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PubMed1993

Vocal communication in the first 18 months of life.

Fifty-one normally developing infants aged birth to 18 months, 10 or 11 in each of five age groups, were videorecorded in their homes before and after an expected change in the form of their vocalizations and under a set of conditions that reflected common daily occurrences. The vocalizations produced were coded according to their communicative contexts, defined in nonvocal behavioral terms. Communicative codes were assigned to seven major categories. The distribution of codes across categories was found to be different for different age groups. It varied between the first and second observations; however, the pattern of change differed across age groups. Data from individuals were transformed to proportions, to control for individual differences in productivity. They were then found to reflect differences in level of development of vocal communication. It was concluded that vocal communication follows an orderly developmental sequence in normally developing infants in the first 18 months of life.

Age Factors↗
PubMedDate not supplied

[Aging in one's occupation: occupational and life's perspectives of elderly male and female employees].

The consequences of social change for the workforce are discussed. In our society of the future we will have to deal with an aging industry as a result of the increasing number of older employees. Furthermore, we expect changes in relation to mandatory retirement in establishing the "Rentenreform 1992" (Retirement age policy). The necessity of intergenerational exchange to avoid "ageism" is explained. The impact of technology on life-long learning and qualifications of older workers is pointed out. Finally, we describe the pluralism of life courses as a characteristic of social change in relation to gender-effects.

Aged↗
PubMed2026

Relationship between participant-reported outcomes, residual beta cell function and metabolic parameters in youth with newly diagnosed type 1 diabetes.

AIMS/HYPOTHESIS: Clinical trials of interventions to preserve beta cell function in new-onset type 1 diabetes frequently employ participant-reported outcome measures (PROMs). However, the expected changes in PROMs scores immediately following diagnosis and their association with residual beta cell function, metabolic markers and continuous glucose monitoring (CGM) are unclear. METHODS: Repeated PROMs including Paediatric Quality of Life Inventory diabetes module (PedsQL) and hypoglycaemia fear survey (HFS) were recorded from participants aged 10-18 years with newly diagnosed type 1 diabetes and their parents in two clinical trials: CLOuD (N=97, hybrid closed loop [HCL] vs multiple daily injections [MDI]) and USTEKID (N=72, ustekinumab immunotherapy vs placebo). Scores were compared with serial mixed meal-stimulated C-peptide levels (AUC C-peptide), HbA1c and CGM data. RESULTS: PedsQL and HFS scores for children/adolescents and their parents showed wide variation between individuals but did not change substantially within individuals over the first 48 months from diagnosis. Baseline scores were highly predictive of scores at 12-48 months (p<0.001). PedsQL scores were higher (better) in those reported by children/adolescents than by their parents (p<0.01). In contrast, HFS scores were higher in parents than children (p<0.001), indicating more fear. Strong correlations were observed between child and parent scores (p<0.001). No significant improvement in these scores was detected following intervention (ustekinumab or HCL). Meta-analysis revealed modest but statistically significant associations between HbA1c and PedsQL (&#x3b2;(std)=-0.11; 95% CI -0.20, -0.03) and HFS (&#x3b2;(std)=0.11; 95% CI 0.00, 0.21), and between CGM time in range and PedsQL (&#x3b2;(std)=0.14; 95% CI 0.03, 0.26) but not HFS (&#x3b2;(std)=-0.05; 95% CI -0.16, 0.06). Beta cell function (AUC C-peptide) was strongly associated with HbA1c (&#x3b2;(std)=-0.29; 95% CI -0.39, -0.20) and CGM time in range (&#x3b2;(std)=0.41; 95% CI 0.30, 0.52). Higher beta cell function showed a trend towards better PedsQL (&#x3b2;(std)=0.11; 95% CI -0.03, 0.25) and lower HFS (&#x3b2;(std)=-0.05; 95% CI -0.17, 0.07) but this did not reach statistical significance. CONCLUSIONS/INTERPRETATION: PedsQL and HFS scores changed little during the first 48 months after diagnosis of type 1 diabetes. These scores showed modest but statistically significant associations with measures of glucose management (HbA1c and CGM time in range), whereas the relationships with residual beta cell function (C-peptide) were weaker and did not reach significance. The modest size of these effects suggests current PROMs capture only limited aspects of the clinical benefit associated with beta cell preservation. Future research should incorporate psychometric instruments that are specifically adapted for young people using modern diabetes technologies and undergoing disease-modifying therapy, to ensure outcomes are meaningfully represented in early-stage type 1 diabetes trials.

