Objectives/purpose: Demoralization is a syndrome of existential distress that is associated with higher symptom burden in cancer patients, but little is known about demoralization in older adults with cancer (OACs; age 70+) whose perceptions of health are compounded by aging related concerns. The objective of this study was to determine whether attitudes towards aging mediated the relationship between self-reported health status and demoralization in OACs.
Methods: Three measures from a baseline assessment from an ongoing randomized controlled trial of psychotherapy for OACs (n=256) were analyzed: 1) Self-Reported (a single item asking patients to rank their general health with five options ranging from “Poor” to “Excellent”), 2) Attitudes to Aging Questionnaire, and 3) Demoralization scale. Hypotheses were developed and tested using the Macro PROCESS Model (Hayes) in SPSS.
Of the 256 participants, 79% were female and 86% were White, with a median age of 74. Mediation analyses revealed a marginally significant negative direct effect of self-reported health status on demoralization (path c’: β = -.104, p = .06). Self-reported health status was positively associated with more positive attitudes to aging (path a: β = .136, p = .03) and more positive attitudes to aging were negatively associated with demoralization (path b: β = -.479, p < .001). The indirect path from self-reported health status to demoralization, through attitudes to aging, was statistically significant (path a*b: β = -.065), with a bootstrap confidence interval on 5,000 bootstrap samples was entirely below zero (-.126, -.003), suggesting attitudes to aging mediate the relationship between self-reported health status and demoralization.
Conclusions and clinical implications: Results suggest that the negative association between self-reported health status and demoralization could be caused or exacerbated by negative attitudes to aging. These results suggest interventions in OACs should target attitudes towards aging to improve efficacy.