Taiwanese Older Adults Research Articles

Effects of Group Reminiscence Therapy on Agitated Behavior and Quality of Life in Taiwanese Older Adults With Dementia.

The purpose of the current study was to evaluate short- and long-term effects of group reminiscence on agitated symptoms and quality of life (QOL) for individuals with dementia. A quasi-experimental study using a repeated-measures design was conducted in 43 residents with dementia. Participants received a 50-minute group reminiscence therapy session once per week for 10 weeks. Outcomes were measured 1 week before, 1 week after, and at 3 months postintervention. Results showed no significant difference on the overall agitated behavior of participants. However, verbally aggressive behavior decreased significantly (p = 0.025), whereas intentional falling (p = 0.025), hoarding (p = 0.021), and akathisia (p = 0.027) significantly decreased in the short term. Participation in group reminiscence therapy significantly improved QOL (p < 0.001) across time periods for individuals with dementia. The findings provide information for professional and nonprofessional caregivers of individuals with specific agitated behaviors to improve their QOL. [Journal of Psychosocial Nursing and Mental Health Services, 57(8), 30-36.].

Age-Telling in Intergenerational First-encounter Talks between College Students and Older Adults in Taiwan: A Gerontological Sociolinguistic Study

This study extends gerontological sociolinguistics by investigating how older Taiwanese adults disclosed their age and the relevant conversational sequences around their age-telling behaviours in first-encounter talks with college students. The 13-pair young-old conversational data were coded using Coupland, Coupland, Giles and Henwood’s (1991) six age-telling strategies, and 70 age-telling utterances were identified. Frequency analysis of the age-telling utterances indicated that the older participants mostly constructed their older-age identities by referring to age-related roles and to historical changes they had witnessed. Conversation analysis suggested that both of these age-telling strategies could endow older people with greater power by casting them in roles such as information-givers or proud grandparents, and ascribe positive qualities to their age group. However, the data raised concerns that age-telling conversations could also sometimes be disenfranchising and the younger interlocutors’ minimal responses to such talks were common. Wider implications of the findings for intergenerational communication are discussed in the conclusion.

Identifying Features that Enhance Older Adults’ Acceptance of Robots: A Mixed Methods Study

Background: With global aging, robots are considered a promising solution for handling the shortage of aged care and companionships. However, these technologies would serve little purpose if their intended users do not accept them. While the socioemotional selectivity theory predicts that older adults would accept robots that offer emotionally meaningful relationships, selective optimization with compensation model predicts that older adults would accept robots that compensate for their functional losses. Objective: The present study aims to understand older adults’ expectations for robots and to compare older adults’ acceptance ratings for 2 existing robots: one of them is a more human-like and more service-oriented robot and the other one is a more animal-like and more companion-oriented robot. Methods: A mixed methods study was conducted with 33 healthy, community-dwelling Taiwanese older adults (age range: 59–82 years). Participants first completed a semi-structured interview regarding their ideal robot. After receiving information about the 2 existing robots, they then completed the Unified Theory of Acceptance and Use of Technology questionnaires to report their pre-implementation acceptance of the 2 robots. Results: Interviews were transcribed for conventional content analysis with satisfactory inter-rater reliability. From the interview data, a collection of older adults’ ideal robot characteristics emerged with highlights of humanlike qualities. From the questionnaire data, respondents showed a higher level of acceptance toward the more service-oriented robot than the more companion-oriented robot in terms of attitude, perceived adaptiveness, and perceived usefulness. From the mixed methods analyses, the finding that older adults had a higher level of positive attitude towards the more service-oriented robot than the more companion-oriented robot was predicted by higher expectation or preference for robots with more service-related functions. Conclusion: This study identified older adults’ preference toward more functional and humanlike robots. Our findings provide practical suggestions for future robot designs that target the older population.

