Reflections ~ A Life Assessment Program (How to Die with a Smile on your Face)

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I became more captured by him the more he tilted. At one point, talking to the end, he fell over to his left sprawling straight out on the floor. I immediately jumped up and rushed to the podium; the other hundred or so students were taken by surprise holding their pens as if waiting for the last word. Here I was, this foreigner, somewhat mute, taking charge. I had reacted immediately because I was somewhat prepared for some event to happen. The Jesuit community resided in an adjacent building connected to the building where a Jesuit Professor now lay dead on the floor.

After announcing to the class that our professor had died I went to the office of the Superior of the Jesuit community to tell him of the demise of our teacher. The challenge is to be able to concentrate on the business at hand but also be sensitive to what very significantly is happening to people. Another reflection: Over the years I have not been kind in my judgement of the Jesuit Superior.

How can a man in authority respond so callously to the news that a member of the community had just died by saying he was too busy? After these many years, though, I am kinder in my assessment.

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I have no idea what problems he had faced previous to my intrusion that morning. Maybe the Jesuit I met leaving his office before me had presented some very horrifying news. So, even in extreme circumstances, I am challenged to be aware of the limitations of how humans are capable of reacting. Scaffold theme by Mike Harding. Reflections from Fr. Telephone interviews are used in rich countries, and face to face interviews elsewhere; Gallup pre-tested its questions for lack of mode bias, and even if this cannot be entirely excluded, it should not affect the age patterns within countries, though the institutionalized and disabled elderly populations will be largely missed in the telephone surveys.

The surveys are conducted once a year, lasting two to four weeks, and the majority of countries have been covered every year. Here, we use the data from to to examine patterns of wellbeing with age in different regions of the world; we look at regions because examining results country by country is unwieldy, but note that this means that the sample sizes are different for each region, roughly proportional to the number of countries in each. The U-shaped pattern of life evaluation with age, with the elderly having the highest life evaluation, is most strongly evident in the rich, English speaking world, while in some other regions of the world — most notably the Middle East, the countries of the former Soviet Union, and sub-Saharan Africa — life evaluation declines steadily with age, at least in the period While the latter are diverse in their political and health experiences during the transition in social organisation following the collapse of communism, they have the transition itself in common, and serve to illustrate the diversity of aging experience around the world.

So for all the hedonic experiences, higher values are worse. In the transition countries, life evaluations were lower overall than in the Anglo countries, and the elderly do particularly badly, the opposite of the Anglo countries. Not being happy, which is uncommon in the Anglo countries, is quite common in the transition countries, particularly so among the elderly, where nearly 70 percent of those aged 65 and above did not experience happiness in the previous day. Worry increases with age in the transition countries, and decreases in the Anglo countries. The Cantril ladder ranges from 0 worst possible life to 10 best possible life , and the graph shows the average.

Those aged 76 and above are excluded. There are 13, observations for happiness, and a little less than 25, for the other measures. Sample size is approximately proportional to the number of countries in the region. Happiness measures were not collected in all waves. There are 63, observations for happiness, and around , for the other measures.

See also notes to Figure 1. These features undoubtedly reflect the recent experiences of the region cohort effects , and the distress these events have brought to the elderly, who have lost a system that, however imperfect, gave meaning to their lives, as well as, in some cases, their pensions and their healthcare.

The results and patterns elsewhere testify to the lack of globally universal age patterns.

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In sub-Saharan Africa, Figure 3 , life evaluation is extremely low at all ages a reflection of the strong positive cross-country relationship between life evaluation and income 19 but there is little or no variation with age. The prevalence of worry, stress, and unhappiness all rise mildly with age.

The much richer region of Latin America and the Caribbean, Figure 4 , is different yet again, with life evaluation falling with age— though not as sharply as in the Eastern European countries—while worry and stress peak in middle age, though the age-profile is not as marked as elsewhere.

Even so, the Cantril ladder measures of overall life evaluation are almost identical for men and women, another indication of the importance of distinguishing different aspects of wellbeing. A strength of these new results is that they use identical questions on different aspects of subjective wellbeing for random samples for a large number of countries.

