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Cerebrovascular disease (CVD) can result in cerebral small vessel disease (cSVD) and structural brain changes such as decreased cortical volume, brain atrophy and cerebral infarcts which are major causes of stroke and dementia. CVD is also associated with increased depression and depressive symptoms in later life. Midlife vascular disease and adult socioeconomic status (SES) are well established risk factors but less is known about the effect of factors from earlier in life on CVD and depressive symptoms in later life. A series of systematic reviews of current literature examining early life factors and stroke, cSVD and depression following stroke are presented at the beginning of this thesis. These reviews found that childhood IQ, education and childhood SES were associated with stroke and cSVD in later life. The reviews also found that education level was associated with depression following stroke. However few of the studies adjusted for vascular risk factors and adult SES. Therefore this thesis aimed to investigate associations between birth and childhood factors and cerebrovascular disease and depressive symptoms, after adjustment for vascular risk factors and adult SES, in four community dwelling cohorts: the Stratifying Resilience & Depression Longitudinally (STRADL) cohort (n=280, 45% male, mean age= 62.1 (SD=4.1) years), the Dutch Famine Birth cohort (n= 151, 44% male, mean age 67.6 (SD=0.9) years), the Lothian Birth Cohort 1936 (LBC 1936, n= 865, 50% male, mean age 72.7 (SD=0.7) years), and the Simpson cohort (n=130, 31% male, mean age 78.5, (SD=1.5) years). This Thesis first examined associations between (i) cSVD burden (ii) total and regional brain volumes and (iii) self-reported symptoms of depression and anxiety measured using the Hospital Anxiety and Depression Scale. All analyses were adjusted for age, sex, hypertension, smoking behaviour, adult SES and cognition. Neither cSVD nor brain volumes were associated with symptoms of anxiety. Higher white matter hyperintensity volumes, having one or more cerebral infarct and increased cerebral atrophy were associated with increased depressive symptoms independent of vascular risk factors and adult SES. Secondly, this thesis examined associations between birth and childhood factors and cSVD burden and total and regional brain volumes. Each cohort was analysed individually and then all available data meta-analysed. All analyses were adjusted for age, sex, hypertension, smoking behaviour, adult SES and other early life factors. Meta-analysis found that increasing birth weight was associated with decreased risk of lacunes across all cohorts. Placental weight, which was only available for the Simpson cohort, was associated with decreased risk total cSVD, WMH severity and volume and cerebral infarcts. In the LBC 1936 and Simpson cohort increasing childhood and premorbid IQ and more years of education were associated with fewer cortical infarcts. The association between premorbid and childhood IQ and infarcts was independent of education level. Across three cohorts low education level was associated with more microbleeds. These findings suggest that factors other than traditional vascular risk factors may contribute to cSVD and structural brain changes in later life. Thirdly, this thesis examined associations between birth and childhood factors and self-reported symptoms of depression and anxiety measured using the Hospital Anxiety and Depression Scale (HADS) and the Quick Inventory of Depressive Symptoms (QIDS-16). All analyses were adjusted for age, sex, hypertension, smoking behaviour, adult SES and cognition In the Dutch Famine Birth Cohort people born before the famine had lower scores of depression and anxiety on the HADS compared to those exposed to famine in early gestation and those conceived after the famine. In the LBC 1936 increasing ponderal index was associated with lower depressive symptoms, increasing childhood and premorbid IQ were associated with lower symptoms of anxiety and depression. Lower educational attainment and some indicators of childhood SES were associated with higher symptoms of depression and anxiety. Overall results suggest that early life factors, particularly childhood IQ, may contribute to structural brain changes and symptoms of depression and anxiety in later life, independent of vascular risk factors and other early life factors. Efforts to understand factors which may contribute to late life health, from the earliest stages of life, are important and may be used to inform changes in social policy. The effect sizes and potential impact of these findings suggest that larger sample sizes with more vascular disease and more depression are needed to robustly test these associations.

