Philadelphia Geriatric Center Morale Scale Research Articles

Scaling Down the PGCM Scale to Assess Views on Ageing More Efficiently: Finding a New Alternative.

The aim of the study is to present a new and efficient way of measuring the quality of life among older populations, with special attention to morale, positive outlook on life and ageing. The measure is based on the Philadelphia Geriatric Center Morale Scale (PGCM), originally consisting of 22 items. The growing numbers and proportions of older people among European populations has increased the need to obtain more reliable data on their needs, values, life experiences and overall quality of life. Using data from six surveys conducted in the Czech Republic, we have formulated a three-item positive outlook on life and ageing (POLA) scale. Our analyses are divided into three steps: (1) constructing the scale and testing its internal consistency; (2) testing the scale’s external validity using mean comparisons and correlation coefficients; and (3) determining the factors affecting a positive outlook on later life, such as gender and education. We have confirmed that the three-item approach to measuring positive outlook on ageing as a part of morale is highly applicable to surveys, producing compelling results in assessing important quality-of-life sub-concepts, such as subjective health, subjective age, and loneliness.

Morale in Old Age and Its Association with Sociodemographic, Social, and Health-Related Factors in Different Age Groups.

Morale can be viewed as a future-oriented optimism or pessimism regarding challenges associated with aging and is closely related to subjective well-being. Promoting morale in old age could be considered to have important implications for aging well, and increased knowledge about morale in different stages of old age is needed. Hence, the aim of this study was to investigate factors associated with morale in different age groups among old people. Data were derived from a survey conducted in 2016, as a part of the Gerontological Regional Database (GERDA). The sample consisted of 9,047 individuals aged between 65 and 86 years from Ostrobothnia and Southern Ostrobothnia in Finland, and Västerbotten in Sweden. Morale was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS) and regressed upon a number of sociodemographic, social, and health-related factors using linear regression analyses. The results showed that older age was an independent factor explaining lower level of morale. Additionally, the sociodemographic, social, and health-related variables could explain a large proportion of the variance in morale. Perceived loneliness, having gone through a crisis in life, poor self-rated health, and depression were associated with lower morale, and sleeping well with higher morale, in all age groups. Furthermore, the oldest age groups seem to be more exposed to several risk factors of lower morale identified in this study. Multidimensional interventions targeting especially social and mental health and the oldest-old could therefore be recommended.

Longitudinal Dyadic Effects of Aging Self-Perceptions on Health.

Adults' perceptions of aging are known to affect their mental and physical health. However, not much is known about how perceptions of aging within the couple-unit affect each member of the unit. Therefore, the current study explores the effects of husbands' and wives' self-perceptions of aging (SPA) on each other's physical and mental health, both directly and indirectly, through impacting each other's SPA. The study used data from the Health and Retirement Study, focusing on couples aged 50 and older. Self-rated health and Center for Epidemiological Studies Depression scale (CES-D) were used as indicators of physical and mental health. SPA was measured using the "Attitudes toward aging" subscale of the "Philadelphia Geriatric Center Morale Scale." An actor-partner interdependence mediation model was used to examine the effects of the 2008 SPA of couples on each other's 2012 SPA and 2016 health. The SPA of both husbands and wives was associated with their own future mental and physical health in 2016, but not with that of their partner. However, their SPA was associated with their partner's health indirectly, by influencing the SPA of the partner. That is, the SPA of both husbands and wives in 2008 impacted their partner's SPA in 2012, which was subsequently related to that partner's mental and physical health in 2016. Older couples can influence each other's health indirectly, by affecting each other's SPA. This indicates that adults' SPA are interconnected, and thus, the entire couple-unit should be targeted to enhance positive SPA.

