Regarding the lack of studies that have validated the CASP-12 in older people exclusively, we assessed the structure of the CASP-12 SHARE version using confirmatory factor analysis (CFA) in a sample of 1,108 people aged 60 years and over from Spain. Thus, considering the contradictory hypotheses stated to date, we checked the CASP structures traditionally proposed (one-dimensional, four dimension first-order factor and second order factor model) and tested, for the first time, the three domains model proposed by Wiggins et al. (2008) with the objective of constructing a model with acceptable fit to the data that also retains the theoretical value of the scale.

We found that the three factor model showed a good overall fit: 1) pleasure, 2) self-realization and 3) autonomy and control. In contrast, the other tested models showed a lower overall fit. The three-factor model seemed to be more appropriate, suggesting the need to unite the factors control and autonomy in one domain. Since life satisfaction arises from feelings of mastery which includes aspects of control and autonomy, it is not surprising that control and autonomy belonged to the same factor. Also, an adequate internal consistency was obtained.

The study results suggest that the Spanish CASP-12 presents a factorial structure and reliability indexes similar to its original version. Thus, our study provides empirical evidence of the importance of the assessment of QoL in older people using a broader and a holistic approach that is different from the approach based on the dominant paradigm of decline in older people. Knowing that QoL acts as a significant mediator between chronic and disabling conditions and the perceived effects of burden, having QoL assessment instruments with strong psychometric support may contribute to give a better answer to older people needs.

To sum up, this is one of the first, and the largest study on the levels and psychometric properties of CASP-12 in Spain. CASP-12 is a valid and reliable tool for assessing QoL among older adults aged 60 years or older. Quality of life in later life has become a major global policy and research issue. This version of CASP is recommended to be used in future studies investigating QoL in Spanish population. This study provides Spanish-speaking countries a good scale to measure QoL in later life. Hopefully, future studies in these countries will be able to use this scale when assessing the impact of Public Health services and cross-cultural comparisons.

Posted by Gema Pérez-Rojo1, Noemy Martín2, Cristina Noriega1 and Javier López1

1 CEU San Pablo University (Madrid, Spain)

2 Francisco de Vitoria University (Madrid, Spain)

Reference

Pérez-Rojo, G., Martín, N., Noriega, C., & López, J. (2017). Psychometric properties of the CASP-12 in a Spanish older community dwelling sample. Aging & Mental Health. doi:10.1080/13607863.2017.1292208

 

CASP and the Leisure Paradox

Leisure activities have a significant impact on older adults’ quality of life. Despite the benefits of leisure, seniors face numerous constraints to leisure participation, including increased functional impairment, social isolation and lower motivation. Facing more constraints to leisure may lead to a gradual change in the significance of leisure to older adults’ quality of life. In this context, there are two contradictory hypotheses. One hypothesis implies that leisure becomes less important to quality of life with age, as seniors may become less activity-oriented and more self‑reflecting. Another hypothesis suggests that leisure becomes more important to quality of life as people age, as leisure becomes a means for keeping healthy, maintaining cognitive abilities, and preserving one’s youth, thus helping older adults cope with and resist the risks posed by the aging process.

In an attempt to assess the abovementioned contradictory hypotheses, my colleague, Prof. Galit Nimrod from Ben-Gurion University of the Negev, and I used longitudinal data from the Survey of Health, Ageing, and Retirement in Europe (SHARE). We analyzed data from close to 8,000 interviews with retired persons aged 60 years and older from 19 countries across Europe. These interviewees reported their leisure activities (e.g., doing voluntary or charity work, attending an educational or training course) and completed the frequently used measure of quality of life – CASP-12.

We found that the advantage in CASP-12 scores that highly active persons (i.e., those who participated more in leisure activities) had over non-active persons (i.e., those who participated less in leisure activities) had increased as both groups aged. In other words, leisure is not only valuable to seniors’ quality of life, but also becomes increasingly more beneficial across the later life course. Interestingly, leisure remained linked with CASP-12 even after accounting for the effects of demographics and physical and cognitive health on CASP-12. This implies that even if people become less activity-oriented with age due to various physical and personal circumstances, they can still preserve their quality of life to some extent by maintaining involvement in leisure.

