Five-year Longitudinal Study Research Articles

Five-year longitudinal study of frailty prevalence and course assessed using the Kihon Checklist among community-dwelling older adults in Japan

The aim of this study was to analyze the 5-year natural course of frailty status assessed with the Kihon Checklist (KCL) and the risk factors of transition towards frailty in community-dwelling older adults. We used the data from the postal KCL survey conducted by the municipal government between 2011 and 2016. The sample of the current study consisted of 551 older adults (265 men and 286 women) aged 65–70 years in 2011. The median KCL score increased from 2 (interquartile range 1–3) in 2011 to 3 (1–5) in 2016 (p < 0.001). Hence, the prevalence of frailty increased from 8.0 to 12.3% (p < 0.001). Regarding the 5-year transitions in frailty status, 68.3% of participants remained unchanged, while 21.4% transitioned towards a worse frailty status, and 10.3% towards an improved status. Of the 507 respondents who were robust or prefrail at the baseline, 44 experienced a transition towards frailty, indicating that the 5-year incidence of frailty was 8.7%. These 44 individuals had higher body mass indexes (BMI) and lower physical activity scores on the KCL than others (p < 0.05), the latter of which was an independent predictor of transition toward frailty in the multivariate analysis. This study was the first to evaluate the 5-year natural course of frailty status assessed using the KCL in community-dwelling elderly adults, in which the prevalence of frailty increased by 4.3%. To prevent transition towards frailty, maintaining optimal physical activity is recommended.

Predictors of generativity and satisfaction with life in a sample of women offenders

ABSTRACT This article identifies predictors of two influences on desistance from crime – generativity (caring for others) and life satisfaction. Using data from a five-year longitudinal study of 260 women on probation and parole in Michigan, the goal is to determine whether risks and needs common to women offenders are related to generativity and satisfaction with life. Predictors included average values, and changes in values over time, for a range of psychological, social network, contextual, and resource indicators of characteristics common to women offenders. Regression analyses showed that, controlling for the effects of average levels of each variable, women who increased in self-efficacy and educational strengths and those who decreased in employment/financial needs reported high generativity. Women who improved in family relationships and who decreased in economic needs also had high life satisfaction. The findings suggest that community corrections interventions designed to increase women offenders' psychological, financial, and educational resources hold promise for supporting women offenders’ general well-being and potentially their desistance. Relevant to theory, many adversities and circumstances appear to reduce the possibility of generativity and satisfaction with life.

A longitudinal study of lateral ventricle volumes in deficit and non-deficit schizophrenia

Although it is generally accepted that negative symptoms of schizophrenia are associated with larger lateral ventricles, this general assumption could not be validated in patients with primary negative symptoms. To elucidate this issue, we conducted a five-year longitudinal study, including deficit (n = 13) and non-deficit (n = 26) schizophrenia patients with healthy controls (n = 18). Analysis with linear mixed effects modeling showed that both the left and the right lateral ventricles of the deficit patients enlarged more than the non-deficit patients. Our results suggest that structural alterations in deficit patients might follow a different trajectory than those in non-deficit patients.

Cognitive outcome in children with infantile spasms using a standardized treatment protocol. A five-year longitudinal study

Aim: To evaluate the long-term developmental trajectory of children with infantile spasms (IS) and identify the clinical protective and risk factors associated with their cognitive outcome.Methods: We analyzed the five-year follow-up results of 41 children (13 female) from the previously published cohort (n = 68) recruited in a multicenter randomized controlled trial for 2-years, examining the effect of an adjunctive therapy (Flunarizine) on standardized IS treatment. The children were subsequently monitored in an open-label study for additional 3 years. The Vineland Adaptive Behavior Scale, second edition, and either the Stanford-Binet Intelligence Scale, Fifth Edition (SB5) or the Bayley Scales of Infant Development, second edition (BSID-II) were used as cognitive outcome measures.Results: Etiology was the strongest predictor of outcome. Children with no identified etiology (NIE) showed a progressive improvement of cognitive functions, mostly occurring between 2 and 5 years post-diagnosis. Conversely, symptomatic etiology was predictive of poorer cognitive outcome. Developmental delay, other seizure types (before and after IS diagnosis), and persistent electroencephalographic abnormalities following treatment were predictive of poor cognitive outcome.Interpretation: Given the 5-year cognitive improvement, children with IS should undergo a developmental assessment before school entry. Factors influencing their cognitive outcome emphasize the importance of thorough investigation and evidence-based treatment.

