What is Valuation of Life for Frail Communitydwelling Older Adults: Factor Structure and
Criterion Validity of the VOL
Presented by:
Marie P. Dennis, Ph.D., Laraine Winter, Ph.D,
Helen K. Black, Ph.D. and Laura N. Gitlin, Ph.D.
Center for Applied Research on Aging and Health,
Thomas Jefferson University
(Funded by NIA #AG 13687; PI - L. N. Gitlin)
Theoretical Foundations
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Lawton et al. (2001) – defined VOL as a cognitive-affective schema
consisting of complex judgments, emotions and projections influenced
by demographic and QOL factors (internal and external to person)

A broad construct intended to capture active embrace of life or
attachment to life or one’s total reason for living through core
constructs of hope, futurity, meaning/purpose in life, persistence and
self-efficacy


Reflect subjectively experienced worth of a person’s life
Dynamic assimilation-accommodation process of adjustment to
illness and decline

Independent of psychopathology, domain-specific QOL, and healthrelated factors

Predictive of years of desired life as alternative to the health utility
and time trade-off measures to estimate the point beyond which
longevity is no longer desirable
Valuation of Life
(Complex Cognitive/Affective Schema or Judgment )
Objective QOL
Subjective QOL
Health
Hope
Persistence
Mastery
Self-efficacy
Meaning/Purpose
Cognition
Futurity
Positive Affect
Depression
Previous Research
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Limited applied research to date on VOL
 Lawton et al. (1999, 2001, 2002) - Predictors of YDL; Construct and
criterion validation study of VOL with YDL as criterion; Personal
projects and well-being
 Heterogeneous Sample of Elders - primarily well-elderly with few but
broad set of health conditions
 Main Findings:

Two dimensions of VOL - Positive and Negative; Negative VOL
error prone for less educated elders so dropped

Health and QOL factors only related to YDL through VOL

Bivariate relation of VOL to positive affect and inversely to
depression

Multivariate relation of VOL to Spiritual/Moral, Intellectual,
Other-directed, and home planning personal projects; inversely
related to age, race and health conditions
Need
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Given the scarcity of research on positive VOL to date:
 It is unknown whether the positive VOL dimension is a valid, internally
consistent measure of how specific subgroups of older adults actively
embrace life, e.g., frail, functionally vulnerable, community-dwelling
elders

The number of core constructs Lawton et al. (2001) sought to
capture suggests that positive VOL may consist of more than one
dimension
Given the strong association of VOL to positive mental health/affect:
 It is unknown which aspect(s) of positive mental health are most
relevant to frail, functionally vulnerable elders in valuing their lives
Given the observed differential association of age, race and health to VOL:
 It is unknown whether frail, functionally vulnerable, community
dwelling elders will exhibit the same differences in their attachment to
life
Purpose of the Study
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
To determine the dimensions of Valuation of Life for frail,
functionally-vulnerable, community-dwelling elders
enrolled in Project ABLE

Examine factor structure of elders’ responses to
Lawton’s (2001) 13-item positive VOL measure

Examine internal consistency reliability of positive VOL
and any derived factors

Examine convergent and discriminant correlational
evidence to support a construct interpretation of VOL

Provide preliminary evidence of the construct and
predictive validity of positive VOL for frail, functionallyvulnerable, community-dwelling elders
Inclusion Criteria
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




Ambulatory community-living adults
70 years of age or older
English-speaking
Functionally vulnerable:
• Difficulty performing > 2 IADLs
• Difficulty with 1+ ADL task
• Use of mobility device
• Pain
• Difficulty with bathing, transferring
• 1+ falls
MMSE > 24
Study Design (N = 319)
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 Older adults were recruited from Philadelphia Corporation for Aging,
Para-transit client lists, media announcements, Senior Centers, Senior
Housing from 1999 – 2003 to participate in Project ABLE
•
Respondents screened by telephone for eligibility (N=423)
78.3% willing to participate
Unwilling did not differ from willing respondents
•
•
Willing participants were informed of study procedures
Completed IRB-approved consent form
 In-home structured two hour interview
•
•
Participants rated level of difficulty in performing activities of
daily living, psychological health and use of control strategies
4% ineligible due to MMSE < 24
Overall Sample (N = 319)
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
Mean Age: M =79 (SD = 5.9)

Race: 57.2% White, 47.3% Non-white

Gender: 18.2% Male, 81.8% Female

Education: < HS (31%), HS (32.3%), > HS (36.7%)

Religion: Jewish (22.7%), Christian (71.4%), Other (3.1%),
None (2.8%)

