Oldest Old

Background: Mental wellbeing is formed by our daily environments, which are, in turn, influenced by public policies, such as the welfare state. This paper looks at how different aspects of life conditions may mediate the welfare state effect on mental wellbeing in oldest old age.
Methods: Data were extracted from Round 6 of the European Social Survey (2012). The dataset comprised of 2058 people aged 80 years and older from 24 countries. Mediation analyses determined possible links between the welfare state, including eleven intervening variables representing life conditions and five mental wellbeing dimensions. Results: Our study confirms that the higher the level of welfare state, the better mental wellbeing, irrespective of dimension. Although several life conditions were found to mediate the welfare state effect on mental wellbeing, subjective general health, coping with income and place in society were the most important intervening variables.
Conclusions: All three variables centre around supporting autonomy in the oldest old age. By teasing out how the welfare state influences mental wellbeing in the oldest old, we can better understand the many drivers of wellbeing and enable evidence informed age-friendly policy making.

The " Real " Old Age and the Transition between the Third and Fourth Age. My paper focuses on the relation between chronological age and health. I understand health decline as an indicator of the transition into the fourth age. Currently the definition of the fourth age has been somewhat unclear. Some of the authors consider the fourth age as a synonym of the oldest-old and they define individuals in the fourth age based on their chronological age, mostly between 75 and 80 years. From the perspective of social gerontology, however, such a view is insufficient. Fourth-agers might be characterized especially by the loss of agency, ability to care and to make decisions about themselves. The SHARE data analysis for the Czech Republic confirmed the connection between health decline, frailty and chronological age, but it is not easy to define the exact boundary of the fourth age. Ageing is undoubtedly very individual. The frequently used boundary of 75 years seems to be unsuitable since frailty and general health decline occur more after 80 in men and women. Although the quality of life of older adults declines apparently with age, the decline is more affected by health status than chronological age. Health and quality of life are significantly influenced by the cultural and economic capital of older adults. Older adults with basic education and low income are more at risk of poorer health and lower quality of life. There are also significant gender differences. Women are more fragile, the analysis of the impact of income and education showed, however, that the relationship of gender, health and quality of life is much more complicated. To reach higher quality of life, women benefit from higher income more than men, higher education, however, brings greater benefit to men. Generally, structural factors seem to intervene in health and quality of life significantly.

People over the age of 90 years--the oldest old--are the fastest growing sector of the population. A substantial proportion of these individuals are affected by dementia, with major implications for the individual as well as society. Research on dementia in the oldest old is important for service planning, and the absence of dementia at this exceptional old age may serve as a model of successful ageing. This Review summarizes population-based epidemiological studies of dementia and its underlying neuropathology in nonagenarians and centenarians. The available data, although somewhat limited, show an age-specific and sex-specific profile of dementia status in very late life, resulting from a variety of neuropathologies that often co-occur. Extensive overlap in neuropathology between cognitively normal and cognitively impaired individuals is evident despite challenges to gathering data particular to this population. A complex picture is emerging of multiple pathogenetic mechanisms underlying dementia, and of the potential risk and protective factors for dementia that interact with genetics and lifestyle in normal and exceptional cognitive ageing.

AIM: Gaining an insight into the utilization of antihypertensive medicines against a background of evolving hypertension treatment guidelines that might not be relevant to the oldest old is important. The aim of the present study was to characterize the overall trends in the utilization of antihypertensive medicines in the oldest old by therapeutic class and chemical type, stratified by age and sex over a decade. METHODS: Antihypertensive medicines utilization was examined using the therapeutic and chemical groups based on the World Health Organization Collaborating Center for Drug Statistics Mythology's Anatomical Therapeutic Chemical classification system for all individuals aged ≥80 years. Regression and repeated cross-sectional analyses was carried out, and defined daily dose was used to describe the utilization per thousand older people per day. RESULTS: Utilization of antihypertensive medicines increased over the decade from 187.28 in 2005 to 205.01 defined daily dose per ...

Purpose
Improved life expectancy imposes new challenges for policy-makers. The growing oldest-old age group (defined as 80 and over) is often characterised by increased support needs. Greater attention to wellbeing in this population group is necessary, and may well require a shift in social policy focus. The current review seeks to explore current research on determinants of mental wellbeing for the oldest old.

Methods
An iterative rapid review approach was used to review existing literature in line with four dimensions of mental wellbeing defined by the European Welfare Models and Mental Wellbeing in Final Years of Life (EMMY) study; functional, social, personal and environmental. A specific focus on articles employing multidimensional definitions of mental wellbeing was adopted.

Results
Multidimensional indicators reflect the multifaceted and multidirectional dynamics of wellbeing in very old age. Considerable variety in both measures and terminology was found within the literature making precise comparison difficult. The current review takes steps towards comparability by focusing on studies implementing multiple measures of mental wellbeing including evaluative, hedonistic and eudaimonic factors. Clearly defined and multifaceted measures of mental wellbeing are needed to sharpen evidence used in policy development, appraisal and evaluation in light of the considerable diversity of health and functional states experienced in later life.

Conclusions
Previous studies appear to line up the four main dimensions of mental wellbeing identified in the EMMY study. Actively improving opportunities for older adults to produce benefits to society can be done via a stronger focus on resources such as mental wellbeing.

Background and Objectives:
This article addresses the representations of dementia and caregiving in the fourth age as depicted in Erica Jong’s later-life work. It shows how the experience of parental care leads to the discovery of new ways of human interaction and expressions of personhood.

Research Design and Methods:
Framed within literary-cultural age studies, the article shows how humanities-based inquiry can illuminate important aspects of aging and care of the oldest old, which are significant and revealing, but often hidden under the dark shadow of dementia.

Results:
Newly discovered ways of communication challenge the notion of the loss of agency as they demonstrate that the body itself has the power of creative and intentional capacities and self-expression.

Discussion and Implications:
Care-related narratives offer new insights into aging, dementia and subjectivity that can help pursue a better analysis of the ‘deep’ old age, strengthen collective solidary and manage increasing ageism, especially pronounced during the Covid-19 pandemic.

The oldest-old population is increasing in Europe, and greater focus is placed on promoting mental well-being (MWB) in this population. The European Welfare Models and Mental Wellbeing in Final Years of Life project aims to develop a better understanding of how best to promote positive MWB in the oldest-old population. Using a resources approach, the present study aimed to provide empirical evidence about the structure of MWB in the 80 + year age group and to compare this with the structure of MWB in the old (65–79 years) and adult (18–64 years) population. Twenty-eight items reflecting a focus on positive aspects of MWB were selected from the European Social Survey data (24 countries). After application of an exploratory approach using Exploratory Structural Equation Modelling, five- and six-factor model solutions were found to be statistically appropriate, and the results are consistent with the most widely studied dimensions of MWB. Despite specific differences in the factor mode...

The oldest-old population is increasing in Europe, and greater focus is placed on promoting mental well-being (MWB) in this population. The European Welfare Models and Mental Wellbeing in Final Years of Life project aims to develop a better understanding of how best to promote positive MWB in the oldest-old population. Using a resources approach, the present study aimed to provide empirical evidence about the structure of MWB in the 80 + year age group and to compare this with the structure of MWB in the old (65–79 years) and adult (18–64 years) population. Twenty-eight items reflecting a focus on positive aspects of MWB were selected from the European Social Survey data (24 countries). After application of an exploratory approach using Exploratory Structural Equation Modelling, five- and six-factor model solutions were found to be statistically appropriate, and the results are consistent with the most widely studied dimensions of MWB. Despite specific differences in the factor mode...