Social exclusion experienced by older adults: factors for designing healthcare settings in Taipei, Taiwan

ABSTRACTResearch has demonstrated that social exclusion can lead to negative implications on an individual’s health status. In response to the need to examine health disparities among the older adult populations, this study explores social exclusion issues faced by older Taiwanese adults as a predictive factor to healthcare. The 80-item Social Inclusion/Exclusion Scale was developed and validated with input from 327 older adults recruited from 40 social service agencies in Taiwan. Findings suggest that to improve the overall health status among older Taiwanese adults, healthcare reforms must aim to increase social inclusion levels through a better understanding of five factors at both the service provider and individual levels: 1) knowledge of service provisions, 2) depression, 3) individual autonomy, 4) types of care home, and 5) gender-sensitive practice.

Walk Score® and Its Associations with Older Adults' Health Behaviors and Outcomes.

This study aimed to investigate the associations between Walk Score® and lifestyle behaviors and health outcomes in older Taiwanese adults. A nationwide survey was conducted through telephone-based interviews with older adults (65 years and older) in Taiwan. Data on Walk Score®, lifestyle behaviors (physical activity, sedentary behavior, healthy eating behavior, alcohol use, and smoking status), health outcomes (overweight/obesity, hypertension, type 2 diabetes, and cardiovascular disease), and personal characteristics were obtained from 1052 respondents. A binary logistic regression adjusting for potential confounders was employed. None of the Walk Score® categories were related to the recommended levels of total physical activity. The categories “very walkable” and “walker’s paradise” were positively related to total sedentary time and TV viewing among older adults. No significant associations were found between Walk Score® and other lifestyle health behaviors or health outcomes. While Walk Score® was not associated with recommended levels of physical activity, it was positively related to prolonged sedentary time in the context of a non-Western country. The different associations between the walk score and health lifestyle behaviors and health outcomes in different contexts should be noted.

Mild cognitive impairment in combination with comorbid diabetes mellitus and hypertension is negatively associated with health-related quality of life among older persons in Taiwan.

To fill the gap in knowledge about associations of health-related quality of life (HRQoL) with comorbid diabetes mellitus (DM), hypertension (HTN), and/or mild cognitive impairment (MCI) in the elderly, we explored associations of comorbid DM, HTN, and/or MCI with HRQoL. Data for this study were from a population-based cross-sectional survey of elderly Taiwanese (≥ 65years old). Participants (N = 4,634; 47.9% male) were categorized into eight chronic-illness groups: DM only (n = 224); HTN only (n = 1226); DM and HTN (n = 365); MCI only (n = 497); DM and MCI (n = 58); HTN and MCI (n = 303); DM, HTN, and MCI (n = 101); and none (healthy; n = 1860). Associations were examined between the eight chronic-illness groups and HRQoL (measured by EQ-5D scores) using binary logistic regression analyses and generalized linear models adjusted for covariates. Index scores were calculated from EQ-5D scores using Taiwan's general population-preference weights. Compared to the healthy group, after adjusting covariates, MCI alone or with other comorbidities was significantly, negatively associated with HRQoL. Among all chronic-illness groups, comorbid DM, HTN, and MCI exhibited the lowest HRQoL. After adjusting covariates, between-group odds ratios for index scores were significant when comparing comorbid DM and MCI to DM only, comparing comorbid HTN and MCI to HTN only and comorbid DM, comparing HTN and MCI to comorbid DM and HTN, suggesting that MCI additively affects HRQoL. HRQoL of older Taiwanese adults was negatively associated with having MCI. Thus, clinicians managing older persons with chronic illnesses should assess their cognitive function to identify high-risk groups needing HRQoL assistance.