Functional Difficulty: M = 2.2 (SD=.5) “a little difficulty to
some difficulty”

MMSE: M = 26.9 (SD=1.8)

Health Conditions: M = 6.9 (SD=2.7)
Procedures
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
½ participants (n = 159) rated 13 positive VOL items

Submitted to principal axis factoring


Rotated to varimax solution

R2 as estimate of common variance

Eigenvalues > 1.00
Yielded 2 dimensions of positive VOL - Spiritual
Self-efficacy Beliefs and Personal Agency
• 56% explained variance

Kaiser criterion of .3 + for item retention
 All

items loaded above cutoff criterion
Reliability analysis - Cronbach alphas
• 13-item positive VOL (α = .90)
Dimension I: Spiritual Self-efficacy Beliefs – Sample I (n = 159)
Here are statements about the meaning of life and personal
goals. For each statement, indicate whether you (5) agree
very strongly, (4) agree, (3) neither agree or disagree, (2)
disagree, (1) disagree strongly
Spiritual Self-efficacy
Beliefs
(α = .87)
Life has meaning for me
.83
I have a strong will to live right now
.81
My personal beliefs allow me to maintain a hopeful
attitude
.74
Each new day I have much to look forward to
.71
I intend to make the most of my life
.51
My life these days is a useful life
.48
My life is guided by strong religious or ethical beliefs
.47
I feel hopeful right now
.39
Dimension II: Personal Agency – Sample I (n = 159)
Here are statements about the meaning of life and
personal goals. For each statement, indicate whether you
(5) agree very strongly, (4) agree, (3) neither agree or
disagree, (2) disagree, (1) disagree strongly
Personal Agency
(α = .83)
I can think of many ways to get the things in life that are
most important to me
.76
Even when others get discouraged, I know I can find a
way to solve the problem
.72
I can think of many ways to get out of a jam
.64
I meet the goals I set for myself
.56
I feel able to accomplish my life goals
.53
Measures
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
CES-D – Radloff’s (1977) 20-item measure of the frequency of depressive
symptoms in past week with responses from 0 = “rarely/none of the time”
to 3 = “most/all of the time”; higher scores = greater depression (=.72)

Mastery Beliefs – Pearlin & Schooler’s (1978) 7-item self-rated measure
of the amount of perceived control over one’s life with responses from
1=“disagree a lot” to 4 = “agree a lot”; higher scores = greater mastery
( =.65)

Function-oriented Control Strategies – investigator-developed self-rating
measure of 8 goal engagement control strategies on a 4-point scale from
1 = “not at all true” to 4 = “very much true”; higher scores = greater use
of control strategies ( =.69)

Falls – single item measure reporting # of recent falls in past 6 months

Cognitive Status – Folstein, Folstein & McHugh’s (1975) MMSE assessing
orientation, recall, attention, calculation and language with <24 indicating
cognitive impairment; higher scores = greater cognitive functioning
( = .70)
Study Hypotheses
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Convergent Evidence

Depressive symptoms will be significantly but inversely
related to Spiritual Self-efficacy Beliefs, Personal Agency
and positive VOL

Mastery beliefs and use of engagement control strategies
will be significantly and positively related to Spiritual Selfefficacy Beliefs, Personal Agency and positive VOL
Discriminant Evidence

Number of recent falls and cognitive status will not be
associated with Spiritual Self-efficacy Beliefs, Personal
Agency or positive VOL
Statistical Analyses
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
Frequency distributions and summary statistics for each
demographic factor

Chi Square and Wilcoxon Rank-Sum tests to examine
differences in Samples I and II
• No differences observed

Examined distribution of residuals for each outcome
measure to identify violations of the normality assumption
• No violations observed

