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Morale in very old people: With focus on stroke, depression and survival
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.ORCID iD: 0000-0001-5050-3720
2015 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Livsgnista hos mycket gamla människor : med fokus på stroke, depression och överlevnad (Swedish)
Abstract [en]

Background: Morale is a multidimensional concept, often defined as a future-oriented optimism or pessimism regarding the problems and opportunities associated with ageing. Very old people, older than 80 years, constitute an age group that is expected to increase in Europe from 4.7% of the general population today to 12.0% in the year 2060 in Europe. The overall aim of this thesis was to explore morale among very old people.

Method: The Umeå 85+/GErontological Regional Database study (GERDA) is a population-based study carried out in parts of northern Sweden and western Finland in which every second 85 year old, every 90 year old and everyone aged 95 years and older were invited to participate. The study started the year 2000 and every five years re-invites previous participants and invites new individuals to participate in the study. The Philadelphia Geriatric Center Morale Scale (PGCMS), which is widely used to measure morale in old people, has been translated into many languages.

Results: There were 598 individuals who answered the PGCMS in the Umeå 85+/GERDA study. Despite respondents’ advanced age 92.6% (554/598) answered 16 or 17 of the questions. The construct validity of the Swedish version of the PGCMS was tested among the 493 individuals who answered all 17 questions using confirmatory factor analysis and the analysis showed a generally a good fit. Reliability tested with Cronbach’s alpha was 0.74. Reliability was also tested in a convenience sample of 54 individuals (mean age of 84.7±6.7 years) and the IntraClass Correlation coefficient (ICC) was 0.89.

Almost 20% (91/465) of participants who could answer the PGCMS had had a stroke. Those with stroke had significantly lower PGCMS scores than those without (10.9±3.8 vs 12.1±3.0, p-value 0.008), but there were 38.5% with stroke history who had high morale. A multiple linear regression analysis showed that depression, angina pectoris and impaired hearing were independently associated with low morale among those with a stroke history.

A logistic regression model showed that each point increase in PGCMS score lowered the risk of depressive disorders five years later (odds ratio 0.779, p<0.001, with each point increase in PGCMS). In a Cox model adjusted for several demographic, health- and function-related confounders, including age and gender, mortality was higher among participants with low morale (RR=1.36, p=0.032) than those with high morale. There was a similar but non-significant pattern towards increased mortality in participants with moderate morale compared to high morale (RR=1.21, p-value=0.136).

Conclusion: The feasibility and psychometric properties of the Swedish version of the PGCMS seems to be satisfactory among very old people. A large proportion of very old people have had a stroke, which is associated with reduced morale. Depression, angina pectoris and impaired hearing were independently associated with low morale among those with stroke. Among very old people, a higher level of morale seems to be associated with a lower risk of suffering from depressive disorders five years later. High morale is independently associated with increased five-year survival among very old people.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2015. , 129 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1750
Keyword [en]
Morale, aged 80 and over, Sweden and Finland, Psychometrics testing, Feasibility studies, Quality of Life, Stroke, Depressive disorders, Geriatric psychiatry, Salutogenic factor, Survival, Longevity, Future-oriented optimism
National Category
Gerontology, specializing in Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-111123ISBN: 978-91-7601-350-2OAI: oai:DiVA.org:umu-111123DiVA: diva2:867667
Public defence
2015-12-04, Sunderby sjukhus aula, Luleå, 12:00 (Swedish)
Opponent
Supervisors
Available from: 2015-11-12 Created: 2015-11-06 Last updated: 2015-12-08Bibliographically approved
List of papers
1. Psychometric properties and feasibility of the Swedish version of the Philadelphia Geriatric Center Morale Scale
Open this publication in new window or tab >>Psychometric properties and feasibility of the Swedish version of the Philadelphia Geriatric Center Morale Scale
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2015 (English)In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 24, no 11, 2795-2805 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Morale is related to psychological well-being and quality of life in older people. The Philadelphia Geriatric Center Morale Scale (PGCMS) is widely used to assess morale. The purpose of this study was to evaluate the psychometric properties and feasibility of the Swedish version of the 17-item PGCMS among very old people.

METHODS: The Umea 85+/GERDA study included Swedish-speaking people aged 85, 90 and 95 years and older, from Sweden and Finland. Participants were interviewed in their own homes using a predefined set of questions. In the main sample, 493 individuals answered all 17 PGCMS items (aged 89.0 +/- 4.3 years). Another 105 answered between 1 and 16 questions (aged 89.6 +/- 4.4 years). A convenience sample was also collected, and 54 individuals answered all 17 PGCMS items twice (aged 84.7 +/- 6.7 years). The same assessor restated the questions within 1 week.

RESULTS: Cronbach's alpha was 0.74 among those who answered all 17 questions in the main sample. Confirmatory factor analysis was used to test the construct validity of the most widely used version of the PGCMS, with 17 items and three factors, and showed a generally good fit. Among those answering between 1 and 17 PGCMS questions, 92.6 % (554/598) answered 16 or 17. The convenience sample was used for intra-rater test-retesting, and the intraclass correlation coefficient (ICC) was 0.89. The least significant change between two assessments, with 95 % confidence interval, was 3.53 PGCMS points.