Reductions in cognitive functioning are associated with decreases in satisfaction with aging. Longitudinal findings based on a nationally representative sample

ObjectiveThe objective of this study was to investigate the link between cognitive functioning and satisfaction with aging. MethodsData were drawn from a population-based sample, the German Ageing Survey (wave 5 and wave 6 with n = 6,384 in the analytical sample). The validated Philadelphia Geriatric Center Morale Scale was used to quantify satisfaction with aging. Cognitive functioning was measured using the digit symbol test. Linear fixed effects regressions were used. ResultsAdjusting for socioeconomics and various health-related covariates, regressions showed that decreases in cognitive functioning were associated with decreases in satisfaction with aging (β = .002, p = .02). Furthermore, regressions showed that decreases in satisfaction with aging were associated with increases in age (β=-.01, p < .001), decreases in physical functioning (β = .002, p < .01), worsening self-rated health (β=-.12, p < .001) and they were inversely associated with changes from employment to retirement (β = .11, p < .001). ConclusionStudy findings stress the importance of maintaining cognitive functioning for sustaining satisfaction with ageing. Strategies to postpone cognitive decline among middle-aged and older adults may contribute to aging satisfaction and ultimately to successful aging.

Self-perceptions of ageing, GP visits and frequent attendance. Longitudinal findings from the German Ageing Survey

Objectives The aim of this study was to clarify the link between self-perceptions of ageing and the number of general practitioner (GP) visits, as well as frequent GP visits, longitudinally. Methods In this study, longitudinal data with n = 7,062 observations from 2014 (wave 5) to 2017 (wave 6) were taken from the German Ageing Survey (representative sample of middle aged and older individuals residing in private households). The five-item Attitudes Toward Own Ageing subscale of the Philadelphia Geriatric Center Morale Scale (PGCMS) was used to quantify self-perceptions of ageing. The frequency of GP visits in the past 12 months served as outcome measure (first model: measured continuously; second model: top 10% were defined as frequent attenders). To exploit the features of panel data, and to mitigate the problem of unobserved heterogeneity, fixed effects regressions were used. Results Adjusting for predisposing characteristics, enabling resources and need-factors, regressions showed that an increase in self-perceptions of ageing was associated with decreases in the number of GP visits (IRR= .83 (95% CI: .77-.91)), and a decreased likelihood of becoming a frequent attender (OR= .44 (95% CI: .29-.66)). Conclusions Using data from a longitudinal study and exploiting the longitudinal data structure, the current study adds to our current knowledge by demonstrating that self-perceptions of ageing contribute to the frequency of GP visits as well as frequent attendance. Since self-perceptions of ageing are modifiable, this may help to manage health care use.

Effects of a lifestyle development program designed to reduce the risk factors for cognitive decline on the mental health of elderly individuals.

The incidence of Alzheimer's disease (AD) along with depression is high in the elderly. In the present study, a program that allows the elderly individuals to voluntarily manage and develop lifestyles that may reduce the risk factors for cognitive decline was applied to the participants to evaluate its effect on the mental health of these individuals. The participants were randomly assigned to an intervention group and a control group. The program was conducted during 7 months in the intervention group, and it had seven times of group activities, performed once a month for about 1 h, and individual activities to reduce the risk factors for cognitive decline, performed every day. To evaluate the effects of the program on the mental health of the participants, the Geriatric Depression Scale (GDS) and Philadelphia Geriatric Center Morale Scale (PGC) were used. These two scales were applied twice to the intervention and control groups. The GDS score revealed no change in the score in the intervention group before and after the 7-month program implementation; however, in the control group, the score was significantly higher after program implementation than that before. The PGC score revealed no change in the intervention group before and after 7-month program implementation; however, in the control group, the score was significantly lower after program implementation than that before. Additionally, it revealed no change in the GDS score in the depression-prone control group before and after 7-month program implementation; however, in the depression-prone intervention group, the GDS score was significantly lower after program implementation than that before. The intervention program that allows the elderly individuals to voluntarily manage and develop lifestyles that may reduce the risk factors for cognitive decline is expected to maintain mental health in elderly individuals.

Associations between occupational performance and quality of life, well-being, and instrumental activities of daily living in older adults