One possible weakness compared with earlier results 12 , 14 , 20 —with which they are only partially consistent—is the lack of a time dimension, which cannot be realistically explored with only four years of data. There are , observations in all, with country sample sizes ranging from nearly 7, Mauretania to 1, for six countries. There are 96, observations in all, with country sample sizes ranging from over 5, to There are many remaining challenges in understanding the patterns of age and wellbeing around the world.

A fundamental problem for this research area is obtaining funding for the continuation of worldwide polls, and this should not be underestimated, especially in fiscally difficult times. Concerns have been voiced regarding potential methodological problems including ensuring comparability in the sampling techniques and standardizing the interpretation of questions and response scales across countries. Finally, there is work to be done on understanding the reasons for the observed age patterns. Current theories are not yet adequately accounting for the age patterns and country differences.

In spite of these and other challenges, we believe that over the last decade there has been significant progress in documenting age differences in self-reported wellbeing.

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The notion that impaired psychological wellbeing is associated with increased risk of physical illness is not new, since there is an established research literature linking depression and life stress with premature mortality, coronary heart disease CHD , diabetes, disability and other chronic conditions. There is also the issue of publication bias, with evidence that studies showing a favourable impact of wellbeing on health are more likely to appear in print.

However, stronger evidence is beginning to emerge, using both retrospective questionnaire assessments of eudemonic wellbeing and momentary hedonic measures taken repeatedly over the day. Eudemonic wellbeing was assessed with items from a standard questionnaire assessing autonomy, sense of control, purpose in life, and self-realisation see online supplement. The cohort was divided into quartiles of wellbeing, and Cox proportional hazards regression was applied.

The proportion of deaths was The regression analyses document the graded association between eudemonic wellbeing and survival Table 1.

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Other independent predictors of mortality in the final model were older age, being male, less wealth, being unmarried, not being in paid employment, a diagnosis at baseline of cancer, coronary heart disease, diabetes, heart failure, chronic lung disease and stroke, reporting a limiting longstanding illness, smoking and physical inactivity see supplementary Table 1 for the full model 5. Figure 5 shows a Kaplan-Meier plot of survival in relation to baseline eudemonic wellbeing in the fully adjusted model.

Survival in months from baseline is modelled after adjustment for age, gender, demographic factors, baseline health indicators, history of depressive illness and depression symptoms, and baseline health behaviours. Reference group is lowest eudemonic well-being group.

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These results do not unequivocally demonstrate that eudemonic wellbeing is causally linked with mortality. There is a danger in overstating the evidence for a causal link, since people may feel that they are to blame for not seeing the meaning in life or perceiving greater control in the face of serious illness. But the findings do raise intriguing possibilities about positive wellbeing being involved in reduced risk to health. They also raise the question of whether wellbeing-selective mortality can help explain the age patterns of wellbeing in the previous section.

The US life table for shows a decadal mortality rate of If all this mortality came from those with the lowest life evaluation—which is the maximum possible effect—the average ladder rating would have risen from 6. Of course, we do not know the ladder scores of either survivors or decedents, but this calculation suggests that effects of selective mortality might be big enough to play a role. Against this, however, is the fact that mortality rates from age 60 are higher in Latin America and sub-Saharan Africa than in the rich English speaking countries, which would lead to a stronger U, not the complete absence that we observe.

Progress is also being made in understanding the behavioural and biological correlates of positive psychological wellbeing. Among lifestyle factors, physical activity is probably the most important link between psychological wellbeing and health. Regular physical activity at older ages is already recommended for the maintenance of cardiovascular health, muscle strength and flexibility, glucose metabolism, and healthy body weight, and is also consistently correlated with wellbeing. Positive affect has been related to reduced inflammatory and cardiovascular responses to acute mental stress, and is associated with lower levels of inflammatory markers such as C-reactive protein and interleukin 6 in older women, and with higher levels of the steroid hormone dehydroepiandosterone sulfate.

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Clinical and community studies show that a wide range of medical conditions are associated with raised levels of depression, including illnesses that are prevalent at older ages. A sizable proportion of individuals show increases in depressive symptomatology following diagnoses of diabetes, CHD, stroke, some cancers and chronic kidney disease, 35 - 37 while collaborative care that focuses both on mental health and physical illness has beneficial effects on both.