Risk Factors and Cognitive Deficits in First Episode Major Depression: A Five-Year Longitudinal Study of Explorative Subgroups

Mood disorders are associated with cognitive deficits, even in remission. There is heterogeneity in prevalence- and severity of such deficits, however. Risk factors like relapse, depressive symptoms, rumination, comorbidity, and family history of mental disorders, could exacerbate cognitive deficits. Longitudinal assessment of first episode depression could elucidate on how such risk factors are related to cognition.

Predictors of Recurrent High Emergency Department Use among Patients with Mental Disorders.

Few studies have examined predictors of recurrent high ED use. This study assessed predictors of recurrent high ED use over two and three consecutive years, compared with high one-year ED use. This five-year longitudinal study is based on a cohort of 3121 patients who visited one of six Quebec (Canada) ED at least three times in 2014–2015. Multinomial logistic regression was performed. Clinical, sociodemographic and service use variables were identified based on data extracted from health administrative databases for 2012–2013 to 2014–2015. Of the 3121 high ED users, 15% (n = 468) were recurrent high ED users for a two-year period and 12% (n = 364) over three years. Patients with three consecutive years of high ED use had more personality disorders, anxiety disorders, alcohol or drug related disorders, chronic physical illnesses, suicidal behaviors and violence or social issues. More resided in areas with high social deprivation, consulted frequently with psychiatrists, had more interventions in local community health service centers, more prior hospitalizations and lower continuity of medical care. Three consecutive years of high ED use may be a benchmark for identifying high users needing better ambulatory care. As most have multiple and complex health problems, higher continuity and adequacy of medical care should be prioritized.

Do personal assistance activities promote participation in society for persons with disabilities in Sweden? A five-year longitudinal study

Purpose To explore whether the personal assistance (PA) activities provided by the Swedish Act concerning Support and Service for Persons with Certain Functional Impairment in 2010 and 2015 promote participation in society according to Article 19 of the United Nations’ Convention on the Rights of Persons with Disabilities (UNCRPD). Methods Register data and data from two questionnaires were used (N = 2565). Descriptive statistics and chi-square (McNemar’s test) were used to describe the basic features of the data. Mixed binominal logistic regression was used to examine correlation between gender and hours of PA between 2010 and 2015. Results Despite an increase in the number of PA hours, more care activities and a reduction of most PA activities representing an active life were found. The result was especially evident for women, older people, and for a particular person category. Conclusions The results offer evidence of a shift to a medical model and indicate a risk of social exclusion due to fewer activities representing an active life. An increase on average of 16 h of PA over the period studied does not guarantee access to an active life and may indicate a marginal utility. The noted decline of PA for participation in society enhances the importance of monitoring content aspects to fulfil Article 19 of the UNCRPD. Implications for Rehabilitation Personal assistance (PA) in Sweden is a supportive measure for persons with disabilities; however, there are few studies to show whether PA activities are fulfilling disability rights of participation in society. The results show that PA activities are used more for medical care and home-based services over the five-year period. The study highlights the importance of monitoring aspects of content to ensure that the activities of PA comply with the policy objectives of the LSS legislation and Article 19 of the United Nations’ Convention on the Rights of Persons with Disabilities (UNCRPD), i.e., full participation in society. Monitoring efforts should include individualised planning and follow-up, moreover, ensure compliance with social service capacity at PA providers.