Abstract This study aimed to investigate the associations between occupational performance and quality of life, well-being, and instrumental activities of daily living in older Japanese adults by examining the correlations between the Canadian Occupational Performance Measure and other assessment instruments. We recruited 45 participants (≥65 years old, without dementia) from inpatient and outpatient rehabilitation services in Japan. The associations between the Canadian Occupational Performance Measure as a measure of occupational performance and satisfaction and the Medical Outcomes Study Short Form-36 as a measure of the quality of life, Philadelphia Geriatric Center Morale Scale as a measure of well-being, and Tokyo Metropolitan Institute of Gerontology Index of Competence as a measure of instrumental activities of daily living were examined using Spearman’s correlation coefficient. The Canadian Occupational Performance Measure performance and satisfaction scores showed fair correlations with the physical and mental component summary scores of the Medical Outcomes Study Short Form-36 (r = 0.35 and 0.45, respectively) but not with the role or social component summary scores. Both performance and satisfaction scores showed fair correlations with the total Philadelphia Geriatric Center Morale Scale score (r = 0.35 and 0.41, respectively), but not with the total Tokyo Metropolitan Institute of Gerontology Index of Competence score. The occupational performance showed fair correlations with quality of life and well-being but not with instrumental activities of daily living in older Japanese adults.

Social Support and Morality Among Community Dwelling Elders

Social support prevents mental and psychological distress of elderly people. Elderly individuals are revered and respected by family and friends. Many moral values elderly people can acquired through their relations with their children, friends and relatives. This study aimed to investigate the relationship between social support and morality among community dwelling elders. The study followed a descriptive correlational research design. It was conducted on 240 elders, at Damanhour and Alexandria governorate elders’ clubs. Multidimensional Scale of Perceived Social Support (MSPSS) and The Philadelphia Geriatric Center Morale Scale (PGCMS) scales were used to collect the data of this study. The results revealed that there is a significant relationship between elders perceived social support and their level of morality.It was concluded that, there is a significant relation between morals and multi-dimensions perceived social support among community dwelling elders. There is a significant relation between Sons/daughters, relative visits and having friends and multidimensional perceived social support and morality. Recommendations encompassed that increasing numbers of elders’ clubs with sufficient financial support; will permit elders to engage in club activities. Family members should respect the elders’ decisions, appreciate their personal achievements, as it will reflect that elders are still valued, wanted and useful; this will increase their feeling of satisfaction and enhance their morals. Elders must be encouraged to participate actively in the economic, political, social and cultural life of their societies. Keywords: Social support, Morality, community dwelling elders DOI : 10.7176/JHMN/70-02 Publication date: January 31 st 2020

Self-perception of aging among HIV-positive and HIV-negative participants in the Multicenter AIDS Cohort Study

ABSTRACT Self-perception of aging is an important predictor of quality of life. Therefore, we sought to examine self-perceptions of aging (age discrepancy and aging satisfaction) between HIV-positive and HIV-negative men in the Multicenter AIDS Cohort Study (MACS). We included 835 HIV-negative and 784 HIV-positive men aged 50 years and older who had completed a survey about age discrepancy and aging satisfaction from the “Attitude toward own aging” subscale of the Philadelphia Geriatric Center Morale scale. Multinomial generalized logit models were generated to assess self-perception of aging by HIV-status. Most of the participants self-identified as white, former smokers, and had completed high school. HIV-positive individuals reported higher prevalence of comorbidities than HIV-negative individuals. After adjusting for covariates, positive age discrepancy (older subjective age) was positively associated with being HIV-positive and having less than a high school education, depressive symptoms, diabetes, and medium and low aging satisfaction. Low aging satisfaction was associated with being a current and former smoker and having depressive symptoms, diabetes, and no age and positive age discrepancy. Being black had decreased odds of low aging satisfaction. These findings should inform health care professionals to promote positive views of aging in the assessment and management of HIV, depression, and diabetes.

A coaching program to improve quality of life in older people in Japan: a randomised controlled trial.

As the world's population ages, efforts to improve quality of life (QOL) in old age are gaining public attention. In this study, a programme was conducted for older people with the aim of clarifying their life goals related to QOL and the meaning of their existence, and the effect of the programme in improving QOL was evaluated. Participants were randomly assigned to the intervention or control group after registration. The program consisted of four 90-minute classes. The primary outcome was the Philadelphia Geriatric Center Morale Scale score (PGC), and changes in outcomes were compared between groups. The intervention group had significantly improved PGC scores (P<0.003). Further, the scores of PGC subscales 'Acceptance of one's own ageing' and 'Lonely dissatisfaction' showed significant improvements after the intervention (P<0.001). The findings suggest the effectiveness of the developed program in improving QOL in people aged ≥65 years.