Dietary Patterns and Foods Associated With Cognitive Function in Taiwanese Older Adults: The Cross-sectional and Longitudinal Studies

ObjectivesTo find dietary patterns and foods associated with cognitive function. DesignA cross-sectional study of short-term effects and a prospective study for long-term effects. SettingNutrition and Health Survey in Taiwan (NAHSIT) 2014-2016 and NAHSIT 1999-2000. ParticipantsA total of 1245 older patients enrolled in the NAHSIT 2014-2016 and 1436 in the NAHSIT 1999-2000. MeasurementsDietary intake was appraised with a food-frequency questionnaire. Cognitive function was assessed by the Mini-Mental State Examination score (MMSE). ResultsUsing reduced rank regression to data-mine NAHSIT 2014-2016 cross-sectional data, we found in both genders a dietary pattern associated with high MMSE score, which was characterized by higher intakes of fresh fruits, nuts and seeds, whole grains, breakfast cereals, coffee, dairy products, seafood products, and fish. Moreover, in women, the pattern included a few additional items: tea, eggs, soybean products, and vegetables. Presence of mild cognitive impairment was inversely associated with the dietary pattern score, with declined adjusted odds ratio (95% confidence interval) from tertile 1 (as reference), tertile 2, to tertile 3 in both men [1 → 0.85(0.45-1.61) → 0.32 (0.14-0.78)] and women [1→0.44 (0.25-0.76) → 0.39 (0.20-0.75)]. Using the NAHSIT 1999-2000 as a baseline, along with 11 years of follow-up, we found with the Cox proportional hazards model that higher intake (≥4 vs <1 time/wk) of either tea or fish, but not other foods, was associated with a lower risk of developing dementia. Higher intakes of both tea and fish were associated with an even lower risk. Conclusions/ImplicationsA dietary pattern characterized by high intakes of phytonutrient-rich plant foods (fruits, whole grains, nuts/seeds, and vegetables), tea and coffee, and protein-rich foods such as eggs, dairy products, and fish, was associated with the presence of better cognitive function in older adult. Higher intakes of fish and tea combined showed a long-term protective effect. Further research is warranted to understand the long- and short-term effects of diet.

Personal and behavioral correlates of total and domain-specific sedentary behaviors in older Taiwanese adults

BackgroundEvidence of the harmful health effects of sedentary behavior is emerging; however, little is known about domain-specific sedentary behavior correlates. Thus, in this study, the personal and behavioral correlates of total and domain-specific sedentary behavior in older Taiwanese adults were identified.MethodThe sample comprised 1046 older adults (aged ≥65 years). Cross-sectional data on self-administered personal behavioral variables and time spent engaging in domain-specific sedentary behavior were obtained using computer-assisted telephone-based interviews. Binary logistic regression analyses were performed.ResultsThose aged older than 75 years were less likely to have longer total sedentary, computer use, and transportation times. Compared to women, older men were more likely to have longer total sedentary and transportation times. Older adults with low educational levels were less likely to have longer total sedentary and computer use times but were more likely to have an excessive television (TV) viewing time (≥2 h/day). Older adults who lived alone and were overweight had a longer TV viewing time. Furthermore, unemployment was associated with an excessive TV viewing time and shorter transportation time. Older adults residing in nonmetropolitan areas had lower total sedentary, TV viewing, and computer use times. Older adults who engaged in insufficient leisure time physical activity were more likely to have longer total sedentary and transportation times.ConclusionsBoth common and distinct personal and behavioral factors were associated with total and domain-specific sedentary behavior. Interventions for reducing total and domain-specific sedentary behavior should focus on both common and distinct subgroups of the Taiwanese older population.

Apolipoprotein E, cognitive function, and cognitive decline among older Taiwanese adults.

Apolipoprotein E (APOE) genotype is believed to play a role in the onset of dementia, though less is known about its relationship with non-pathogenic age-related cognitive decline. We assessed whether APOE was a risk factor for cognitive decline among older Taiwanese adults using nationally representative data. General cognition was measured longitudinally over eleven years; domain-specific cognitive assessments of working memory, declarative learning and three aspects of attention (executive function, alerting, and orientation) were performed once. Having at least one risky APOE allele was associated with more rapid longitudinal cognitive decline compared to those with no risky alleles. Some evidence from the cross-sectional analysis of domain-specific cognitive assessments suggested that APOE genotype may be more closely associated with working memory and declarative learning than with attention. Most genetic studies of cognition include only populations of European descent; extension is crucial. This study confirmed the association between APOE genotype and the rate of cognitive decline in a predominantly Han Chinese population. Additional studies on diverse populations are warranted.