The Impact of Job Conditions on Health-Related Quality of Life among Working Japanese Older Adults: A Five-Year Longitudinal Study Using J-MICC Okazaki Study Data

ObjectivesThe number of older adults who continue working after retirement is increasing in Japan. Little is known about how job conditions affect older adults’ health. We examined the association between job conditions and health-related quality of life (HRQOL) during a five-year follow-up study. MethodsThis study included participants aged 65 years or older from the Japan Multi-Institutional Collaborative Cohort Study in the Okazaki area recruited at baseline between 2007 and 2011 and followed up five years later. Participants completed a self-reported questionnaire on the physical and mental health aspects of HRQOL (SF-8™), employment status, and job conditions (job satisfaction, skill use, and job suitability). ResultsData of 1,146 men and 522 women were analyzed (mean age: 69.1 and 68.6 years, respectively). Generalized mixed linear regression analysis revealed that, compared to the not-working group, skill use was positively associated with mental health aspects among men (skill use × time: β = 0.16, SE = 0.08, p < 0.05), while poor job satisfaction and job suitability were negatively associated with mental health aspects among women (job satisfaction, not satisfied × time: β = -0.93, SE = 0.47, p < 0.05; job suitability, not suitable × time: β = -1.06, SE = 0.50, p < 0.05). ConclusionsRegarding job conditions among older adults, skill use in men was marginally associated with mental health, and poor job satisfaction and suitability in women were negatively associated with mental health. Considering the job conditions of older workers is necessary to protect their mental health.

Rejection sensitivity and the development of social anxiety symptoms during adolescence: A five-year longitudinal study

Rejection sensitivity is a bias toward expecting rejection that can result from negative social experiences and degrade emotional adjustment. In this study, rejection sensitivity was expected to predict patterns of adolescent social anxiety over 5 years when considered alongside other known or expected risk and protective factors: peer rejection (peer-reported), emotion dysregulation, self-worth, temperament (parent-reported), female gender, and grade. Participants were 377 Australian students (45% boys; 79% White, 15% Asian) aged 10 to 13 years (M = 12.0, SD = .90) and their parents (84%) who completed seven repeated surveys across 5 years. In an unconditional latent growth model, social anxiety symptoms had a significant quadratic pattern of growth, with symptoms increasing about midway into the study when adolescents were age 14, on average. In a model with all predictors, rejection sensitivity was uniquely associated with a higher intercept and a more pronounced quadratic growth pattern of social anxiety symptoms. Other predictors of growth in symptoms were the temperamental trait of negativity affectivity and emotion dysregulation; negative affectivity was associated with a higher intercept and a more pronounced quadratic pattern, and emotion dysregulation was associated with a higher intercept and a less pronounced quadratic pattern. Gender was associated with the intercept, with girls higher in symptoms than boys.

Specific Activities and the Trajectories of Cognitive Decline Among Middle-Aged and Older Adults: A Five-Year Longitudinal Cohort Study

How specific activities influence cognitive decline among different age groups, especially the late middle-aged and the early old, remains inadequately studied. To examine the association between specific activities with trajectories of cognitive functions in different age groups in China. A longitudinal cohort study was conducted based on data from the China Health and Retirement Longitudinal Study (CHARLS). Mixed effects growth models were applied to analyze the association between specific activities and cognitive functions. Interacting with friends (infrequent: β= 0.13, confidence interval [CI] = 0.03 to 0.22; daily: β= 0.19, CI = 0.09 to 0.28), playing Mah-jong or other games (infrequent: β= 0.12, CI = 0.02 to 0.22; daily:β= 0.26, CI = 0.10 to 0.42), infrequent providing help to others (β= 0.24, CI = 0.11 to 0.37), and going to a sport (infrequent: β= 0.31, CI = 0.08 to 0.54); daily: β= 0.22, CI = 0.05 to 0.38) are significantly associated with participants' memory. Infrequently playing Mah-jong or other games (β= 0.30, CI = 0.17 to 0.43) and daily sports (β= 0.24, CI = 0.03 to 0.45) are significantly associated with better mental status. Effect of each activity varies among population of different age, education level, gender, and residence. This study identifies four social activities that are associated with better cognitive functions, and provides a comprehensive, in-depth understanding on the specific protective effect of each activity among different subgroups.