Our study points to the leisure paradox in old age; that is, older adults, who may benefit from leisure involvement more than their younger peers, are precisely those who face more constraints to beneficial use of leisure. Therefore, society should explore ways to help seniors apply strategies that help them preserve a high level of leisure involvement and quality of life in spite of challenging circumstances (e.g., help them adjust leisure aspirations, improve time arrangement and encourage skill development).

Reference

Nimrod, G., & Shrira, A. (2016). The paradox of leisure in later life. Journal of Gerontology: Psychological Sciences and Social Sciences, 71, 106-111. doi: 10.1093/geronb/gbu143

Posted by Prof. Amit Shrira, Bar-Ilan University, Israel

 

CASP in the classroom

Exploring CASP-19 as a definition of quality of life in a Massive Open Online Course (MOOC)

CASP-19 is useful not only as a measure of quality of life in research, but also as an approach to defining quality of life. Quality of life is a complex and difficult concept to define, with research studies and other literature using multiple and diverse definitions. The difficulties inherent in defining quality of life are a focus of Week 2 in the upcoming Trinity EngAGE Massive Open Online Course (MOOC) – Strategies for Successful Ageing. The CASP-19 is put forward for discussion as a potential definition of quality of life at older ages.

In the MOOC, we discuss some of the challenges faced in defining quality of life. We emphasise the difficulties associated with definitions of quality of life that focus on health, particularly physical health. We draw on qualitative and quantitative evidence that shows that many people with poor health see themselves as having a good quality of life, and that as we get older physical health may become less important to our overall evaluations of our quality of life.

The CASP-19 is offered as a potential alternative definition of quality of life that is less focussed on physical health. It also includes concepts such as self-determination and purpose in life that are increasingly seen as fundamental to wellbeing. As part of the MOOC, we invite participants to discuss the CASP-19 approach to defining quality of life, and whether it fits with their own concepts of quality of life.

Definitions of quality of life are not just a technical and methodological issue. Concepts of quality of life that are overly focussed on physical health may influence our attitudes to ageing, leading to an overly pessimistic view of what life is like as we age. Definitions of quality of life that have the potential to capture the positive aspects of ageing can lead to a more positive outlook on ageing, for both individuals and society.

The Massive Open Online Course (MOOC) Strategies for Successful Ageing is now open for registration on the FutureLearn platform. This free five-week MOOC launches on the 8th of February 2016. It presents world-leading research in ageing and offers strategies to support health and well-being. The lead educator is Professor Rose Anne Kenny, Director of Mercer’s Institute for Successful Ageing and Founder of The Irish Longitudinal Study on Ageing (TILDA). She is joined by Trinity EngAGE Principal Investigators including: Professors Davis Coakley, Brian Lawlor, Ian Robertson, Des O’Neil, Virpi Timonen, Fiona Newell, Sabina Brennan, Richard Layte and Dr David Thomas.

See the course description here: https://www.futurelearn.com/courses/successful-ageing/1

TCD Online Education: https://www.tcd.ie/OnlineEducation/

Posted by Dr Eithne Sexton

Welcome

This site is designed to provide information for researchers who are interested in using the CASP measure of quality of life. CASP stands for Control, Autonomy, Self-realisation and Pleasure. It is an easy to administer, self-completion scale of either 19 or 12 questions that measures quality of life in later life. Since it was developed in 2003/4 CASP has gone on to be used in a variety of studies around the world and has been translated into several languages. It has been included in the Survey of Health, Ageing and Retirement in Europe (SHARE), the English Longitudinal Study of Ageing (ELSA), the Health and Retirement Survey (HRS), the Health, Work and Retirement (HWR) survey in New Zealand, the Irish Longitudinal Study on Ageing (TILDA) and many more. It has also been used in smaller scale studies and even Randomised Control Tests. The validity, utility and adaptability of the CASP have made it one of the most commonly used measures of quality of life in later life.