Gerlach Katharina, Ram Nilam, Infurna Frank J, Vogel Nina, Wagner Gert G, Gerstorf Denis
Department of Psychology, Humboldt University Berlin.
Department of Human Development and Family Studies, Pennsylvania State University.
Dev Psychol. 2017 Sep;53(9):1795-1809. doi: 10.1037/dev0000368. Epub 2017 Jun 26.
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. (PsycINFO Database Record
晚年的幸福感往往会急剧下降，但其中的影响因素尚未得到充分理解，部分原因是关于人们生命最后一年的数据稀缺。在此，我们借鉴并检验了理论观点，即与健康相关的脆弱性会破坏老年人通常用来维持幸福感的体验和技能（查尔斯，2010年）。为此，我们研究了各种发病因素如何塑造生命最后一年的幸福感轨迹。我们将变化分数模型应用于社会经济面板的回顾性代理报告（N = 1776；死亡年龄 = 19 - 101岁；47%为女性），并对死者和丧亲代理的特征进行了协变量分析。代理报告的幸福感在不到一年的时间里下降了0.57个标准差，在死亡前3个月与12个月相比个体差异更大。据报道，健康状况不佳、需要护理、非死于突发死因、死于癌症以及非在家中死亡的人的幸福感下降更为明显。进入生命最后一年时幸福感和认知功能良好的人，在最后一年的幸福感下降更为急剧。发病因素共同解释的方差不到20%，这表明健康状况下降以多方面的方式塑造了生命最后一年的幸福感，但并非是一些人幸福感下降而另一些人没有下降的全部原因。特定发病因素的独特影响较小，这表明普遍存在的多种疾病使得特定情况在一定程度上具有可互换性。我们的研究结果扩展了通常可获得的直至死亡前1年的自我报告数据，表明基于代理报告的结果使我们对临终幸福感下降的理解更进一步。（PsycINFO数据库记录）