Risk factors for a decrease in high morale in very old people over a 5-year period: data from two Nordic countries

High morale could be considered to be an essential part of aging well and increased knowledge of how to prevent a decrease in high morale in very old age could have important implications for policy, and social and health care development. The objective was to identify social and health-related risk factors for a decrease in morale over 5 years in very old people among those with high morale at baseline. The study is based on data derived from the Umeå85+/GERDA study conducted in Northern Sweden and Western Finland. The final sample consisted of 174 individuals who were 85 years and older at baseline and who had completed the follow-up 5 years later. Morale was measured with The Philadelphia Geriatric Center Morale Scale (PGCMS). A set of social and health-related variables were used to test which factors were associated with a decrease in morale over 5 years. Linear regression was used for the multivariable analyses. The sample had a mean change of − 1.3 (SD = 2.5) in PGCMS scores from T1 to T2. The results from the regression analyses showed that development of depressive disorders, increased feelings of loneliness and the death of a child during the follow-up period were associated with a decrease in morale. The results from our study indicate that preventing the development of depressive disorders and increasing loneliness are key factors in preventing a decrease in high morale. Additionally, very old people who have recently lost an adult child should receive adequate psychosocial support.

Association between subjective well-being and presence of primary care dentists in community-dwelling elderly people: A cross-sectional study.

The aim was to investigate the relationships between subjective well-being and the existence of primary care dentists in community-dwelling elderly people. Some studies have reported subjective well-being focusing on oral health, but no studies have examined the relationship between subjective well-being and primary care dentists. This cross-sectional study used data from community-dwelling elderly people aged ≥70years (n=624). The Philadelphia Geriatric Center Morale Scale (PGCMS; range=0 [low morale]-17) was used to assess subjective well-being. Additional information regarding age group, sex, medical consulting situation (ambulatory care/home care), primary care dentists, family structure, economic status, health status was collected via questionnaire. The average PGCMS score in ambulatory care patients (ACP) group who have primary care dentists was highest among community-dwelling elderly people. In a logistic regression model, a low PGCMS score (0-11) was independently correlated to 80-89 age group (OR=1.70; 95% CI, 1.13-2.54; P=0.008), ≥90 age group (OR=3.86; 95% CI, 1.83-8.18; P<0.001), unsatisfied for economic status (OR=2.68; 95% CI, 1.59-4.53; P<0.001), unsatisfied for health status (OR=3.94; 95% CI, 2.60-5.98; P<0.001) and having no primary care dentists (OR=1.81; 95% CI, 1.09-3.01; P=0.021) in ACP group. The subjective well-being of ACP who have primary care dentists was higher than in other people. Primary dentists contributed to the subjective well-being of elderly people.

Relationship between depression and social support and morale in the elderly

Context: The priority of health issues in each community changes with aging and some problems related to aging, especially morale. Many factors such as social support and depression affect morale in the elderly. Aims: Current study aimed to assess the effect of depression and social support on morale in the elderly in the City of Mashhad. Setting and Design: This is a correlational study, which was conducted in 2016. Materials and Methods: Seventy elders from Bafti and Adviy-e-Chi urban health centers in the City of Mashhad participated in this correlational study in 2016. Related data were collected using Individual Characteristic Questionnaire, Geriatric Depression Scale, Duke Social Support Scale, and Philadelphia Geriatric Center Morale Scale. Statical Analysis Used: Data analysis was done in SPSS version 16 using multiple regression tests and Pearson correlation coefficient Results: The mean age of elders was 71.0 ± 6.2 years old and 68.6 percent (n= 42) of participants were female. Multiple regression test revealed significant reverse relationship between depression and morale in the elderly (P=0.022; β= 0/705), whereas social support had a significant and direct relationship with morale in the elderly (P= 0.003; β= 0.347). Findings of Pearson correlation coefficient revealed a significant reverse correlation between depression and morale in the elderly (P= 0.031; r= 0.261) and also a direct relationship between social support and morale (P= 0.006; r= 0.389). Conclusion: Regarding the effect of depression and social support on morale in the elderly, it is recommended to adopt caring and educational programs focusing on depression prevention and augmenting social support in order to improve morale during elderly.

Oral health-related quality of life as a predictor of subjective well-being among older adults-A decade-long longitudinal cohort study.

