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

Abstract

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.

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

“…Very old age is often characterized as a period of frailty and high disease-burden and is related to the transition from the third age to the fourth age [31], which in turn can place considerable constraints on the well-being of the individual [25]. In a study of Puvill et al [32], however, lower life satisfaction in those 85 years and older was mainly associated with poor mental health, in terms of depressive symptoms and loneliness, rather than poor physical health, which is similar to the results of Näsman et al [16]. Furthermore, the gap between objective health and perceived well-being seems to be widened in advanced aging, suggesting that very old individuals can express a high sense of well-being even with deteriorated health, also known as the well-being paradox [33].…”

“…Furthermore, it is also uncertain whether the associations between morale and different sociodemographic, social, and health-related variables varies in different stages of old age, and only one study on morale has so far touched upon this matter. In the study of Näsman et al [16], no interaction effects between age and the variables included were found. However, the study included only individuals aged 85 years and older, so no comparisons with younger old were made, thus warranting further exploration.…”

“…It was also consistently associated with lower morale on a statistically significant level when looking at the joint effects, indicating that loneliness has a detrimental effect on morale in all age groups. Considering that perceived loneliness also previously has been associated with a decrease in morale over time in very old age [16], interventions targeting loneliness are highly necessary. Importantly, since both social and health-related as well as sociodemographic factors can influence loneliness (e.g., [52]), the underlying causes should be examined in order to be able to provide individually adapted support.…”

“…Morale has also been associated with sociodemographic factors such as gender [13], level of education [13], income [11], and type of housing [14,15]. In a recent five-year follow-up study of very old adults, the death of one's child, depressive disorders, and perceived loneliness emerging over the follow-up period were identified as key risk factors of a decrease in morale [16].…”

Mental health symptoms, spiritual well‐being and meaning in life among older adults living in nursing homes and community dwellings

“…Unfortunately, the elderly may not be able to develop the psychosocial resources needed to restore their deteriorating mental health balance. In relation to this, a study has shown that the development of depressive disorders, feelings of loneliness and experiencing loss may lead to a decrease in morale with advanced age 13 . Furthermore, biopsychosocial changes or experiences of loss in the elderly may cause certain problems, which may prevent them from spending their remaining life in a healthy way.…”