Adolescent↗
PubMed1983

Measuring function and health status in rheumatic disease clinical trials.

We have summarized the limitations of traditional outcome measures in rheumatology, reviewed the growing field of measures emphasizing the patient's perception of improvement, and provided guidelines for choosing a specific instrument for a clinical trial. Newer measures have measurement properties equal to or surpassing traditional measures, but no one ADL or quality-of-life instrument can be used to assess outcome in every situation as no one test can indicate success of a treatment in a chronic disease. An instrument needs to be judged by the following criteria: Is it metrically sound? Does it fit the socio-demographic characteristics of the target population? Does it measure the specific changes which are likely to be affected by the treatment? Will it capture or measure the expected changes?

Arthritis, Rheumatoid↗
PubMed1998

Sustainable development and quality of life: expected effects of prospective changes in economic and environmental conditions.

In the context of "sustainable development", we studied which attributes are important to people's quality of life (QoL) and which changes in QoL people would expect from future economic and environmental improvements or deteriorations. About 200 adult subjects evaluated the relative importance of 22 different QoL attributes. They subsequently indicated expected changes in those attributes, under three different scenarios in which economic and environmental conditions would either improve or deteriorate. On average, subjects judged the QoL attributes "healthy", "family", "environmental quality", "nature" and "safety" to be most important, while "recognition", "comfort", "status" and "spiritual life" were found least important. The most important QoL attributes as well as "security" were judged as more important by women than by men. Also observed were income and age effects on relative attribute importance. Our (Dutch) subjects expected significant and varied negative QoL changes from an environmental-deterioration scenario involving either an improved or a deteriorated economy. In contrast, they had mixed positive-negative QoL expectations about environmental improvement combined with economic deterioration. Subjects high in environmental concern assigned greater weight to "environmental" QoL attributes, and they expected environmental improvement versus deterioration to more strongly affect their QoL-attributes "environmental quality", "nature", "health" and "unity with nature", than did subjects low in environmental concern. We conclude that quality of life can be meaningfully conceived as a multi-attribute value concept, useful for assessing the expected effects of future economic and environmental conditions. Suggestions are given for methodological improvement and for further research.

Adolescent↗
PubMed1994

Targeted pharmacotherapy in depression management: comparative pharmacokinetics of fluoxetine, paroxetine and sertraline.

In contrast to tricyclic antidepressants (TCAs), the selective serotonin reuptake inhibitors (SSRIs) have a high affinity for the serotonin uptake site with little or no affinity for alpha-adrenergic, cholinergic or histaminic receptors. SSRIs, again in contrast to TCAs, do not slow intracardiac conduction. These differences between TCAs and SSRIs are important in terms of both discomforting and more serious adverse effects. Despite their more focused effects, the SSRIs are as effective as TCAs in treating major depression. The SSRIs have similar properties in terms of their pharmacodynamics, but important differences in terms of pharmacokinetics and their effects on hepatic function. Sertraline, and the starting dose of paroxetine have an elimination half-life (t1/2) of approximately 24 h. However, the half-life of paroxetine, but not of sertraline, becomes longer at higher doses due to paroxetine's inhibition of its own clearance. At t1/2 of 24 h makes once-daily dosing feasible and allows for new steady-state concentrations and wash-out within a reasonable time after dose adjustment. Fluoxetine has a t1/2 of 2-4 days and has an active metabolite with a t1/2 of 7-15 days. Such a half-life makes dose titration more difficult, and can result in prolonged effects even after dose reduction or drug discontinuation. Sertraline has dose-proportional changes in plasma concentrations, in contrast to fluoxetine and paroxetine. Thus, dose increases with fluoxetine and paroxetine produce greater than expected changes in plasma drug concentration, and hence, in concentration-dependent effects.(ABSTRACT TRUNCATED AT 250 WORDS)

1-Naphthylamine↗
PubMed1993

Pharmacokinetics of L-thyroxine after its oral administration in dogs.