Early-Life Circumstances and Late-Life Loneliness: Findings From In-Depth Interviews

This case study examines loneliness from the perspective of two older men, who were interviewed three times as part of a five-year qualitative longitudinal study on loneliness in later life. Both interviewees self-identified as feeling lonely “often” or “all the time” and had experienced loneliness also in previous life phases. The interviews revealed trajectories of long-term loneliness which were impacted by life events and circumstances in early life, childhood and youth. Two critical experiences were identified: childhood bereavement and sexual abuse. These factors contributed to emotional insecurities and impacted the ways the interviewees perceived their selves and their relations with others. The acknowledgement of past life experiences is important for the theoretical and conceptual understanding of loneliness and the development of different intervention strategies. However, more longitudinal analysis is needed on the cumulative disadvantages making people vulnerable to long-term loneliness.

Palliative Care Research: Successful Recruitment and Retention Strategies of Patient-Caregiver Dyads

Research shows that the well-being of patients with serious illness and their family caregivers is significantly associated. Thus, to build the scientific knowledge upon which to establish high quality palliative and end-of-life care practices for these patients and their caregivers, research studies should include successful recruitment and retention strategies that focus on the patient-caregiver dyad. Aims: To review the literature focusing on successful dyadic recruitment and retention strategies and to describe successful recruitment and retention strategies, and attrition in a longitudinal study of end-stage liver disease (ESLD) patient-caregiver dyads. Methods: A five-year prospective longitudinal study of dyads included quantitative and qualitative data collected at 5 time points over 1 year: at baseline, 3, 6, 9, and 12 months. Results: Over a 32-month period 336 dyads were approached and 241 were enrolled. The refusal rate was 27 dyads (8.0%). Over the course of the study, 31 patients or caregivers withdrew for various reasons (too sick, liver transplantation). The attrition due to death of patients was 53 dyads (20.2%). Successful strategies used for recruitment and retention included tailoring to provider preference for referral, accommodating patient preference for data collection method, and having predictable and ongoing contact between a specific study staff and dyads. Conclusions: Less than 10 studies address recruitment and retention strategies most effective in dyadic research in various serious illnesses and clinical settings. Recruitment of ESLD patient-caregiver dyads is challenging. Future longitudinal dyadic studies of serious illnesses and palliative care may benefit from strategies learned from the current ESLD study.

Subjective Well-Being in Early Adolescence: Observations from a Five-Year Longitudinal Study

This article aims to redress the lack of longitudinal studies on adolescents’ subjective well-being (SWB) and highlight the relevance of knowledge deriving from such research in designing public policies for improving their health and wellbeing in accordance with the stage of development they are in. To achieve this, the evolution of SWB during early adolescence (in adolescents aged between 10 and 14 in the first data collection) was explored over a five year period, considering boys and girls together and separately. This involved comparing different SWB scales and contrasting results when considering the year of data collection versus the cohort (year of birth) participants belonged to. The methodology comprised a generalized linear mixed model using the INLA (Integrated Nested Laplace Approximation) estimation within a Bayesian framework. Results support the existence of a decreasing-with-age trend, which has been previously intuited in cross-sectional studies and observed in only a few longitudinal studies and contrasts with the increasing-with-age tendency observed in late adolescence. This decrease is also found to be more pronounced for girls, with relevant differences found between instruments. The decreasing-with-age trend observed when the year of data collection is taken into account is also observed when considering the cohort, but the latter provides additional information. The results obtained suggest that there is a need to continue studying the evolution of SWB in early adolescence with samples from other cultures; this, in turn, will make it possible to establish the extent to which the observed decreasing-with-age trend among early adolescents is influenced by cultural factors.