The objective of this study was to evaluate possible longitudinal associations between oral health-related quality of life (OHRQoL) and subjective well-being among quinquagenarians and septuagenarians over up to 10years of clinical observation. This research is part of the "Interdisciplinary Study on Adult Development and Aging (ILSE)." All participants lived in an urban region of southwest Germany. One hundred and fifty-two participants born in 1930-1932 (older cohort, OC; n=54) and 1950-1952 (younger cohort, YC; n=98) underwent comprehensive psychological, medical and dental examinations at baseline and up to 10years thereafter. The Geriatric Oral Health Assessment Index (GOHAI) was used to assess OHRQoL. The Philadelphia Geriatric Center Morale Scale (PGCMS), general life satisfaction (GLS) and individuals' general satisfaction with their health (SWH) were used to evaluate subjective well-being. Regression models and structural equationmodelling (SEM) were used to analyse the longitudinal associations between OHRQoL and subjective well-being. A cross-lagged prediction model revealed a positive association between baseline OHRQoL and subjective well-being across 10years for both birth cohorts, OC [0.49 (0.21; 0.69)] and YC [0.36 (0.24; 0.52)]. However, higher subjective well-being at baseline was not a predictor of better OHRQoL 10years later for either cohort. OHRQoL seems to be a substantial predictor of subjective well-being in quinquagenarians and septuagenarians across the rather long observational period. Further studies with larger sample sizes are required to confirm this finding.

Attitude Toward Own Aging: Age Invariance and Construct Validity Across Middle-Aged, Young-Old, and Old-Old Adults

The Attitude Toward Own Aging (ATOA) Scale assesses an individual’s evaluation of their own aging, and has been widely used in the field of subjective aging literature. The present study examined whether the ATOA scale measures the same construct across middle-aged (40–60), young-old (61–74), and old-old adults (ages 75 or older) and also evaluated the construct validity of the ATOA construct in relation to measures of subjective well-being. Data drawn from the 2008 wave of the German Aging Survey (DEAS; n = 6091) were used. ATOA was assessed by the ATOA subscale of the Philadelphia Geriatric Center Morale Scale (PGCMS), and subjective well-being was assessed with the Satisfaction with Life Scale (SWLS) and the Positive and Negative Affect Scale (PANAS). Confirmatory factor analysis revealed that the model fit of the one-factor model consisting of four items fits the data well. Multi-group invariance analyses provide evidence for configural and metric invariance of the ATOA scale across the age groups, but not for scalar invariance. Additional analysis assessing construct validity indicated that the ATOA items exhibited convergent validity. The findings support the utility of the 4-item scale when examining age group differences of ATOA across a wide age range and that ATOA is distinct from measures of subjective well-being.

Development of a Measurement Scale to Evaluate Self-Care Stability for Patients Diagnosed with Type 2 Diabetes at an Older Age

Objectives: For the medical care of older adults diagnosed with type 2 diabetes later in life, it is necessary to provide medical staff support considering their life stage and to ensure that they live a stable life without fatigue. However, there is no measure for evaluating whether older diabetic patients have a stable life at the time of diagnosis. This study aimed to develop a scale to evaluate self-care stability for diabetic patients and to verify its reliability and validity. Methods: A cross-sectional study was conducted at four hospitals in Japan. A draft scale comprising 39 items was developed to identify patients’ stability of diabetes self-care in life. A total of 69 patients diagnosed with diabetes for the first time at age 60 or older responded effectively to questionnaires. Results: As a result of item analysis and factor analysis, seven factors comprising 20 items were extracted. The cumulative contribution ratio before rotation was 70.577%. Cronbach’s α was 0.700 overall. The total score on this scale and the sum of the revised Philadelphia Geriatric Center Morale Scale scores were significantly positively correlated (r = 0.379). On comparing the total scale score based on glycated hemoglobin level, the scale score of the stable group was found to be higher. Therefore, this scale was found to be reliable and valid. Conclusions: This scale may have utility in the measurement of self-care stability in patients diagnosed with type 2 diabetes later in life.

The Mediating Effects of Resilience, Morale, and Sense of Coherence Between Physical Activity and Perceived Physical/Mental Health Among Japanese Community-Dwelling Older Adults: A Cross-Sectional Study.

