21 33 14th Sept feedback talk1

Well-being in older people a summary of the WestFocus project 14th Sept 2006: 

Well-being in older people a summary of the WestFocus project 14th Sept 2006

Slide2: 

Health The Questions Well-being? ?

Well-being is subjective: 

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

Well-being is multidimensional: 

Well-being is multidimensional Schickler, 2005 This is why we had to ask you so many questions!

Slide5: 

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 Have better cognitive health (especially memory) Well-being is not be the same as health but it can promote health Summary of multiple studies

Slide6: 

What is the mechanism by which what we feel about ourselves and our lives can affect our physical health? Is well-being all in your head?

Results: Age and Gender: 

Results: Age and Gender Age was not associated with well-being, health or life satisfaction. There were no differences between men and women in well-being, health, life satisfaction or any of the other measures. BUT there were marked gender differences in the meaning of well-being and the way well-being and other psychological variables related to health.

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Results: Well-being in Men and Women Men Women Rank order of what found to be important Vitality Positive psychological state Lack of negative psychological state Mental well-being Emotional support Spiritual wellness Vitality Physical wellness Spiritual wellness Lack of body pains Emotional support Social interactions Financial status Tangible support

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Negative and positive psychological states e.g. Negative Felt constantly under strain Felt everything getting on top of me Been losing confidence in myself Positive Been managing to keep busy and occupied Been feeling hopeful about the future Been managing as well as most people would in my shoes

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For women, but not men, good physical health was very important. For women, but not men, good tangible social support and financial status was important. For men, but not women, a positive psychological state and lack of negative psychological state was very important. In both men and women vitality and spiritual wellness was associated with high levels of well-being. Summary of correlates of Well-being

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Results: Correlates of good Physical Health Men Women Rank order of what found to be important Lack of negative psychological state Positive psychological state Mental well-being Spiritual wellness Spiritual wellness Tangible support Emotional support

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For women, but not men, reporting of good physical health was associated with good support networks (emotional and tangible). For men, but not women, good physical health was strongly associated with a positive psychological state and lack of negative psychological state. In both men and women spiritual wellness was associated with good physical health. Summary of correlates of good Physical Health

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Negative and positive psychological states e.g. Negative Felt constantly under strain Felt everything getting on top of me Been losing confidence in myself Positive Been managing to keep busy and occupied Been feeling hopeful about the future Been managing as well as most people would in my shoes

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High Positive Low Positive Low Negative High Negative 30% 35% 18% 17% Huppert and Whittington, 2003 Quadrants of positive and negative psychological state (n=6,317) Being positive, but not being less negative, predicted longevity in a 7-year follow up

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34% 26% 24% 16% Quadrants of relative positive and negative psychological state n=50 High Negative Low Negative High Positive Low Positive

Three systems link the brain with the body: 

Three systems link the brain with the body The nervous system - direct control of bodily organs by nerves The adrenal gland - secretes adrenaline The hypothalamic pituitary adrenal axis - secretes cortisol

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Threat to self esteem Lack of control Anticipation Unpredictable events Novelty Cortisol is the body’s main stress hormone Physical illness Lack of social support Cortisol

What does cortisol do?: 

What does cortisol do? Cortisol spreads throughout the body and prepares it to respond to threat by increasing blood pressure, reducing inflammation and mobilising energy stores Cortisol has potent effects on multiple organ systems BUT cortisol is much more than this

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Cortisol tells the rest of our body when it is night and day

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Cortisol has a marked daily rhythm Edwards et al., 2001 Light at dawn helps the early morning rise in cortisol. In the dark the hormone melatonin becomes dominant

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The predictable light/dark cycle Unpredictable life events or stressors Adrenal cortex Cortisol cycle Basal levels or circadian patterns Stress responses Changes in feedback regulation Frequent

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High overall levels of cortisol associated with poor physical health Stroke, depression, poor memory, high blood pressure, heart attack, allergy, diabetes, slow wound healing, osteoporosis, infections, accelerated cancer progression, accelerated HIV progression

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Deuschie et al., 1997 The circadian pattern of cortisol secretion changes with age Morning Evening Night Plasma cortisol ng/ml

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Sephton et al., 2000 Two groups of breast cancer patients -distinguished by their cortisol cycles

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The cortisol cycles predicted survival

Slide27: 

The cortisol diurnal pattern on 2 consecutive days No difference between day 1 and day 2

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The mean cortisol diurnal pattern of males and females F=4.82; df=2.89, 138.49; p<0.004

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Mean waking vs. mean rest of day in relation to gender Females fall more than males: p<0.005 * Males greater than females p<0.05

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Mean cortisol profiles in relation to the 2 largest quadrants

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Mean cortisol profiles for high positive but high and low negative

Conclusions: 

Conclusions Although no differences were found in levels of well-being between men and women there were clear gender differences in what was important for well-being, health and life satisfaction. Cortisol secretion was higher than in a younger group – but showed the same dynamic pattern. There were gender differences in cortisol secretion over the day. The cortisol cycle was associated with psychological state in both men and women, but not with health – possible early marker? Positive psychological state alone was not associated with lower cortisol levels - it had to be accompanied by a lack of a negative psychological state.

Implications: 

Implications In future it will be important to take account of gender when exploring well-being. Need for gender-specific packages of support? It is not enough to decrease negative state (fire-fighting) it is also important to actively promote positive psychological well-being. Cortisol sensitive to differences in psychological state, even within this very high functioning group, therefore provides a useful pre-clinical marker or early warning sign.

What next?: 

What next? Further analysis of the data. Evaluation of a range of interventions designed to actively promote dimensions of well-being (as well as relieve distress). Promote the availability of more widespread strategies to improve well-being and life satisfaction in older Also, if you are willing we would very much like to stay in contact with you over the next couple of years.

Slide35: 

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

How to contact us: 

How to contact us Professor Angela Clow clowa@wmin.ac.uk Denise Forte dforte@hscs.sgul.ac.uk Participating Institutions: Kingston University, Westminster University, Royal Holloway University of London