Leisure time activities as mediating variables in functional disability progression: An application of parallel latent growth curve modeling.

ObjectivesThe aims of this study were to investigate (1) whether and (2) the extent to which Taiwanese older adults’ leisure time activity (LTA) trajectories mediated the potential association between their sociodemographic factors and their functional disability trajectories.MethodsLongitudinal data from four waves of the Taiwan Longitudinal Study on Aging (TLSA), collected between 1996 and 2007, were used for analysis (N = 3,429). Parallel-process latent growth curve modeling was adopted to evaluate the process by which LTA mediated between sociodemographic factors (age, gender, education, self-rated health, comorbidities, and depression) and the outcome process of functional disabilities.ResultsWhen mediated by baseline level of LTA, five sociodemographic factors—age, gender, education level, self-rated health, and number of comorbidities—had significant and negative mediating effects on baseline or change in functional disability, thus improving disability outcomes. However, four of the sociodemographic factors (age, education level, and number of comorbidities), when mediated through the rate of change in LTA, were found to have significant and positive mediating effects, which increased disability levels. The proportion of effects mediated by the LTA trajectory ranged from 0% to 194%.DiscussionThe large proportion of effects mediated through the LTA process underlines the importance of LTA to public health policy and health programs for older adults. The study’s findings shed light on how to better target populations of older adults to promote an active lifestyle and achieve more successful aging in late life in Asian countries.

Culturally-specific productive engagement and self-rated health among Taiwanese older adults

Productive aging is one of the most prominent gerontological concepts in Western societies over the past three decades. However, it is relatively unknown what types of productive engagement affect self-rated health in Asian societies. The mechanisms linking them are also not thoroughly explored. Using the representative 2017 Taichung Good Elderly Life Survey (N = 616), this study examined whether and how work-related, family-related, and community-related types of productive engagement are associated with self-rated health among older adults in Taiwan. This study first revealed the culturally-prioritized types of family-related engagement (i.e., emotional support for adult children and leisure care for grandchildren) and several types of community-related engagement were significantly and positively related to self-rated health, whereas employment, financial and instrumental types of support/grandparenting, and volunteering were not. Second, this study indicated that the previously understudied psychosocial mechanisms (i.e., resilience, sense of control, making new friends, and schedule compliance) partially accounted for the association between productive engagement and self-rated health. Findings suggest the importance of examining culturally-specific indicators of productive aging and their differential health effects in non-Western contexts.

Development of the Taiwanese version of the Health Enhancement Lifestyle Profile (HELP-T).

ObjectivesTo develop and validate a Taiwanese version of the Health Enhancement Lifestyle Profile (HELP-T) for community-dwelling older Taiwanese adults (≥ 55 years).MethodsThe original Health Enhancement Lifestyle Profile (HELP) is a 56-item self-report questionnaire measuring various aspects of health-related lifestyles in older adults. The standard cultural-adaptation procedure was used for questionnaire translation and modification. A field test was conducted for culturally specific item selection, rating-scale analysis, and psychometric validation of the HELP-T in a sample of 274 community-dwelling older adults via classical test theory.ResultsThe 59-item HELP-T is culturally adapted from the original 56-item HELP. The original 6-point rating scale was modified to a 3-point scale for easy use by Taiwanese older adults. The HELP-T had good internal consistency (Cronbach’s alpha = 0.82). The test-retest reliability for the total score was high (0.92), and moderate to high (range: 0.57–0.92) for subscales. The construct validity was supported by the significant correlations between each subscale and the total score (Spearman’s rho = 0.41–0.67, p < 0.0001) and by the ability of the scores to significantly discriminate between participants with different levels of self-rated health (p = 0.0001).ConclusionsThe HELP-T is a suitable clinical tool for assessing and monitoring lifestyle risk factors, establishing client-centered lifestyle intervention goals, and determining the outcomes of lifestyle interventions.