The aim of this study was to examine the mediating effects of resilience, morale, and sense of coherence on the relationship between physical activity and respondents' perceived physical/mental health and depression among community-dwelling older adults in Japan. The study included 369 participants with an average age of 74 years from Kasuishimohara District in Fukuoka Prefecture, Japan. They completed a survey that included the Resilience Scale, the Sense of Coherence Scale, the Medical Outcomes Short Form 8, the Philadelphia Geriatric Center Morale Scale, the Geriatric Depression Scale (Short Form), and a demographic questionnaire. The results of the path mediation analyses revealed that resilience and morale fully mediated the relationship between physical activity and perceived physical/mental health and depression. However, sense of coherence was not a significant mediator. Some intervention programs are suggested to maximize the effects of physical activity on one's well-being. At-risk populations who need such programs are also discussed.

Five-year change in morale is associated with negative life events in very old age

ABSTRACTObjectives: The objectives were to study changes in morale in individuals 85 years and older, and to assess the effect of negative life events on morale over a five-year follow-up period.Method: The present study is based on longitudinal data from the Umeå85+/GERDA-study, including individuals 85 years and older at baseline (n = 204). Morale was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS). Negative life events were assessed using an index including 13 negative life events occurring during the follow-up period. Linear regression was used for the multivariate analyses.Results: The majority of the sample (69.1%) had no significant changes in morale during the five-year follow-up. However, the accumulation of negative life events was significantly associated with a greater decrease in PGCMS. A higher baseline PGCMS score did not attenuate the adverse effect negative life events had on morale.Conclusion: Morale seemed to be mainly stable in a five-year follow-up of very old people. It seems, nonetheless, that individuals are affected by negative life events, regardless of level of morale. Preventing negative life events and supporting individuals who experience multiple negative life events could have important implications for the care of very old people.

Subjective well-being in centenarians: a comparison of Japan and the United States

ABSTRACTObjective: The present study examined the cultural differences and similarities in the levels and predictors of subjective well-being in Japanese and American centenarians.Method: We analyzed data on cognitively intact Japanese (N = 59) and American (N = 125) participants from the Tokyo and Georgia Centenarian Studies, respectively. The Philadelphia Geriatric Center Morale Scale was used to measure subjective well-being, while sociodemographic, social, and health resources were assessed as potential predictors.Results: The American participants reported higher scores on well-being (satisfaction with social relations and psychological comfort). However, cultural differences in the levels of well-being disappeared after we controlled for its predictors. The regression models revealed that health resources (cognitive function, hearing problems, and activities of daily living) were strong predictors of well-being in both countries. Social resources (living with others) were strongly associated with one dimension of well-being (attitude toward one's aging) among the Japanese participants.Discussion: The findings support the existing lifespan and cross-cultural literature, indicating that declines in health impose certain limitations on adaptive capacity in oldest-old age irrespective of cultures, and that social embeddedness is valued in Eastern cultures. The authors speculate that cultural values, i.e. personal autonomy versus relational harmony, play an important role for well-being in oldest-old age.

Arthritis, Other Medical Illnesses and Morale Among Chinese Nonagenarians and Centenarians

Summary Background Limited studies have explored the impact of arthritis, other medical illnesses on morale in the elderly. Our study is aim to assess the association between arthritis and morale among Chinese nonagenarians and centenarians. Methods This work was conducted as a cross-sectional study. The presence of arthritis, other medical illnesses was based on the subjects' report of diagnoses as told by their doctors and medical records from the investigation. The 17-item Philadelphia Geriatric Center Morale Scale (PGCMS) was used to measure morale. Low morale was defined as PGCMS score Results Our population included 650 unrelated Chinese nonagenarians and centenarians (67.3% women, mean age 93.5 years). The mean (SD) PGCMS score for the sample was 12.2 (2.9), and the prevalence of arthritis was 34%. After adjustment for potential confounders, multiple logistic regressions demonstrated that arthritis is associated with low morale among Chinese nonagenarians and centenarians (OR = 2.079, 95% CI 1.293 to 3.343). Conclusion Our study demonstrates that R1.5 arthritis may be associated with low morale among Chinese nonagenarians and centenarians.