Twelve mature (5 sexually intact males, 4 castrated males, and 3 females) mixed-breed dogs were surgically thyroidectomized and used in a Latin-square design pharmacokinetic study of orally administered L-thyroxine. The dogs were treated with 44, 22, and 11 micrograms of L-thyroxine/kg as a single morning dose or in divided doses, morning and evening. Serum concentration of thyroxine (T4) was evaluated to determine a number of pharmacokinetic variables for comparison. Mean steady-state concentrations (Css) were determined from the area under the curve. Variables were analyzed for comparisons between dosages by use of ANOVA. Concentration at steady state was highest for dogs of the 44-micrograms/kg of body weight once-daily group and was lowest for dogs of the group given 11 micrograms/kg in 2 daily doses. Single daily administration resulted in higher Css, except at the 22-micrograms/kg/d dosage. Clearance was faster for the 22- and 44-micrograms/kg/d dosages than for the 11-micrograms/kg/d dosage. The half-life (t1/2) and mean residence time (MRT) also were shorter for the 44-micrograms/kg/d dosage, possibly indicating more rapid elimination of the drug at higher doses and dose-dependent kinetics. Perhaps, as the dogs' metabolism increased with higher iodothyronine concentrations, hormone degradation was accelerated. Interval (divided vs single dose) caused some expected changes: maximal concentration was higher and minimal concentration was lower when single administration was used. These undulations resulted in iodothyronine concentrations above the physiologic range for a number of hours, whereas concentration closer to physiologic ranges was achieved by use of divided doses.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1990

Effects of coronary risk reduction on the pattern of mortality.

Control of coronary risk factors is associated with lower age-specific risks, but people will then live longer, with increased exposure to the higher mortality rates of the elderly. Expected changes in pattern of mortality, based on the 15-year follow-up of men in the Whitehall study, have been calculated. Non-smokers live longer than smokers, but death (when it comes) is more likely to be due to heart attack and less likely to be due to cancer. By contrast a lower level of plasma cholesterol, which is also associated with longer life, is expected to reduce the lifetime risk of fatal heart attack, its place then being taken by a typical mixture of other causes of death.

Age Factors↗
PubMed1984

Flecainide: its proarrhythmic effect and expected changes on the surface electrocardiogram.

The proarrhythmic potential and electrophysiologic effect of flecainide acetate, a potent class IC anti-arrhythmic agent, are considered in this report. Although the definition of a proarrhythmic effect is arbitrary, several such definitions are discussed and applied to data on flecainide. In patients with chronic ventricular arrhythmias, an increase in VPC frequency developed in 0 to 4% of patients, compared with 1 to 8% of patients who received quinidine and 2% who received encainide, another class IC agent. In patients with acute hemodynamically significant ventricular arrhythmias, the proarrhythmic effects were noted in 5 to 12%. Proarrhythmic effects appear to be more common in patients with left ventricular dysfunction and life-threatening ventricular arrhythmias. The depression of atrioventricular conduction produced by flecainide is similar to that seen with other class IC agents. Increases in PR and QRS intervals are related to dose and plasma concentration and are approximately 25% at therapeutic levels. These changes in the electrocardiographic intervals do not appear to carry important clinical implications and do not require discontinuation of flecainide. QT prolongation is absent or minimal with flecainide. Guidelines for management of patients with flecainide are suggested.

Anti-Arrhythmia Agents↗
PubMed2000

The advanced glaucoma intervention study, 6: effect of cataract on visual field and visual acuity. The AGIS Investigators.

