Mikaela Birgitta von Bonsdorff

We investigated stressful adversities older adults face, examined whether older men and women experience them differently, assessed the stressfulness of these events and studied their relationship to resilience—the ability to overcome adversity. This cross‐sectional study included 1179 respondents from the Helsinki Birth Cohort Study, born between 1934 and 1944. At a mean age of 75 years, respondents reported the most stressful adversity in the past five years, its perceived stressfulness and resilience using the Hardy–Gill resilience scale. Adversities were coded using a qualitative content analysis. General linear modelling was used to examine the relationship between perceived stressfulness and resilience across types of adversity. We identified ten types of highly stressful adversities, with the five most common being personal illness (23.6%), illness (17.6%) or death (15.8%) of a close relative, relationship adversity (12.7%) and adversity related to living situations (8.6%). 4.8% of participants experienced ageing‐related changes as the most stressful adversities. Reported adversities were generally perceived as highly stressful, while resilience scores were intermediate. Men reported more self‐related adversity, perceived these as less stressful and showed better coping (a higher mean resilience scale score) than women after a highly stressful adversity. The identified highly stressful adversities included two previously unreported types related to the ageing process: ‘having to give up…’ (e.g., driving) and ‘health/functional decline’. Although the reported adversities were highly stressful, respondents coped well, suggesting a good capacity to manage adversity in later life.

Background: Patient safety incident reporting systems foster a nonblaming culture and support organizational learning. By incorporating an ethical dimension, these systems can support nursing managers in addressing ethical incidents, strengthen healthcare professionals’ ethical competence and conduct, and promote the delivery of high‐quality patient care. Aim: This study aimed to describe the types of reported ethical incidents, outline the actions and measures implemented to prevent recurrence, and reflect on how our findings inform the organization of ethical incident prevention management. Design: This retrospective register study was conducted using an artificial intelligence‐based closed data analysis program and inductive content analysis. The standards for reporting qualitative research (SRQR) checklist was used. Research Context: Data were collected using the HaiPro system at a university hospital in Finland from 2018 to 2021. During this time, 3615 patient safety incident reports were submitted, of which 579 (16%) were categorized as ethical incidents and subsequently analyzed. Ethical Considerations: Ethical requirements were met. According to the Finnish ethical guidelines, an ethical review was unnecessary for this register study. The research permit was provided by the participating organization. Results: We found two main categories: (1) ethical incidents, with subcategories of professional conduct and patient care management and (2) actions and preventive measures, emphasizing continuous improvement, enhancing professional competence, fostering professional communication and conduct, improving data management, and enhancing patient care through the reporting system. Conclusions: Cultivating an ethical culture through the strategic management of ethical incidents is vital. An efficient structure for handling such incidents can improve decision‐making, ensure accountability, support professionals, and reduce their burden, ultimately enhancing care quality. Implications: This study provides valuable insights for nursing managers on effectively addressing ethical incidents. Their role is pivotal in shaping an ethical culture through strategic leadership, promoting educational initiatives, and supporting the implementation of ethical practices.

How do workers decide to comply with, alter, or resist algorithmic surveillance? We argue that decontextualization is a key, yet overlooked, mechanism that shapes workers’ responses to algorithmic surveillance. Research has widely critiqued algorithmic surveillance, focusing on diminished worker control and agency. However, the control-resistance mechanisms related to algorithmic surveillance are undertheorized and underexplored. We draw on socio-technical systems theory and micro-level legitimacy to examine mechanisms of surveillance and resistance in online crowdwork. Our findings, based on three-wave data from 435 European online crowdworkers, show that perceived algorithmic surveillance undermines trust and fairness, while increasing privacy concerns, which in turn inform workers’ intentions to comply, alter, or resist algorithmic surveillance. Perceived decontextualization moderates these relationships, exacerbating the adverse effects on trust and fairness while mitigating the effects on privacy concerns. These outcomes extend the view that individual outcomes are shaped by social and technical factors only by demonstrating that perceived decontextualization and micro-level legitimacy judgments—that is, trust, privacy concerns, and fairness—are important socio-technical mechanisms that also impact workers’ compliance. By highlighting the overlooked role of decontextualization in shaping resistance and compliance, this study challenges dominant control-centric narratives and offers a new lens on algorithmic governance.