Early Antecedents of School Burnout in Upper Secondary Education: A Five-year Longitudinal Study

School burnout symptoms are prevalent among upper secondary education students, but thus far, very little is known about the background of these symptoms. The present study examined the extent to which school burnout symptoms (i.e., exhaustion and cynicism) among upper secondary education students have their roots in primary and lower secondary school and whether early antecedents of school burnout symptoms could be identified. The sample consisted of 1544 Finnish students followed up four times (Time1–Time 4) from the end of primary school (T1; mean age 12.74 and range 11.71–14.20) to the first year of upper secondary education (T4; mean age 16.66 and range 15.55–18.39). The results of latent growth curve modeling showed that school burnout symptoms in upper secondary education were predicted by the level of school burnout symptoms at the end of primary school and by an increase in these symptoms across the transition from primary school through lower secondary school. In addition, psychological well-being, academic skills, and gender were found to contribute to the prediction of school burnout symptoms. Overall, the present study suggest that potential warning signs of school burnout should not be ignored and attention should be directed to earlier education phases.

104 - Awareness of Dementia and Coping to Preserve Quality of Life: A Five-Year Longitudinal Narrative Study

AbstractBackground:Awareness of dementia is examined in different scientific fields as significant for assessment of diagnosis, and for treatment and adaptation to the disease. There are very few longitudinal studies of individual experiences of awareness among people with dementia, related to quality of life.Aim:To examine how younger people (&lt; 65 years) with dementia (YOD) express awareness of the dementia and how, over time, they seem to handle awareness as a strategy to preserve quality of life.Method:A longitudinal qualitative study with individuals with YOD was performed with interviews every six months over five years for a maximum of ten interviews. The interviews were analysed by modified grounded theory.Findings:Awareness is a complex, multidimensional concept. Awareness of dementia is predisposed by personality, life history and established coping styles. The main coping styles – live in the moment, ignore the dementia, and make the best of it – seem to be rather consistent throughout the progression of the disease. Transitions in life situation, such as moving to a nursing home, may change the individual’s awareness of dementia.Conclusion:Unawareness of dementia may have an important adaptive function to preserve quality of life. To increase awareness must be approached with reflexivity and the utmost sensitivity.

Cascading Control Changes, Incoherence, and Dialogue: Insights from a Longitudinal Case Study

Environmental shifts regularly urge organizations to adapt, which may entail management control (MC) changes. Changes to an MC element such as a performance measurement system, however, may in turn create incoherence with other, non-changed elements, generating a need for more changes, and thus trigger a cascade effect. To date, however, we know little about how this sequential process unfolds and what managers can do to deal with incoherence. This paper contributes by enhancing the understanding of sequential changes, drawing on the organizational ecology literature, and we empirically inform our research with a five-year longitudinal case study. Our data illustrates in detail how initial MC changes, intended to cope with an environmental shift, trigger a cascade effect. This sequential process results in an extensive change period, during which various incoherent MC elements coexist. Our study acknowledges that incoherence among MC elements can decrease control effectiveness by creating intra-organizational frictions, yet we highlight the role of managers in mitigating such negative effects. Specifically, we show how managers can alleviate the unfavorable effects of incoherence by changing their use of performance measures in order to better facilitate organizational dialogue, learning and problem solving.

‘My life is like a massive jigsaw with pieces missing’. How ‘lower-attaining’ children experience school in terms of their well-being

ABSTRACT ‘Lower-attaining’ children are known to encounter negative experiences in school, including experiencing feelings of upset, shame and inferiority. Using extensive interview and observation data from the first two years of a five-year longitudinal study of 23 ‘lower-attaining’ children (age 7–9), we draw on Seligman’s theory of well-being to identify the children’s experiences of school in terms of their emotions, relationships and sense of achievement. Our analysis finds that on balance, these children are experiencing threats to their well-being in relation to their perceived lack of attainment and its associated shame, in an increasingly performative educational culture. We conclude that such threats are hampering the well-being of these children, which may cause both immediate and longer-term damage.