OBJECTIVE: To investigate the effect of cataract on visual function and the role of cataract in explaining a race-treatment interaction in outcomes of glaucoma surgery. METHODS: The Advanced Glaucoma Intervention Study (AGIS) enrolled 332 black patients (451 eyes) and 249 white patients (325 eyes) with advanced glaucoma. Eyes were randomly assigned to an argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy sequence or a trabeculectomy-ALT-trabeculectomy sequence. From the AGIS experience with cataract surgery during follow-up, we estimated the expected change in visual function scores from before cataract surgery to after cataract surgery. Then, for eyes with cataract not removed, we used these estimates of expected change to adjust visual function scores for the presumed effects of cataract. In turn, we used the adjusted scores to obtain cataract-adjusted main outcome measures. MAIN OUTCOME MEASURES: Average percent of eyes with decrease of visual field (APDVF) and average percent of eyes with decrease of visual acuity (APDVA). RESULTS: Within the 2 months before cataract surgery, visual acuity was better in eyes of white patients than of black patients by an average of approximately 2 lines on the visual acuity test chart. Cataract surgery improved visual acuity and visual field defect scores, with the amounts of improvement greater when preoperative visual acuity was lower. Adjustments for cataract brought about the following relative reductions: for APDVF, a relative reduction of 5% to 11% in black patients and 9% to 11% in white patients; for APDVA, a relative reduction of 45% to 49% in black patients and 31% to 38% in white patients; and for the APDVF and APDVA race-treatment interactions, relative reductions of 25% and 45%, respectively. CONCLUSIONS: On average, visual function scores improved after cataract surgery. The findings of reduced race-treatment interactions after adjustment for cataract do not alter our earlier conclusion that the AGIS 7-year results support use of the ALT-trabeculectomy-trabeculectomy sequence for black patients and of the trabeculectomy-ALT-trabeculectomy sequence for white patients without life-threatening health problems. The choice of treatment should take into account individual patient characteristics and needs.

Adult↗
PubMed1993

Coping with the Gulf war: subculture differences among ischemic heart disease patients in Israel.

The purpose of this study was to assess short term effects of the Gulf war on ischemic heart disease patients of different ethnic origin. Three dimensions of patients' reactions to the war situation were studied: psychological, physical and behavioral. The study first focused on changes in patients' responses on these dimensions over three stages of the war, differentiated according to degree of threat. Second, differences stemming from ethnic origin were examined among patients who live in the same geographical region, use the same health services and were exposed to the same threatening life event. One hundred ischemic heart disease patients were interviewed while waiting in outpatient hospital clinics for a regular examination at the end of the war. The results of intrapersonal comparisons showed that the intensity of responses, as expected, increased significantly on the three dimensions from the week before the war started to the first week of the war, which was the most stressful period for Israelis. During the last week of the war, however, when stress was significantly reduced, the expected change was found primarily with regard to psychologic responses. That is, worries were significantly reduced, but no significant reduction in frequency of anginal pain and in drug consumption followed, indicating differences in the adjustment process on the psychologic and physical levels. Subcultural differences were found in the studied responses: Patients of Asian or North African countries of origin reported having more frequent anginal pains, and consuming more drugs than patients from Western countries.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1996

Symptom experiences of midlife women: observations from the Seattle Midlife Women's Health Study.

UNLABELLED: Symptoms experienced by perimenopausal women are varied with little agreement about their nature, cause or stability. OBJECTIVE: To describe the type and stability of symptoms experienced by midlife women. METHODS: A community-based sample of 301 women ages 35-55 (Mean 41.1; S.D. = 4.2), had at least one menstrual period in the past year, and took no ovarian hormones. Women completed a daily symptom diary for at least one cycle for 3 consecutive years. Symptoms were rated from zero to four. The 5 premenses days were targeted for consistency and as those most symptomatic. Twenty-eight symptoms commonly reported as perimenopausal were factor analyzed using principal components analysis with varimax rotation. Test-retest reliability and stability estimates were calculated according to the method of Heise (Heise, D. Am Sociol Rev 1969; 34: 93-101) that accounts for expected change over time. RESULTS: Twenty-five of the 28 symptoms loaded on five factors labeled dysphoric mood, vasomotor, somatic, neuromuscular, and insomnia together accounting for 51.7% of the variance. Test-retest reliability estimates were highest for dysphoric mood (r = 0.78) and somatic (r = 0.70) symptoms. The reliability for the other three clusters ranged from r = 0.65 to r = 0.53). The stability of the clusters across 3 years was high for dysphoric mood, neuromuscular, and insomnia. The vasomotor and somatic clusters had the most change between years 1 and 3. DISCUSSION: These results indicate that dysphoric mood is not a part of vasomotor symptoms or insomnia or other somatic symptoms suggesting an origin for vasomotor symptoms apart from the other symptoms. The stability of dysphoric mood across 3 years suggests a chronic situation possibly due to high stress, overwork, or an ongoing emotional illness. The stability of the neuromuscular and insomnia symptoms suggests underlying chronic physical conditions. The reduction in stability of vasomotor symptoms may reflect the changing nature of hormones as women approach menopause. Finally, the low stability of somatic symptoms suggests that they represent acute episodic illnesses. Together the identification of five distinct symptom clusters with varying stability over 3 years suggests that they are due to different underlying mechanisms and are not all attributed to the changing hormone patterns associated with the menopausal transition. Many other events in a midlife woman's life can account for these symptoms including life stress and acute and chronic illnesses.