Personality researchers have described dispositional traits to typically show stability over the life course and yet one such trait, shyness, has rarely been examined in later life. Shyness as a global trait has been linked negatively to multiple psychological indices of childhood well-being, including loneliness. Despite the fact that older adults may be already at risk for experiencing heightened loneliness, regret, or decreased fulfillment, research has not assessed these experiences in relation to personality in later life. In recent years, withdrawal research has begun to move past shyness as a global trait to examine the motivations behind socially withdrawn behavior. The current study used regression analyses to examine ways that three facets of withdrawal (shyness, avoidance, and unsociability) may relate to loneliness, regret, and fulfillment in later life. Data from 309 older participants of the Huntsman Senior Games were used to explore associations. Results indicated that shyness, avoidance, and unsociability significantly predicted increased loneliness and regret, and decreased fulfillment to some extent. Further, marital status (married, divorced, widowed) moderated links between withdrawal and psychological indices of later life well-being.

This paper brings together theoretical work on gender, caregiving, and illness to investigate emotion work performed in response to a spouse’s physical illness. We analyzed qualitative in-depth interview data with 36 individuals in 18 long-term heterosexual marriages (N=36) wherein one or both spouses experienced illness. Findings indicated that men and women performed, received, and interpreted their emotion work in gendered ways. Women with an ill spouse performed emotion work more often than men. Women who were ill themselves often performed emotion work to relieve the burden on their spouse—a dynamic not found among men who were ill. When women performed emotion work, they constructed this work as a natural propensity. Men who did not perform emotion work constructed themselves as protective and problem-solving. These findings point to underlying intra- and inter-personal processes that may help to explain why women experience higher levels of caregiver burden and depression than do men. / text

Provisional Question for the thesis to address: Indicated and selective prevention of common mental health problems in later life: Is there a theoretical rationale for an Acceptance and Commitment Therapy approach? Background The burden of late life depression and anxiety is significant. Even subthreshold symptoms result in great individual, community, economic and societal cost. However, common mental health problems in later life are under‐recognised and under‐treated despite evidence in support of pharmacological and psychological intervention. Previous research regarding psychological therapy for late life mental health problems has been dominated by cognitive behavioural therapy. However, the effectiveness of this approach has been questioned, leading researchers to explore alternative approaches. Acceptance and Commitment Therapy has received increasing attention from researchers keen to explore an alternative and some have argued that this approach is particularly suited to older people. In the context of demographic change and a significant increase in the proportion of community dwelling elderly there is a need to provide evidence to support the use of alternative management strategies for late life mental health problems, for example, focusing on prevention. Methods A systematic review will evaluate the current evidence for the use of ‘indicated’ and ‘selective’ prevention interventions for older people at risk of developing a major depressive or anxiety disorder due to the experience of subsyndromal symptoms or the presence of significant physical, socioeconomic, and psychosocial risk factors. This paper will be followed by an empirical article in which the relationship between psychological processes and ageing will be explored. Specifically, this study will explore psychological flexibility, the use of Selection, Optimisation and Compensation strategies, and the presence of psychopathology in a non clinical sample of community dwelling older people. Results Findings of the systematic review provide preliminary evidence for indicated and selective prevention of late life depression, however there is no clear evidence of benefits of these interventions in late life anxiety. The relationships between variables in the empirical study were explored using descriptive statistics, correlation analysis, and conditional process modelling. Although the study did not find age to be a specific predictor of variance in psychological variables explored, the study did provide empirical support for the potential to use Acceptance and Commitment Therapy with older people. Discussion The systematic review article provided preliminary evidence for the efficacy of selective and indicated prevention interventions for late life depression. However, further research is required to consolidate these findings. The empirical paper found significant relationships between the perception of positive health, reduced psychopathology and theoretical variables including cognitive fusion, engagement in valued living, and the use of Selection, Optimisation, and Compensation strategies. Cognitive fusion was found to mediate these relationships and as such, findings provide support for the use of an Acceptance and Commitment Therapy approach with older people. The theoretical and clinical implications of these findings are discussed in detail.