Dog ownership, dog walking, and leisure-time walking among Taiwanese metropolitan and nonmetropolitan older adults

BackgroundThis study examined the prevalence of dog ownership and dog walking and its association with leisure-time walking among metropolitan and nonmetropolitan older adults.MethodsA telephone-based cross-sectional survey targeting Taiwanese older adults was conducted in November 2016. Data related to dog ownership, time spent dog walking (categorized as non-dog owner, non-dog walkers, and dog walkers), and sociodemographic variables were obtained from 1074 older adults. Adjusted binary logistic regression was then performed.ResultsIn this sample, 12% of Taiwanese older adults owned a dog and 31% of them walked their dogs for an average of 232.13 min over 5.9 days/week (standard deviation = 2.03). Older adults living in nonmetropolitan areas were more likely to own a dog (14.7% vs. 9.1%) but less likely to walk their dog (25.9% vs. 39.6%) than were those living in metropolitan areas. Compared with non-dog owners, only older adults living in nonmetropolitan areas who were dog walkers achieved 150 min of leisure-time walking (odds ratio: 3.03, 95% confidence interval: 1.05–8.77), after adjustment for potential confounders.ConclusionOlder Taiwanese adults living in nonmetropolitan areas who owned and walked their dogs were more likely to achieve health-enhancing levels of leisure-time walking. Tailored physical activity interventions for promoting dog walking should be developed for older adults who are dog owners living in nonmetropolitan areas and who do not engage in dog walking.

A Systematic Review of Reminiscence Therapy for Older Adults in Taiwan.

Population aging is an increasing phenomenon in many countries around the world. It has been estimated that more than one quarter of all older adults experience a mental or neurological disorder or disease such as dementia, depression, anxiety, and substance abuse. Reminiscence is a popular treatment for enhancing well-being in older adults. Previous studies have shown that reminiscence therapy improves the cognitive functions, behaviors, and other psychosocial outcomes in older adult patients. The themes and materials that are used in reminiscence treatments for the older adults in Taiwan differ from those used in other countries because of Taiwan's unique historical background and culture. The main purpose of the current study was to review systematically the application and outcomes of reminiscence therapy in Taiwan. The terms "reminiscence," "dementia," "Alzheimer's disease," and "Taiwan" were used in an Integrated Resources Search that was conducted at National Taiwan Normal University. Sixteen articles were systematically reviewed using a synthesis of two matrices of experimental designs and intervention designs. Reminiscence group sizes ranged between 7 and 12 participants, session frequencies were all once a week for periods lasting between 4 and 16 weeks, and session durations ranged from 30 minutes to 2 hours. The memories of the participants were stimulated using materials dating from their youth such as Taiwanese folk songs, toys, photos, radio programs, newspapers, and food and drinks. In terms of research methodology, most of the studies that were reviewed used quasi-experimental designs without random assignment or control group due to sample size. A minority of the reviewed studies applied the randomized controlled treatment method. Only a few of the studies evaluated indicators in pretest, posttest, and follow-up periods. The results of these studies identified several benefits of reminiscence therapy in Taiwanese older adults, including improvements in cognitive function, anxiety, depressive symptoms, self-esteem, life satisfaction, and personal interaction. Reminiscence is a good noninvasive treatment for the prevention and treatment of mental diseases in Taiwanese older adults. Furthermore, reminiscence promotes mental health in older adults. Finally, this study provides recommendations for further study and clinical application of reminiscence therapy in Taiwan.

