Piloting an Intervention to Promote Well-Being in Older Adults

1. Piloting an Intervention to Promote Well-Being in Older Adults A one-year translational research grant from ICTR, UW Madison

2. Community/Academic Partners University of Wisconsin-Madison Elliot Friedman, PhD Carol Ryff, PhD Kenosha County ADRC LaVerne Jaros Renee Foy Helen Sampson Debbie Rueber

3. WELL BEING • Different than absence of depression • Well Being is: • Hedonic--More positive emotions than negative ones, general satisfaction with life • Eudaimonic—Engagement in pursuits that are personally meaningful and valued

4. MEASURES OF WELL-BEING • Haedonic Measures • Happiness, joy • Depression, sadness • General satisfaction with life • Ryff Scales • Autonomy • My decisions are not usually influenced by what everyone else is doing • Environmental Mastery • I general, I feel I am in charge of the situation in which I live • Personal Growth • For me, life has been a continuous process of learning, changing, and • growth • Purpose in Life • I enjoy making plans for the future and working to make them a reality • Positive social relationships • Most people see me as loving and affectionate • Self-acceptance • When I look at the story of my life, I am pleased with how things have • turned out

5. WHY ARE WE CONCERNED ABOUT WELL-BEING? Studies have shown: • Sense of well-being is lower among older adults than younger persons • Correlations between well-being, positive health measures and longevity Nun Study Written expression of positive emotions at age 22 predicted longer life decades later Danner et al. J Personality Social Psych, 2001 Chicago Study 1,238 healthy adults in their 70s living in the community in Chicago

6. Purpose in life is protective against Alzheimer’s Disease and cognitive impairmentSame study- 7 year follow-up 90th 2.4 times as likely to remain free of Alzheimer’s Disease than 10th Boyle et al, Archives of General Psychiatry, 2010

7. WELL-BEING AND BIOLOGY • 135 older women living independently in Wisconsin • Aging women with higher well-being (purpose in life, positive relations) had: • Lower cardiovascular risk • Better neuroendocrine regulation • Lower inflammatory markers • Better sleep Philosophical Transactions of Royal Society of London, 2004

8. “…centenarians are often extroverts who embrace the world from an optimistic and carefree perspective…neuroticism was notably the exception.” ”…’the main message of the study is that [although] these centenarians have a 'nice' personality now, that was not always the case,’ opening the door to the notion that it's never too late to adopt a ‘can-do’ spirit”

9. PROMOTING WELL-BEING • Well-Being Therapy (WBT) • Based on cognitive behavioral therapy • Focus on improving awareness of positive experiences and extending their enjoyment Fava et al, Archives of General Psychiatry, 1998

10. Well-being therapy and depression Fava et al, Archives of General Psychiatry, 1998

11. Promoting Well Being Among Older Adults: Lighten UP! • 8-week program • Centered on eudaimonic well-being • 90 min class sessions-various community settings • Group discussion; brainstorming • Cognitive behavioral therapeutic perspectives on emotion • Theories of well-being • Daily homework (well-being diaries) • Evaluation • Open-ended questions about program • Questionnaires before and after program • Psychological well-being • Overall health and vitality • Depression

12. Lighten UP! • Progress 6 classes, January-June, 2012 56 participants completing 7-8 sessions • Preliminary data • Descriptive information on 49 participants • 7 men and 42 women • Average age = 73.4 (range: 60-97) • 33% married • 42% have High School degree or less • 63% live alone • Before and after data on 27 participants

13. In their own words… • “…becoming more aware of what might ‘interrupt the positive’” • “I learned that most of my bad feelings about getting old are fixable by me. My approach and outlook are paramount to getting through and enjoying the last part of me.” • “More aware of doing some things that were mundane but very important to my life.” • “I learned how to handle life’s ups and downs better through hearing others’ experiences...” • “Each day brings something of value.” • “I truly see how my diminished health has changed the way I handle my life now. I am happy that I accept the adjustments I’ve made.” • “I do things with friends more. I’m exercising more.” • “Took positive steps to control leg pain.” • “Have begun to take a broader look at my emotional reactions to things.”

14. Lighten UP!Psychological Well-Being

15. Lighten UP!Vitality How much of the time during the last 4 weeks did you have a lot of energy?

16. Lighten UP!Geriatric Depression Scale 50% decrease

17. SUCCESSES • Recruitment close to target (56/60) • High completion rates • Positive outcomes for participants • Leader manual and materials developed • Wonderful individual stories • CHALLENGES • Staffing for part time, short term project • Delay in start due to IRB approval requirements • Continued funding

18. FUTURE DIRECTIONS • Control group • To determine whether improvements are related to the program or to something more generic (e.g. social interaction) • Expand the program • More counties • Telephone- or computer-based version for home-bound seniors • Extend the measures • Biological variables • Funding to sustain program