The Role of Morbidity for Proxy-Reported Well-Being in the Last Year of Life
The Role of Morbidity for Proxy-Reported Well-Being in the Last Year of Life
复制标题
发病率对生命最后一年代理报告的幸福感的作用
DOI：
10.1037/dev0000368
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发表时间：
2017
影响因子：
4
通讯作者：
Gerstorf
中科院分区：
文献类型：
--
作者：
Gerlach;Infurna;Wagner;Gerstorf
晚年的幸福感往往会急剧恶化，但造成这种状况的因素还不太清楚，部分原因是有关人们生命最后一年的数据很少。在这里，我们从理论角度得出并验证了与健康相关的脆弱性会破坏老年人通常用于维持健康的经验和技能（Charles, 2010）。为此，我们研究了各种发病率因素如何塑造最后一年的幸福轨迹。我们将变化评分模型应用于来自社会经济小组（N= 1,776；死亡年龄= 19-101岁；47%为女性）的回顾性代理报告，并对死者和丧亲代理的特征进行协方差分析。在不到一年的时间里，代理报告的幸福感的最终下降达到0.57 SD，在死亡前3个月与12个月的个体差异更大。据报道，健康状况不佳、需要护理、非猝死、死于癌症和不在家中死亡的人的死亡率下降幅度更大。那些在进入最后一年时保持了幸福感和认知能力的人，在最后一年的衰退幅度更大。发病率因素加起来只占不到20%的方差，这表明健康状况的下降从多方面影响了最后一年的幸福感，但这并不是一些人幸福感下降的全部原因，也不是最终原因。特定发病率因素的独特影响是适度的，这表明普遍的多发病使得特定的条件在一定程度上是可互换的。将自我报告数据扩展到通常可获得的死亡前1年，我们的研究结果表明，基于代理的结果进一步推动了我们对临终幸福感下降的理解。
Late-life well-being often shows steep deteriorations, but the contributing factors are not well understood, in part because data about people’s final year of life are scarce. Here, we draw from and test theoretical perspectives that health-related vulnerabilities undermine the experience and skills older adults typically use to maintain well-being (Charles, 2010). To do so, we examined how various morbidity factors shape final-year well-being trajectories. We applied change score models to retrospective proxy-reports from the Socio-Economic Panel (N= 1,776; age at death= 19–101 years; 47% women) and covary for characteristics of the deceased and the bereaved proxy. Terminal decline in proxy-reported well-being amounted to 0.57 SD in less than a year, with larger individual differences at 3 months versus 12 months before death. Declines were reportedly steeper for those in poor health, need of care, not dying from sudden causes of death, dying with cancer, and not dying at home. People who entered their final year with preserved well-being and cognition experienced steeper final-year decrements. Morbidity factors conjointly accounted for less than 20% of variance, indicating that health decrements shape final-year well-being in multifaceted ways, but are not the be-all and the end-all of why well-being declines for some, but not for others. Unique effects of particular morbidity factors were modest, suggesting that prevailing multimorbidity makes the particular conditions in part interchangeable. Extending self-report data typically available until 1 year before death, our findings suggest that proxy-based results move our understanding of terminal well-being decline further.