Successful ageing in adversity: the LASER-AD longitudinal study.
BACKGROUND
Most models of successful ageing do not allow for the possibility of living "successfully," despite some degree of cognitive or physical impairment. We reviewed the successful ageing and related quality of life literature to identify their potential predictors. We then tested our hypotheses that wellbeing in adversity would be predicted by mental health (anxiety and depression) and social factors rather than physical health and that it would be stable over time.


METHODS
We interviewed 224 people with Alzheimer's disease (AD) and their family carers, recruited to be representative of those living with AD in the community. We re-interviewed 122 (73.1% of eligible) participants 18 months later. Our main outcome measure was the perception of the person with AD on their life as a whole.


RESULTS
Mean "wellbeing in adversity" scores did not change significantly over time (t = 0.23). Social relationships, subjective mental health, health perception, activities of daily living and baseline wellbeing in adversity were the significant correlates of wellbeing in adversity on univariate analysis. Only baseline wellbeing in adversity and mental health score were significant predictors in our regression analysis. In a well fitting structural equation model, less severe dementia and better health perception predicted fewer mental health problems and social relationships, but were not direct predictors of wellbeing in adversity at 18 months.


CONCLUSIONS
Successful ageing was common among a cohort of people with dementia. The most important predictors of this were mental health and social relationships, which fully mediated the relationship we found between health perception and wellbeing 18 months later.
Livingston
G
G
Department of Mental Health Sciences, University College London, Holborn Union Building, Archway Campus, Highgate Hill, London N19 5LW, UK. g.livingston@ucl.ac.uk
Cooper
C
C
Woods
J
J
Milne
A
A
Katona
C
C
D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000523:psychology*; D001007:Anxiety / Q000523:psychology; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology; D015331:Cohort Studies; D003863:Depression / Q000523:psychology; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012917:Social Adjustment; D012931:Social Environment