CONCLUSION: The Swedish version of the PGCMS seems to have satisfactory psychometric properties and feasibility among very old people.

Keyword
Aged 80 and over, Feasibility studies, Morale, Psychological well-being, Psychometrics, Quality of life
National Category
Gerontology, specializing in Medical and Health Sciences
Research subject
Geriatrics
Identifiers
urn:nbn:se:umu:diva-111119 (URN)10.1007/s11136-015-1009-4 (DOI)000362289300024 ()26031833 (PubMedID)
Available from: 2015-11-06 Created: 2015-11-05 Last updated: 2015-11-27Bibliographically approved
2. Morale in very old people who have had a stroke
Open this publication in new window or tab >>Morale in very old people who have had a stroke
2014 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 58, no 3, 408-414 p.Article in journal (Refereed) Published
Abstract [en]

Stroke incidence increases with age and may impact on morale. The aim of this study was to investigate the prevalence of stroke among individuals aged 85 years or older in Northern Sweden and Western Finland and to evaluate factors associated with morale among those who have had a stroke compared with those without a stroke history. This population- based, cross-sectional study included 708 individuals (504 women and 204 men) aged 85 years and older (range 85-107). The study was conducted through structured interviews during home visits and from reviews of medical records, where demographic data and health-related factors were collected. The 17-item Philadelphia Geriatric Center Morale Scale (PGCMS) was used to assess morale. Stroke-prevalence was 22% (156 of 708) in the study population. Ninety-one of 465 participants who could answer PGCMS questions had had a stroke. Those with stroke had significantly lower PGCMS scores than those without (10.9 +/- 3.8 SD vs. 12.1 +/- 3.0 SD, p-value 0.008), but 38.5% had high morale. A multiple linear regression analysis showed that low morale was independently associated with depression, angina pectoris and impaired hearing among those with stroke and another multiple linear regression, among those without a stroke history, showed that low morale was independently associated with depression, pain and poor nutritional status. A large proportion of very old have had stroke which is associated with reduced morale. Low morale among those with stroke was independently associated with depression, angina pectoris and impaired hearing which could be the focus for future intervention studies. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2014
Keyword
Stroke, Morale, Aged, 80 and older, Sweden and Finland, Quality of life
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-87864 (URN)10.1016/j.archger.2013.11.009 (DOI)000332409200017 ()
Available from: 2014-04-14 Created: 2014-04-14 Last updated: 2015-11-11Bibliographically approved
3. Higher morale is associated with lower risk of depressive disorders five years later among very old people
Open this publication in new window or tab >>Higher morale is associated with lower risk of depressive disorders five years later among very old people
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(English)Manuscript (preprint) (Other academic)
Keyword
Morale, Depressive disorders, Geriatric psychiatry, Aged 80 and over, Salutogenic factor, Future-oriented optimism
National Category
Gerontology, specializing in Medical and Health Sciences
Research subject
Geriatrics
Identifiers
urn:nbn:se:umu:diva-111122 (URN)
Funder
Swedish Research Council, K2014-99X-22610-01-6Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-1512
Available from: 2015-11-06 Created: 2015-11-06 Last updated: 2015-11-11
4. High morale is associated with increased survival in the very old
Open this publication in new window or tab >>High morale is associated with increased survival in the very old
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2015 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 44, no 4, 630-636 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: high morale is defined as future-oriented optimism. Previous research suggests that a high morale independently predicts increased survival among old people, though very old people have not been specifically studied.

OBJECTIVE: to investigate whether high morale is associated with increased survival among very old people.

SUBJECTS: the Umeå 85+/GErontological Regional DAtabase-study (GERDA) recruited participants aged 85 years and older in northern Sweden and western Finland during 2000-02 and 2005-07, of whom 646 were included in this study.

METHODS: demographic, functional- and health-related data were collected in this population-based study through structured interviews and assessments carried out during home visits and from reviews of medical records. The 17-item Philadelphia Geriatric Center Morale Scale (PGCMS) was used to assess morale.

RESULTS: the 5-year survival rate was 31.9% for participants with low morale, 39.4% for moderate and 55.6% for those with high morale. In an unadjusted Cox model, the relative risk (RR) of mortality was higher among participants with low morale (RR = 1.86, P < 0.001) and moderate morale (RR = 1.59, P < 0.001) compared with participants with high morale. Similar results were found after adjustment for age and gender. In a Cox model adjusted for several demographic, health- and function-related confounders, including age and gender, mortality was higher among participants with low morale (RR = 1.36, P = 0.032) than those with high morale. There was a similar but non-significant pattern towards increased mortality in participants with moderate morale (RR = 1.21, P value = 0.136).

CONCLUSION: high morale is independently associated with increased survival among very old people.

Keyword
aged, 80 and older, longevity, morale, mortality, older people, survival
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-101437 (URN)10.1093/ageing/afv021 (DOI)000357420400018 ()25779630 (PubMedID)
Available from: 2015-03-30 Created: 2015-03-30 Last updated: 2015-11-11Bibliographically approved

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