Holistic Healthcare for the Aged: Concepts and Strategies

Advancing medical technology continues to extend the average human life span, resulting in population aging globally as well as in Taiwan. The challenges posed by aging society increase not only medical and care costs but also the burden on pension funds and the social welfare system. In addition, there is currently a desperate need for many well-trained health providers as well as a friendly and comprehensive long-term care system. However, attention should not simply focus on medical payments and long-term care, as this may prolong the length of unhealthy living years for the aged and further strain national finances. Holistic healthcare for the aged should be introduced as early as possible in order to respond effectively to global aging by assisting the aged to maintain their health, to live independently, and to extend their social functions. The purposes of this report are to: 1. analyze the demographic characteristics of Taiwanese older adults; 2. introduce the concept of holistic healthcare as advocated by the World Health Organization (WHO); 3. discuss the promotion of physical-psychological health and the development of age-friendly environments; 4. strengthen the framework of long-term care policies; and 5. recommend the development of a holistic healthcare model for the aged based on the WHO Global Strategy and Action Plan on Aging and Health, announced in 2016. We hope to facilitate active aging, successful aging, self-esteem, and a high quality of life for the elderly in Taiwan.

Associations of Older Taiwanese Adults' Personal Attributes and Perceptions of the Neighborhood Environment Concerning Walking for Recreation and Transportation.

This study examines the cross-sectional associations between personal and perceived neighborhood environment attributes regarding walking for recreation and transportation among older Taiwanese adults. Data related to personal factors, perceived environmental factors, and time spent engaging in transportation-related and recreational walking were obtained from 1032 older adults aged 65 years and above. The data were analyzed by carrying out an adjusted binary logistic regression. After adjusting for potential confounders, two commonly perceived environmental factors, the presence of sidewalks (PS) and the presence of a destination (PD), were positively associated with 150 min of walking for recreation. Different personal and perceived environmental factors were associated with walking for recreation and transportation. These findings suggest that policy-makers and physical activity intervention designers should develop both common and individual environmental strategies in order to improve and increase awareness of the neighborhood environment to promote recreational and transportation walking behaviors among older adults.

Inflammation and Cognition in Older Adults: Evidence from Taiwan

ABSTRACTInflammation has been linked to clinical cognitive impairment, including Alzheimer’s disease. Less is known, however, about the relationship between inflammation and normal, age-associated cognitive decline. An understanding of the determinants of all types of cognitive decline is important for improving quality of life in an aging world. This study investigated whether biomarkers of inflammation were associated with cognitive function and decline in older Taiwanese adults. Data were from the Taiwan Longitudinal Study of Aging and the Social Environment and Biomarkers of Aging Study. Inflammation was measured in 2000 and 2006 as C-reactive protein, interleukin-6, soluble e-selectin, soluble intercellular adhesion molecule-1, and white blood cell count. Cognition was assessed by 10 cognitive and memory tasks, measured in 2006, 2007, and 2011. Growth curve models were used to examine the relationship between inflammation and cognitive score over this time period. Higher levels of inflammation were associated with lower baseline cognitive scores, but not with longitudinal change in cognitive score. This study did not support a causal link between inflammation and cognitive decline among this older cohort. The observed cross-sectional relationship could reflect a causal relationship that arises earlier in life, or confounding; additional research across the life course is warranted.