An increasing proportion of people in the United Kingdom are living longer with long-term conditions. The National Health Service is facing the challenge of increased pressure on its service provision. A number of key health policy initiatives encourage individuals to make informed choices and purport to give them rights and control over their own health and healthcare. Within this context, people are actively encouraged to self-care, manage diseases, and make decisions and choices about healthcare in an informed way. To facilitate this, it is important to gain an understanding of the health information seeking behaviours of older people. Health information is available from various sources but little is known about the health information seeking behaviours of older people and what affects this. By exploring this, it helps to reveal how health information is sought regarding on-going health conditions and provides greater depth in understanding the health information seeking process. The study explores older people's experiences and views on their health information seeking behaviours and endeavours to gain a better understanding of these experiences and views. The study draws on constructivist grounded theory with two phases to data collection: Nine participants completed un-structured diaries over two months with follow up semi-structured interviews, a further twenty participants participated in semi-structured interviews. Major categories were inductively drawn from participant's responses. Strategies of health information seeking behaviours are not necessarily fixed, but subject to change over time. The analysis suggested three main categories that explained the health information seeking behaviours of older people. Three interrelated conceptual categories were identified: (1) Regulating self (2) Self managing and (3) Self-mobilisation. These categories formed the basis of the emergent substantive theory called 'navigating later life'. There were different patterns of behaviours between participants which captured variations in information seeking; these informed the development of a typology of health information seekers. Ageing in the 21st century is a complex process; with older people inhabiting a world of more choice, multiple sources of knowledge, changed healthcare roles and increased self-care undertaken within the home. The study provides important insights for healthcare professionals and raises implications for strategies aimed at improving older people's access to appropriate health information. The navigation model provides a potentially valuable tool for policy makers when considering the support older people require to self-care.

Longitudinal data (N = 263) was used to investigate the bidirectional relationship between engagement (engaged lifestyle activities) and cognition (crystallized & fluid intelligence). Extroversion and openness to experience were also tested as moderators of the relationship between engagement and cognition. Results showed that the relationship between engagement at Wave 1 and cognition at Wave 2 did not differ from the relationship between cognition at Wave 1 and engagement at Wave 2. Testing for moderation with regression indicated that neither extroversion nor openness was moderating the relationship between engagement and cognition in either direction. Structural equation models provided further summary evidence that the relationships among engagement at Wave 1, extroversion, openness, and cognition at Wave 2 were not strong. However, a strong limitation to these results was the measurement error associated with a new measure of engagement.

Although research has been conducted on marriage and volunteerism in later life, little is known about the impact of volunteerism on marital quality, particularly intense volunteer experiences. Missionary couples for the Church of Jesus Christ of Latter-day Saints (LDS) leave their homes for a period ranging from 6-18 months and dedicate the majority of their time to working in church assignments. Qualitative interviews were collected from couples who had served senior couples missions for the LDS Church and returned home in the last year. The mean age of participants was 69, and the mean length of marriage for couples was 37 years. Twelve couples were interviewed conjointly about the experience of their missions, and their perceived marital quality before, after, and during their missions. Qualitative analysis was conducted on these interviews, and several themes emerged from the data, as well as subthemes. The themes were divided into those that occurred prior to serving a mission, those that occurred during the mission, and a separate section for marital themes. Pre-mission themes included factors affecting decision to go on a mission, prior experience. Mission themes included type of mission, adjustments, things enjoyed, and things not enjoyed. Marital themes included arguments, closeness, power, and stress. Each section included an in-depth discussion of what each theme incorporated, as well as quotes from the interviews. Overall, couples felt like their missions had a positive impact on their marriages. Comparisons were done among couples serving different types of missions, as well as couples in first, second, and third marriages. Type of mission and number of marriages had little overall impact on a couple's perception of the effect of their mission on their marriage. Therapists can use these results to inform couples who are contemplating an intense voluntary experience.

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