La percezione soggettiva dell’invecchiamento, o invecchiamento soggettivo, intesa come il modo in cui le persone anziane interpretano e costruiscono aspettative nei confronti del processo di invecchiamento stesso, rappresenta un argomento di enorme interesse clinico. L’ invecchiamento soggettivo è ad oggi considerato un fattore chiave in grado di influire direttamente sulle nostre aspettative di vita. Numerose ricerche hanno studiato la relazione esistente tra invecchiamento soggettivo, o altre concettualizzazioni teoriche comunemente usate, e la salute individuale. Gli individui con una visione negativa dell'invecchiamento corrono maggiori rischi di sviluppare malattie croniche, presentano tassi di ospedalizzazione più elevati, funzionamento cognitivo e fisico compromesso, maggiore incidenza di malattie neurodegenerative e una sostanziale diminuzione della longevità. L'invecchiamento soggettivo appare anche connesso alla salute psicologica e alla qualità della vita degli individui over 65. Inoltre, questo costrutto psicologico appare potenzialmente mutevole e come tale di estrema importanza per tutti quegli interventi che mirano a migliorare la salute psicofisica di una popolazione sempre più longeva. Nonostante il forte legame evidenziato in letteratura tra diversi indicatori di salute e l'invecchiamento soggettivo, il numero di strumenti psicometrici statisticamente validi e teoricamente affidabili è ancora modesto. Questa tesi si concentra sul processo di sviluppo di un nuovo questionario psicologico per la valutazione dell'invecchiamento soggettivo; uno strumento psicometrico che potrebbe essere utilizzato per aumentare la nostra conoscenza sulle diverse componenti specifiche dell'invecchiamento soggettivo in grado di influenzare la salute e il benessere individuale in età avanzata. Il lavoro di tesi trae fondamento da basi teoriche ampiamente consolidate in letteratura nello studio dell'invecchiamento soggettivo, con un focus principale alla teoria dello stereotipo internalizzato sviluppata dalla Dottoressa Becca Levy. Nei diversi capitoli costituenti il lavoro di tesi verranno affrontate diverse domande di ricerca riguardanti la valutazione e le implicazioni sulla salute dell'invecchiamento soggettivo, ampliando potenzialmente la nostra conoscenza psicologica e psicometrica su questo costrutto. / Great emphasis has been given by clinicians to the way older adults experience and view the aging process itself, a research field broadly known as “subjective aging.” Subjective aging or perception of aging in the on-topic literature is now considered a key factor directly affecting the aging trajectory. Several studies have explored the existing relationship between subjective aging, or other commonly used theoretical conceptualizations of it, and health-related outcomes. Individuals holding negative views of aging have been empirically linked to higher risks of developing chronic conditions, higher hospitalization rates, lower cognitive and physical functioning, neurodegenerative diseases, and decreased longevity. Subjective aging has also been connected with psychological outcomes, like depression, anxiety, or older adults’ quality of life. Moreover, this psychological construct seems susceptible to change, and as such of extreme importance for interventions enhancing the psychological and physical health of an aging population. Despite the strong longitudinal relationships highlighted between different health outcomes and subjective aging, the amount of statistically valid and theoretically reliable self-report measures of it is still modest. This dissertation will focus on the development of a new questionnaire assessing subjective aging, a psychometric tool that could be used to increase our knowledge about different specific dimensions of subjective age influencing health and well-being in later life. The current dissertation manuscript will build upon widely established theoretical foundations for the construct of subjective aging, with the main focus being on Becca Levy’s stereotype embodiment theory. In the different chapters comprising this manuscript, different research questions regarding the assessment and health implications of subjective aging will be answered, potentially expanding our psychological and psychometrical knowledge about this fundamental construct.

This study examined the role of health care access and health care resources in the association between subjective aging and activities of daily living among older adults. We examined subjective aging in the context of subjective cognitive decline (SCD) relationships in three studies: (1) a scoping review of healthcare access (HCA) and resources (HCR) on dementia and COVID-19 among African American older adults; (2) subjective cognitive decline in basic activities of daily living (bADL) across age cohorts, older adults and (3) subjective cognitive decline in instrumental activities of daily living (IADL) across older adults' moderation by HCA and mediation by HCR. For the scoping review, we utilized the population, concept, and context inclusion and exclusion criteria for study admissibility for articles published on dementia and COVID-19 studies in English language journals that published from January 2019 to December 2022. The two empirical studies utilized the 2021 round 11 of the National Health and Aging Trends dataset of older adults aged 70 to above 90 funded by the National Institute for Aging. We employed multiple regression and the bias-corrected percentile Bootstrap with 5000 samples using standard path-analytic approaches for the moderated-mediation approach for the two empirical studies. Findings from the scoping review indicated racial and age disparities affected older African American adults with dementia and COVID-19, associated with lower HCA and marginal HCR. Results of mediation–moderation analysis showed SCD, lower HCR, and HCA predict a decline in bADL to be higher among the older-old age (80-89) compared to the middle-old age (70-79) or oldest-old (90 years +) cohorts. We observed similar effects for IADL. The findings from the two empirical studies suggest a "doughnut" effect by which the older-old age cohort of 80-89 may be coping less well with their bADL, as well as IADL, while the oldest-old may have adapted to functional loss in their everyday living and/or comprises adults who may have passed a mortality selection despite a more significant burden of comorbidity.

Yes / It is unclear whether people with dementia (PwD) have more negative attitudes toward own aging (ATOA) than people without dementia and what factors influence ATOA among PwD. We investigated whether PwD have more negative ATOA than individuals without dementia and whether cognition and dementia subtype are associated with ATOA in PwD. Data from the IDEAL and PROTECT studies were used to compare ATOA between 1502 PwD (mean (SD) age = 76.3 (8.5)) and 6377 individuals without dementia (mean (SD) age = 66.1 (7.1)). Linear regressions and ANOVA were used. PwD reported slightly more negative ATOA than people without dementia; this relationship disappeared after controlling for depression and self-rated health. In PwD more positive ATOA showed negligible associations with better general cognition, memory performance, verbal fluency, and visuospatial ability. However, after adjusting for covariates only better visuospatial ability predicted more positive ATOA. Additional analyses showed that before and after controlling for covariates, individuals with poorer self-reported visual acuity have more negative ATOA. Amongst dementia subtypes, people with Parkinson's disease dementia and dementia with Lewy bodies reported most negative ATOA. ATOA between PwD and people without dementia do not differ. ATOA in PwD appear to be affected not by cognitive impairment but by other characteristics that vary across dementia subtypes. Among PwD, those with Parkinson's disease dementia and dementia with Lewy bodies may have higher risk of experiencing negative ATOA due to the motor and visual impairments that they experience. / Improving the experience of Dementia and Enhancing Active Life: living well with dementia. The IDEAL study’ was funded jointly by the Economic and Social Research Council (ESRC) and the National Institute for Health and Care Research (NIHR) through grant ES/L001853/2. The IDEAL-2 study’ is funded by Alzheimer’s Society, grant number 348, AS-PR2-16-001