Adult↗
PubMed1993

An evaluation of an asthma quality of life questionnaire as a measure of change in adults with asthma.

In assessing the effectiveness of management strategies for patients with asthma, it is important to measure outcomes which are relevant to the concerns of patients. Quality of life is one such outcome which may not be adequately reflected in lung function measurements. We have developed an asthma quality of life questionnaire (the AQLQ) for this purpose. The aim of this study was to test the validity and responsiveness of the AQLQ as a measure of change. Forty four adults with asthma were assessed on two occasions 4 months apart. On each occasion subjects completed the AQLQ and the Sickness Impact Profile (SIP). Lung function and the degree of bronchial hyperresponsiveness (BHR) were measured and diary cards were used to derive a symptom score and mean daily peak flow variability. The relation of change in AQLQ scores to change in the other outcomes was assessed. Questionnaire responsiveness was assessed by comparing the change in AQLQ scores between 19 improved and 20 stable subjects. Improvement was assessed on lung function and BHR criteria. As expected, change in AQLQ score was correlated with change in symptom score (r = 0.37, 95% CI -0.04 to 0.64) and change in BHR (r = 0.38, 95% CI 0.06 to 0.64). The associations with change in peak flow variability (r = 0.12, 95% CI -0.26 to 0.47) and change in SIP score (r = 0.18, 95% CI -0.12 to 0.45) were in the expected direction but weaker than expected. The AQLQ was capable of detecting differences between improved and stable subjects (p = 0.007).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2002

Assessing health-related quality of life following myocardial infarction: is the SF-12 useful?

We report on the responsiveness of the SF-12 to changes in quality of life following acute myocardial infarction. Scores at 1, 6, 12, and 24 weeks postdischarge were compared with pre-MI health. Statistically significant differences and standardized response means were examined. Results were compared with the SF-36 subscales and previous reports. Respondents (n = 65) reported the expected poorer physical health at every follow-up, while expected changes in emotional health were observed at 6 but not 24 weeks. Comparison with the SF-36 subscales showed that although the SF-12 reflected the expected pattern of physical health, the summary score obscured an important association between perceptions of general health and participation in usual activities. This information is relevant for developing and evaluating rehabilitation interventions and self-managed recovery following MI. The SF-12 scores obscure important distinctions between quality of life domains, and are therefore not recommended for use following acute MI.

Analysis of Variance↗
PubMed1999

Evaluation of methods for assessing visual function of infants.

PURPOSE: Commonly used behavioral and electrical testing methods for estimation of visual acuity and visual function in infants yield different estimates and may not accurately predict visual acuity and visual function in later life. Moreover, neither test-retest variability nor side-by-side comparisons of the various methods have been thoroughly evaluated in the same infant population. The purpose of this study was to provide such an evaluation. METHOD: The test-retest variability of visual acuity and visual function was evaluated for the Teller Acuity Card (TAC) procedure, sweep visual evoked potential (VEP), as well as latency and amplitude measured by transient pattern VEP. Groups of approximately 20 infants contributed test-retest data. Visual function estimated by the various methods in a larger group of infants (n = 118) was compared. Correlations between methods and the validity of the various methods to detect maturational changes between 4 and 8 months of age were also assessed. Administration of these tests was according to standard and usual procedures. RESULTS: The average percent difference between test and retest estimates of acuity as well as the SD was lowest for transient VEP latency (3%, 7% SD). The other methods were markedly more variable: sweep VEP (2%, 22% SD), TAC procedure (8%, 20% SD), and transient VEP amplitude (7.5%, 39% SD). Average coefficients of variation showed a similar trend: transient VEP latency, 8%; sweep VEP, 15%; TACs, 30%; and transient amplitude, 53%. Correlations among estimates by the methods were poor, but expected changes in visual maturation from 4 to 8 months of age were detected with all methods. CONCLUSIONS: All methods evaluated provide valid and reliable test-retest data for a group, but are less valid for estimating visual acuity and visual function of an individual subject. The poor correlations between any 2 of the testing methods suggest that each test assesses a different aspect of vision. Nonetheless, expected maturational changes between 4 and 8 months of age were readily detectable by all methods evaluated.