The medical insurance system’s weakness to provide economic protection for vulnerable citizens in China: A five-year longitudinal study

ObjectivesLittle is known about the magnitude of catastrophic health expenditure (CHE) attributable to critical disease, especially in the middle-aged and elderly population. This research aimed to exploring the key aspects of how the health insurance fails to protect the middle-aged and elderly against CHE in the past five years. And propose corresponding measures to improve. MethodsData were obtained from the 2011 to 2015 China Health and Retirement Longitudinal Study. The method was adapted from WHO to calculate the catastrophic health expenditure (CHE) and impoverishment by medical expense (IME), and use Generalized Linear Mixed Models (GLMMs) to comprehensively analyze the risk factors that cause middle-aged and elderly people to fall into CHE. ResultsThe incidence of CHE of China’s middle-aged and elderly population has been rose in the five years from 2011 (10.5 %) to 2013 (17.5 %) to 2015 (19.7 %). The CHE of richest families was almost 6 times from 2011 to 2015. Urban Employee Medical Insurance Scheme, the incidence of CHE was up 10 percentage from 2011 to 2015. According to the GLMMs, families have inpatient cares as the most important factor to CHE. The incidence of CHE increased by 2.25 times compared with those who did not use inpatient services. ConclusionsThe health system needs to control the irrational growth of health expenses and reduce residents’ overuse of health services. Government should take supplementary measures to comprehensively strengthen the advantages of health insurance. Raise residents' awareness of health care, enhance citizens' physical fitness, and avoid unnecessary waste of health resources.

Five-Year Longitudinal Cohort Study Determines the Critical Intervals for Periodic Audiometric Testing Based on 5070 Tests of Workers Exposed and Non-Exposed to Noise

Background: Workers exposed to noise undergo periodic audiometric testing for early detection of hearing loss, but the optimal frequency of occupational audiometric tests remains unclear. We compared the progression of 3-, 4-, and 6-kHz thresholds over 5 years and determined the most critical period for occupational risk among workers exposed and non-exposed to noise. Methods: Metallurgy workers were divided into 2 groups: noise-exposed and non-noise-exposed groups. The 6 initial audiometric tests of each worker were analyzed as baseline test and periodic tests 1 to 5. Findings: A total of 845 workers were included, 748 in the noise-exposed group and 97 in the non-noise-exposed group, resulting in 5070 tests analyzed. The non-exposed group showed no significant difference in auditory thresholds between any of the periodic tests in either ear. In the exposed group, a significant difference was observed in auditory thresholds between baseline and Test1 (p=0.001 right ear; p=0.000 left ear), between Test3 and Test4 (p=0.002 right ear; p=0.005 left ear), and between Test4 and Test5 (p=0.003 right ear; p=0.000 left ear). There was no difference between Test1 and Test2 or between Test2 and Test3 in either ear. Interpretation: The progression of mean audiometric thresholds at 3, 4, and 6 kHz differed between workers exposed and non-exposed to noise. Noise-exposed workers had a significant progressive worsening of audiometric thresholds after 3 years of employment. Two critical periods of noise exposure were identified: in the first year and after the third year of employment in a noisy environment. Funding Statement: None. Declaration of Interests: The authors have no conflicts of interest to disclose. Ethics Approval Statement: This study was approved by the Institutional Review Board of the University of Campinas (0810.0.146.000-11).

Mixed-methods analysis of science teacher educator professional development: a five-year longitudinal study

ABSTRACT This investigation explored a learning community approach to professional development (PD) specifically catered to science teacher educators. It was designed to bolster faculty collaboration, help participants learn about new research relevant to teacher development, and share effective teaching strategies. Forty-four science teacher educators attended across five years of implementation. Data included Likert-scale and open-ended survey responses, field notes of PD observations, artefacts, and interviews. These data were analysed using a concurrent transformative mixed-methods approach with regard to PD objectives and to gain insight into participants’ perceptions about strengths and areas for improvement of the programme. Paired sample t tests measured pre- and post-PD scores as well as at a one-year-delayed post-time interval on a range of constructs (i.e. nature of science, problem-based learning, and inquiry instruction). The analysis indicated statistically significant gains across all measured constructs for post-PD scores and the majority of gains were maintained after one year. Participants perceived the PD as an important experience that affected their effectiveness as science teacher educators. Collaboration with colleagues was perceived to be an especially valuable part of the experience. Overall, the programme engaged participants as active learners, promoted collaboration, aligning with broader state science education initiatives.