The personal experience of aging, the resources relevant to it, and the consequences for subjective well-being were investigated in a sample of 4034 Germans aged 40 to 85. The data revealed 3 dimensions of aging experiences as particularly relevant: (a) physical decline, (b) continuous growth, and (c) social loss. Not only being younger but also having better subjective health, higher income, less loneliness, higher education, and greater hope were negatively associated with physical decline and social loss and positively associated with continuous growth. The number of children participants had played no role. All three dimensions of the aging experience were also found to be related to both positive and negative affect and, with the exception of physical decline, to life satisfaction.

ObjectivesThe task force aimed to: (1) develop evidence-based recommendations for patient education (PE) for people with inflammatory arthritis, (2) identify the need for further research on PE and (3) determine health professionals' educational needs in order to provide evidence-based PE. Methods A multidisciplinary task force, representing 10 European countries, formulated a definition for PE and 10 research questions that guided a systematic literature review (SLR). The results from the SLR were discussed and used as a basis for developing the recommendations, a research agenda and an educational agenda. The recommendations were categorised according to level and strength of evidence graded from A (highest) to D (lowest). Task force members rated their agreement with each recommendation from 0 (total disagreement) to 10 (total agreement). Results Based on the SLR and expert opinions, eight recommendations were developed, four with strength A evidence. The recommendations addressed when and by whom PE should be offered, modes and methods of delivery, theoretical framework, outcomes and evaluation. A high level of agreement was achieved for all recommendations (mean range 9.4-9.8). The task force proposed a research agenda and an educational agenda. Conclusions The eight evidence-based and expert opinion-based recommendations for PE for people with inflammatory arthritis are intended to provide a core framework for the delivery of PE and training for health professionals in delivering PE across Europe.

Objective. Although patients with rheumatoid arthritis (RA) experience fatigue, little is known about its causes and consequences, and a fully developed theoretical model explaining the experience of fatigue in RA is lacking. Our goal was to systematically review studies in RA that examined factors related to fatigue to gain more insight into its possible causes and consequences. Methods. Medline, Web of Science, Scopus, and PsycINFO were searched for relevant studies. All studies with RA samples about the relationship between fatigue and other variables that defined dependent and independent variables and used multivariate statistical methods were preliminarily included. After reviewing 129 full texts, we identified 25 studies on possible causes of fatigue and 17 studies on possible consequences of fatigue. Results. The studies found possible causes of fatigue in illness-related aspects, physical functioning, cognitive/emotional functioning, and social aspects. Additionally, being a woman was related to higher levels of fatigue. Inflammatory activity showed an unclear relationship with fatigue in RA. Possible consequences of fatigue were also found among illnessrelated aspects, physical functioning, cognitive/emotional functioning, and social aspects. The strongest evidence for a relationship between fatigue and other variables was found regarding pain, physical functioning, and depression. Conclusion. This review summarizes the current knowledge in the field in order to inform future research on causes and consequences of fatigue in RA. However, the results are based on cross-sectional and longitudinal studies with different designs and different fatigue scales. For a better identification of causal associations between fatigue in RA and related factors, longitudinal prospective designs with adequate fatigue measurements are suggested.

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Results point to the existence of differences in fatigue experience according to gender, age and daily roles. This finding indicates a need for targeting advice and interventions to the individual situation of a patient. Furthermore, the positive aspects patients reported about their fatigue could facilitate an approach that is focused on remaining opportunities and not just on restrictions.

Conceptualizing proactive coping as a set of competencies allows the translation of this approach into interventions. Competencies that facilitate future-oriented self-regulation can be improved by a brief educational program in middle and late adulthood.

These findings indicate that patients perceive the impact of fatigue on their daily lives to be a key factor in decreasing their quality of life. To increase awareness of fatigue in healthcare professionals and patients and to facilitate early fatigue self-management, a pro-active approach by healthcare professionals might be the best way to realize effective tailored treatment.

Perceptions and evaluations of the own body are important sources of self-esteem. Having a rheumatic disease challenges maintenance of positive self-esteem due to consequences of the disease such as unfavorable sensations as pain and limited (physical) functioning. We expect that a positive experience of the own body in spite of a rheumatic disease (body-self harmony) will be associated with higher levels of self-esteem and that experiencing the body as unworthy part of the own person or as disabler for own strivings (body-self alienation) will result in lower levels of self-esteem. For this explorative study, the body experience questionnaire (BEQ) measuring body-self unity was developed and piloted. One hundred sixty-eight patients visiting the outpatient rheumatology clinic of the Medisch Spectrum Twente, Enschede, The Netherlands, completed a questionnaire on touchscreen computers to measure body-self unity (BEQ), illness cognitions (illness cognition questionnaire), pain intensity, functional limitations (health assessment questionnaire disability index), self-esteem (Rosenberg Self-Esteem Scale) and demographics. To analyze predictors of self-esteem, hierarchical regression analyses were employed. The BEQ revealed a two-factor structure with good reliability (subscale harmony, four items, Cronbach's α = 0.76; subscale alienation, six items, Cronbach's α = 0.84). The final model of the hierarchical regression analyses showed that self-esteem can be predicted by the illness cognitions helplessness and acceptance, by harmony and most strongly by alienation from the body. R(2) of the final model was 0.50. The relationship between functional limitations and self-esteem was totally mediated by the psychological constructs body-self unity and illness cognitions. This explorative study showed the importance of the unity of body and self for self-esteem in patients with a rheumatic disease.