Means(SD) and intercorrelations of each predictor and
criterion measure

Regressions of VOL, Spiritual Self-efficacy Beliefs and
Personal Agency on multiple convergent and discriminant
predictors and demographic characteristics of participants
Sample II (n = 160 ) Means, SDs and Theoretical Range for Predictors of
Valuation of Life, Spiritual Self-efficacy Beliefs and Personal Agency
Predictor
Mean (SD)
Theoretical Range
15.1 (11.2)
0 - 60
Mastery Beliefs
2.8 (.6) a
1 - 28
Goal Engagement Control Strategies
3.2 (.5) b
1 - 32
Cognitive Status (MMSE)
26.8 (1.8)
0 - 30
.8 (1.4)
0-?
Depressive Symptoms (CES-D)
Falls
aMean
response category = “Agree a little”
bMean response category = “Moderately true”
Convergent and Discriminant Correlational Support of Spiritual Selfefficacy Beliefs, Personal Agency and positive VOL (Sample II; n = 160)
Spiritual Selfefficacy Beliefsa
Personal
Agencyb
Valuation
of Lifec
Predictor
Unstandardized Beta (SE)
Depressive Symptoms
(CES-D)
-.02 (.01)****
-.10 (.02) ****
-.02 (.00) ****
Mastery Beliefs
.28 (.06)****
1.33 (.33) ****
.28 (.05) ****
Goal Engagement Control
Strategies
.29 (.06)****
1.65 (.35) ****
.31 (.06) ****
Number of Falls
.01 (.02)
.11 (.12)
.01 (.02)
-.01 (.02)
-.08 (.10)
-.01 (.02)
Cognitive Status (MMSE)
****p < .0001
a R2
= .38
bR2 =
.31
c R2
= .42
Interrelationship of Sample Characteristics and Spiritual Self-efficacy Beliefs,
Personal Agency and Overall Valuation of Life (N = 319)
Spiritual Selfefficacy Beliefsa
Predictor
Personal
Agencyb
Valuation of Lifec
Unstandardized Beta (SE)
Age
-.03 (.05)
-.03 (.04)
-.05 (.08)
Race
3.16 (.66)****
1.46 (.46)**
4.62 (1.00)****
Gender
-.86 (.74)
-1.06 (.52)*
Living arrangement
.11 (.60)
.01 (.42)
.12 (.91)
Education
.39 (.34)
.18 (.24)
.56 (.51)
Religious preference
.11 (.08)
.06 (.06)
.17 (.12)
Economic well-being
.51 (.27)
.01 (.19)
.52 (.42)
Social Support
.34 (.05)****
.16 (.04)***
.50 (.08)****
*p < .05
**p < .01
****p < .0001
a R2
= .26
-1.92 (1.12)
bR2
= .13
c R2
= .25
Conclusions
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




Valuing or being attached to one’s life consists of two distinct dimensions
for frail, functionally vulnerable, community-dwelling elders
• Spiritual Self-efficacy Beliefs
• Personal Agency
Spiritual Self-efficacy Beliefs, Personal Agency and VOL appear to be
valid, internally consistent constructs/measures for this population
Depression, mastery and use of goal engagement control strategies are
significantly related to Spiritual Self-efficacy Beliefs, Personal Agency
and positive VOL in frail elders
 VOL is not independent of depression as a health factor
Race and Social Support are significantly and positively associated with
higher levels of Spiritual Self-efficacy Beliefs, Personal Agency and
VOL
 Non-whites score higher in VOL and each dimension of VOL
Gender is significantly related to Personal Agency but not Spiritual Selfefficacy or positive VOL
• Female elders are less confident about pursuing goals
Implications
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 What does the VOL construct contribute?

Identifies new meaning components

Includes deep/profound level of emotionality and
meaning implicit in other constructs, e.g., mood, selfefficacy

May illuminate the assimilative/accommodative
adaptational process by which elders successfully adjust
to illness and decline
 Raises research questions:

What is the relationship of VOL and its dimensions to
elder health and well-being?

If VOL and/or its dimensions support positive aging,
what kind of interventions would strengthen VOL?
Future Directions
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 Examine whether the two observed dimensions of positive
VOL, i.e., Spiritual Self-efficacy Beliefs and Personal Agency
obtain for other homogeneous samples of older adults, e.g.,
individuals suffering sensory impairments or cardio-vascular
disease
 Examine the mediating and moderating influence of Spiritual
Self-efficacy Beliefs, Personal Agency and positive VOL on
frail elders’ affective response to declining capabilities in
Basic, ADL, IADL and Mobility functioning
 Longitudinal study of VOL, Spiritual Self-efficacy Beliefs
and Personal Agency as a function of change in health status,
functional competence and QOL factors
References
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•
Powell, M.P., Moss, M., Hoffman, C., Grant, R., Ten Have, T.,
Kleban, M.H. (1999). Health, valuation of life, and the wish to
live. The Gerontologist, 39, 4, 406-416.
•
Powell, M.P., Moss, M., Hoffman, C., Kleban, M.H.,
Ruckdeschel, K., Winter, L. (2001). Valuation of life: A concept
and a scale. Journal of Aging and Health, 13, 1, 3-31.
•
Powell, M.P, Moss, M., Winter, L., Hoffman, C. (2002).
Motivation in later life: Personal projects and well-being.
Psychology and Aging, 17, 4, 539-547.