Aging↗
PubMed1997

Health-related quality of life after elective surgery: measurement of longitudinal changes.

OBJECTIVE: To examine the responsiveness of the 36-Item Short Form Health Survey (SF-36) to clinical changes in three surgical groups and to study how health-related quality of life (HRQL) changes with time among patients who undergo total hip arthroplasty, thoracic surgery for treatment of non-small-cell lung cancer, or abdominal aortic aneurysm (AAA) repair. DESIGN: Prospective cohort study with serial evaluations of HRQL preoperatively and at 1, 6, and 12 months after surgery. SETTING: University tertiary care hospital. PATIENTS: Of 528 patients, more than 50 years of age, who were admitted for these elective procedures, 454 (86%) provided preoperative health status data and are members of the study cohort. At 12 months after surgery, 439 (93%) of the cohort was successfully contacted and 390 (90%) provided follow-up interviews. MEASUREMENTS AND MAIN RESULTS: The Medical Outcomes Study SF-36, the Specific Activity Scale, five validated health transition questions, and a 0 to 100 scale measure of global health were used to assess changes in health status at 1, 6, and 12 months after surgery. Change in health status as measured by the SF-36 demonstrated that physical function and role limitations due to physical health problems were worse 1 month after these three surgeries. However, by 6 months after surgery, most patients experienced significant gains in the majority of the dimensions of health, and these gains were sustained at 12 months after surgery. Longitudinal changes in the SF-36 were positively associated with responses to the five health transition questions, to changes on the Specific Activity Scale and global health rating question, and to clinical parameters for persons who had AAA repair. These findings indicate that the SF-36 has evidence of validity and is responsive to expected changes in HRQL after elective surgery for these procedures. CONCLUSIONS: For the total hip arthroplasty patients, responsiveness was greatest for the SF-36 scales that measure physical constructs. However, for the two other procedures and at various points of recovery, significant changes were observed for all eight subscales, suggesting that responsiveness was dependent on the type of surgery and the timing of follow-up, and that multidimensional measures are needed to fully capture changes in HRQL after surgery.

Aged↗
PubMed1986

The development of migration expectations: changes throughout the lifecourse.

This research examines how the relative influence of factors that determine an individual's expectations of moving varies throughout the lifecourse. Factors representing personal characteristics, ties to origin, and ties to potential destinations were used to discriminate between expected migrants and nonmigrants in three population subgroups representing different stages of life. These subgroups included a general adult population, a preretirement population, and an elderly population. The results indicate that personal characteristics are most influential among preretirement persons, ties to origin are most influential among the general and elderly populations, and ties to potential destinations are influential among all population subgroups.

Adult↗
PubMed1991

Perceived controllability of expected psychological change across adulthood and old age.

This cross-sectional study focuses on adults' beliefs about the controllability of developmental change in adulthood and old age. Young (n = 33; age range 20-36 years), middle-aged (n = 35; age range 40-55 years), and older (n = 32; age range 60-85 years) adults rated an extensive list of psychological attributes in terms of the degree of expected developmental increase across the adult life span (ages 20-90), the perceived controllability of these changes, their desirability, and their expected age-related timing. The findings indicate a substantial degree of similarity in young, middle-aged, and old adults' overall beliefs about controllability. The three adult age groups agreed in perceiving developmental changes in adulthood as fairly controllable, and with regard to their relative controllability (rank ordering of change-sensitive attributes). Changes expected to occur later in life were consensually perceived to be less desirable, and less desirable changes were perceived as less controllable. However, there were clear age-related differences involving both the age timing of expected changes and the age of respondents. A comparison between the three subject age groups revealed twofold differences: First, the relationship between desirability and perceived controllability was found to increase with subjects' age; second, Q-technique factor analysis showed that large subgroups of the young and the middle-aged adults, but not the old adults, tended to perceive psychological attributes associated with late onset decline as relatively lower in controllability.

Adult↗