The study aimed to investigate whether mental well-being and generativity predict retirement preferences. Longitudinal data ( n = 201) were drawn from the Jyväskylä Longitudinal Study of Personality and Social Development (JYLS). Life satisfaction, psychological well-being, social well-being, and generativity were assessed at ages 42, 50, and 61. Preferred retirement age and willingness to continue working after retirement were assessed at age 61. Bivariate and multivariate logistic regression models were deployed. The results showed that individuals with higher generativity at ages 42 and 61, as well as higher life satisfaction, psychological well-being, and social well-being at age 61, were more likely to prefer later retirement age (i.e., at or after the national minimum retirement age). Those with higher generativity at age 61 were more likely to be willing to continue working post-retirement. Some gender-based differences were observed. Men, but not women, with higher generativity and social well-being at age 42 were more likely to prefer post-retirement working. To conclude, generativity and mental well-being may be relevant in extending the working careers of aging employees.

Importance: Stress-related disorders predict subsequent somatic conditions, suggesting these disorders involve systemic mechanisms, yet evidence from biomarkers remains fragmented across physiological systems. Objective: To investigate whether routinely collected laboratory biomarkers predict the onset of a stress-related disorder and analyze their temporal trends prior to diagnosis. Design, setting, and participants: Nested case-control study using electronic health records from Central Finland (2010-2023). The study included 73,909 participants, aged 34-92 years at baseline, with 6,758 cases of stress-related disorders and 67,151 controls matched to cases on sex and birth year. Average follow-up was 2.8 ± 3.2 years. Main outcomes and measures: Stress-related disorders (International Classification of Diseases, Tenth Revision, category F43 and Z-codes Z73.0 and Z73.3) were the primary outcome. Ten routine laboratory biomarkers were examined: C-reactive protein (CRP), hemoglobin (Hb), glucose, glycated hemoglobin (HbA1c), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), creatinine (Cr), sodium (Na), and potassium (K). Temporal trends in these biomarkers were visualized using generalized additive models, and Cox proportional hazards models were used to assess whether biomarker levels measured within one year prior to diagnosis predicted the onset of stress-related disorders. Results: Five biomarkers significantly predicted stress-related disorders within one year prior to diagnosis. Higher potassium (HR 0.73; 95% CI, 0.63–0.84) and higher HDL cholesterol (HR 0.83; 95% CI, 0.74–0.92) levels were associated with reduced risk, whereas higher LDL cholesterol was associated with increased risk (HR 1.10; 95% CI, 1.05–1.16). Higher hemoglobin (HR, 0.98; 95% CI, 0.98–0.98) and higher sodium (HR, 0.96; 95% CI, 0.95–0.98) were also associated with small reductions in risk. No significant associations were observed for remaining biomarkers. According to temporal trend analysis, lipid differences were detectable years before diagnosis, whereas changes in potassium, sodium, and hemoglobin were more transient. Conclusions and relevance: Several routine laboratory markers predict stress-related disorders up to one year in advance, with potassium and lipids showing strongest effects. These findings contribute to understanding the systemic nature of stress-related disorders and point to opportunities for preventive and integrative care approaches.

Background and Objective: Previous research assessing whether biological ageing (BA) indicators can enhance the risk assessment of cardiovascular disease (CVD) outcomes beyond established CVD risk indicators, such as Framingham Risk Score (FRS) and Systematic Coronary Risk Evaluation (SCORE2)/SCORE2-Older Persons (OP), is scarce. We explored whether BA indicators, namely the Rockwood Frailty Index (FI) and leukocyte telomere length (TL), improve predictive accuracy of CVD outcomes beyond the traditional CVD risk indicators in general population of middle-aged and older CVD-free individuals. Methods: Data included 14 118 individuals from three population-based cohorts: TwinGene, Health 2000 (H2000), and the Helsinki Birth Cohort Study, grouped by baseline age (<70, 70+). The outcomes were incident CVD and CVD mortality with 10-year follow-up. Risk estimations were assessed using Cox regression and predictive accuracies with Harrell’s C-index. Results: Across the three study cohorts and age groups: (i) a higher FI, but not TL, was associated with a higher occurrence of incident CVD (P < .05), (ii) also when considering simultaneously the baseline CVD risk according to FRS or SCORE2/SCORE2-OP (P < .05) (iii) adding FI to the FRS or SCORE2/SCORE2-OP model improved the predictive accuracy of incident CVD. Similar findings were seen for CVD mortality, but less consistently across the cohorts. Conclusions: We show robust evidence that a higher FI value at baseline is associated with an increased risk of incident CVD in middle-aged and older CVD-free individuals, also when simultaneously considering the risk according to the FRS or SCORE2/SCORE2-OP. The FI improved the predictive accuracy of CVD outcomes beyond the traditional CVD risk indicators and demonstrated satisfactory predictive accuracy even when used independently.