PROSPECTIVE RELATIONSHIP BETWEEN OBJECTIVELY ASSESSED SEDENTARY TIME AND COGNITIVE IMPAIRMENT IN LATER LIFE

There is an increasing evidence base suggesting that sedentary behavior is independent from physical activity associated with a plethora of outcomes such as cardiovascular disease, metabolic syndromes, diabetes, cancer, and mortality in aged population. However, the use of self-report measures of time spent in sedentary behaviors is a serious methodological weakness in the literature. It is still equivocal whether too much sedentary time will increase the risk of cognitive impairment in later life. This study aimed to examine whether objectively measured sedentary time is prospectively associated with cognitive impairment in older adults. This was a two-year prospective cohort study. A total of 285 community-dwelling Taiwanese older adults aged 65 or older were interviewed and assessed in 2012. A second wave of assessment was carried out in 2014 involving 274 (96.1%) participants. Time spent in sedentary behaviors was measured using waist worn triaxial accelerometer monitors (GT3X+, ActiGraph) for 7 days. The sedentary time was divided into four levels (< 8, 8–9.99, 10–11.99, 12 or more hours/day). Cognitive impairment was obtained using a Chinese version of the Ascertain Dementia 8-item Questionnaire (AD8) by participants with a potential range between 0 and 8. Multivariable negative binomial regression analyses were conducted because the AD8 score was an over-dispersed count with a highly skewed distribution. Negative binomial regression models with adjustment for baseline cognitive status, accelerometer wear time, socio-demographic variables, lifestyle behaviors, chronic disease conditions, and time spent in moderate-to-vigorous physical activity were performed (α=0.05). After adjusting for baseline cognitive status and accelerometer wear time (Model 1), participants with sedentary time ‘12 hours/day’ (Risk Ratio [RR] = 3.633, 95C%CI= 1.952–6.760, p= <0.001) and those with ‘10–11.99 hours/day’ (RR= 1.670, 95%CI=1.074–2.597, p= 0.023) possessed high risks of subsequent cognitive impairment. The association for older adults with ‘12 hours/day’ remained significant (RR= 2.067, 95%CI=1.009–4.236, p= 0.047) after further adjusting for socio-demographic variables, lifestyle behaviors, chronic conditions, and time spent in moderate-to-vigorous physical activity (Model 2). The 2-year longitudinal data analyses suggest that too much sedentary time, especially 12 hours or more per day, is associated with worse cognitive function in later life.

THE MEDIATING EFFECT OF DISABILITY TRAJECTORY ON DISABLEMENT FACTORS AND LONG-TERM CARE USE IN TAIWAN

AbstractTaiwan has a fast-aging population, and it is expected to see an associated increase in the number of older adults with disabilities. We aimed to understand whether Taiwanese older adults’ disability trajectories mediated the association between disablement process factors and later long-term care (LTC) service use. Data were from the nationally representative Taiwan Longitudinal Study on Aging Survey, 1996–2007 (N = 3,429). Trajectories of disability in activities of daily living and instrumental activities of daily living were identified by using growth mixture modeling. Structural equation modeling was applied to examine the effect of disability trajectory as mediator on disablement process factors, such as demographics, number of comorbidities, depression, and leisure activities (LAs), and on later LTC service use. Three distinct disability trajectories were identified among the group of surveyed older adults: healthy (N = 2,998, 87.43 %), progressive disability (N = 363, 10.59 %), and maintained disability (N = 68, 1.98 %). These disability trajectories, either progressive disability or maintained disability trajectory, were found to have a positive mediating effect on the association between disablement process factors (older, lower educational attainment, larger number of comorbidities, and depressive symptoms) and greater use of LTC services. However, encouraging older adults to engage in LAs reduced later use of LTC services through both total and significant mediating effect of postponing development of disability trajectory in older Taiwanese adults. These findings suggest that an active lifestyle is important for older adults’ physical health and to decrease the societal burden of LTC service use.

Comparison of personality traits and successful aging in older Taiwanese.

The present study aimed to compare the difference of personality traits and successful aging among older Taiwanese adults. The proportions of successful agers who meet the criteria for successful aging was also be proposed. A comparative descriptive study design was applied. To measure the definition of successful aging, three concepts proposed by Rowe and Kahn with five indicators were included. Demographic data were compared by the χ2 -test and Fisher's exact test across the subgroups defined by social economic status, marital status, and health habits. The comparison of personality traits and successful aging was applied by logistic regression. The results of the present study showed that the personality traits of conscientiousness, openness and emotional stability were found to be related to the dimensions of successful aging. In addition, except for the personality trait of openness, the personality traits of conscientiousness, extraversion, emotional stability and agreeableness were significantly different in the successful aging versus the non-successful aging group. The present study found the differences between personality traits and successful aging. Our study also provided essential information with regard to the differences of successful aging for older people. Geriatr Gerontol Int 2017; 17: 2239-2246.