Purpose: Entrepreneurial exit research has overlooked the unique context of exits at retirement age when an exit marks the end of an entrepreneurial career (i.e. retirement). To better understand retirement exit decisions and transitions, this study introduces the concept of work ability (i.e. an individual’s ability to meet work demands) into the entrepreneurial exit literature and, based on role theory, hypothesises its effect and interaction with general life satisfaction in explaining the entrepreneurial exits to retirement. The study clarifies the dynamics between the voluntary and non-voluntary aspects behind exit to retirement.Design/methodology/approach: The authors use mixed-effects ordinal logistic regression with four-wave panel data on 198 Finnish small business entrepreneurs who intend to retire to test hypotheses on the relationship between work ability, general life satisfaction and entrepreneurial exit to retirement.Findings: The study provides partial support for the hypothesis that work ability negatively impacts entrepreneurial exit to retirement and strong support for the idea that this effect is affected by general life satisfaction. Entrepreneurs who experience higher life satisfaction are likely to retire on their own terms, whereas those less satisfied continue working until declining work ability forces them to retire.Originality/value: The study contributes to the entrepreneurial exit literature by showing how the exit dynamics unfold in the unique context of entrepreneurial exit to retirement. The theoretical discussion opens up the potential psychological mechanisms behind such dynamics.

A more holistic view is needed regarding the impact of life events on the quality of life of older adults. We explored how senior housing residents perceive the influence of life events on their current quality of life, from a life course perspective. Semi-structured interviews were conducted with 33 residents aged 68 to 97 years from three senior houses. The thematic analysis suggested that events related to social relationships and human agency may influence quality of life in old age. Experiences that contribute to personal development, feeling safe, social connectedness, and a strong sense of human agency were perceived to add quality to life. Events that cause anxiety, reduces one’s sense of autonomy, and involve loss of social closeness were perceived to detract from quality of life. Life events can also sometimes evoke conflicting feelings. The study implies that the influence of life events depends on whether human needs are met.

Background: Few studies have examined longitudinal changes in lifestyle-related factors and frailty. Methods: We examined the association between individual lifestyle factors (exercise, diet, sleep, alcohol, smoking and body composition), their sum at baseline, their change over the 17-year follow-up and the rate of change in frailty index values using linear mixed models in a cohort of 2,000 participants aged 57–69 years at baseline. Results: A higher number of healthy lifestyle-related factors at baseline was associated with lower levels of frailty but not with its rate of change from late midlife into old age. Participants who stopped exercising regularly (adjusted β × Time = 0.19, 95%CI = 0.10, 0.27) and who began experiencing sleeping difficulties (adjusted β × Time = 0.20, 95%CI = 0.10, 0.31) experienced more rapid increases in frailty from late midlife into old age. Conversely, those whose sleep improved (adjusted β × Time = −0.10, 95%CI = −0.23, −0.01) showed a slower increase in frailty from late midlife onwards. Participants letting go of lifestyle-related factors (decline by 3+ factors vs. no change) became more frail faster from late midlife into old age (adjusted β × Time = 0.16, 95% CI = 0.01, 0.30). Conclusions: Lifestyle-related differences in frailty were already evident in late midlife and persisted into old age. Adopting one new healthy lifestyle-related factor had a small impact on a slightly less steeply increasing level of frailty. Maintaining regular exercise and sleeping habits may help prevent more rapid increases in frailty.

Aims: To describe nurse managers' perceptions of interventions to support nurses as second victims of patient safety incidents and to describe the management of interventions and ways to improve them.Design: A qualitative study using interviews.Methods: A purposive sample of nurse managers (n = 16) recruited from three hospital districts in Finland was interviewed in 2021. The data were analysed using elements of inductive and deductive content analysis.Results: The study identified three main categories: (1) Management of second victim support, which contained three sub‐categories related to the nurse manager's role, support received by the nurse manager and challenges of support management; (2) interventions to support second victims included existing interventions and operating models; and (3) improving second victim support, based on the sub‐categories developing practices and developing an open and non‐blaming patient safety culture.Conclusion: Nurse managers play a crucial role in supporting nurses as second victims of patient safety incidents and coordinating additional support. Operating models for managing interventions could facilitate nurse managers' work and ensure adequate support for second victims. The support could be improved by increasing the awareness of the second victim phenomenon.Implications for the Profession and Patient Care: Mitigating the harmful effects of patient safety incidents can improve nurses' well‐being, reduce burden and attrition risks and positively impact patient safety.Impact: Increasing awareness of the second victim phenomenon and coherent operation models would provide equal support for the nurses and facilitate nurse managers' work.Reporting Method: COREQ checklist was used.What does this paper contribute to the wider global clinical community? Nurse managers' role is significant in supporting the second victims and coordinating additional support. Awareness of the second victim phenomenon and coherent operating models can secure adequate support for the nurses and facilitate nurse managers' work.