Social relations as determinant of onset of disability in aging

When your world gets smaller: how older people try to meet their social needs, including the role of social technology

Social needs are important basic human needs. When social needs are not fulfilled, it can lead to mental and physical health problems. In an ageing society, meeting the social needs of older adults is important to sustain their wellbeing and quality of life. Social technology is used by younger people attempting to fulfil social needs. The aim of this study is to understand the social needs of older people and the role of social technology in fulfilling these needs. Using this information we will uncover opportunities for (technological) interventions. We conducted a qualitative explorative field study by interviewing 19 community-dwelling older adults. The participants were selected by professional care-givers with the help of a list of criteria for people at risk of social isolation or loneliness. Semi-structured interviews were held, using a topic list covering the following topics: social networks, social support, connectedness, neighbourhood, activities and hobbies, as well as use of and experiences with social technology. After thematic analysis, inductive codes were attached to quotations relevant to the research question. The results were described in four sections: (a) social needs and relationships; (b) the influence of life history and personality; (c) possibilities and barriers to meet social needs; and (d) use of and attitude towards social technology. The results indicate that the group of participants is heterogeneous and that their social needs and the way they try to meet these are diverse. The Social Production Functions Theory of Successful Aging (SPF-SA) was found to be a useful basis for interpreting and presenting the data. Social needs such as connectedness, autonomy, affection, behavioural confirmation and status are important for the wellbeing of older people. Although the need for affection is most easy to fulfil for older people, it looks like satisfaction of the need for behavioural confirmation and status are in some cases preferred, especially by the male participants. Resources such as relationships, activities, personal circumstances and social technology can help meet social needs. Where there is a lack of (physical) resources such as health problems, reduced mobility, death of network members, fear of rejection and gossip, and poor financial circumstances, meeting social needs can be more difficult for some older people. Social technology now plays a modest role in the lives of older people and in fulfilling their social needs. Because of its potential and its role in the lives of younger people, social technology can be seen as a promising resource in the satisfaction of social needs. However, since it is yet unknown how and to what extent the use of social network technologies, such as Facebook, can be beneficial for older people, more research in this area is needed. Based on our findings, we conclude that the world of older individuals is getting smaller. The loss of resources,e.g.the loss of one's health and mobility, may make it more difficult for an older person to connect with the world outside, which may result in a smaller social network. We therefore suggest that interventions to support older adults to meet their social needs may focus on two aspects: supporting and improving the world close by and bringing the world outside a little bit closer.

How well do general practitioners know their elderly patients' social relations and feelings of loneliness?

BACKGROUND

Social relationships are important to people and affect their quality of life, morbidity and mortality. The aim of this study was to examine the correlation between elderly patients' descriptions of their social relations and feelings of loneliness, and their general practitioners' assessments of these.

METHODS

Cross-sectional study in 12 general practices in the Capital Region of Denmark. During a three-week period each practice asked their patients aged 65 and older to fill out a questionnaire regarding health, social relations and loneliness; the general practitioner (GP) filled out a matching questionnaire regarding their perception of the patient's social relations and loneliness. Data were collected from February to September 2014.

RESULTS

Of the 767 eligible patients 476 were included in the study. For 447 patients both GP and patient had answered at least one question on loneliness or social participation. The correlations between patients' and GPs' answers regarding social participation and loneliness were low (0.04-0.26). While GPs were less able to identify lonely patients and patients with low social participation, they were better at identifying not-lonely patients or those with high social participation. It was especially difficult for GPs to identify lonely patients when they were not living alone or if the GP believed the patient had high social participation.

CONCLUSION

GPs have difficulty identifying patients who are lonely or have low social participation and this ability is further diminished when the patients do not live alone or if the GP believes them to have high social participation. Given the consequences of loneliness and limited social participation on patients' health and well-being, and GPs' limited ability to identify these patients, GPs' obligations and resources in this area need to be clarified.

Redes sociais e funcionalidade em pessoas idosas: evidências do estudo Saúde, Bem-Estar e Envelhecimento (SABE)

RESUMO: Introdução: Possuir redes sociais ativas parece influenciar positivamente o desempenho funcional de idosos. Objetivo: Verificar a associação entre as características das redes sociais de idosos e o surgimento de comprometimento funcional. Métodos: Estudo longitudinal de base populacional que utilizou as coortesde2006 (n = 1.413) e 2010 (n = 990) do Estudo Saúde, Bem-Estar e Envelhecimento (SABE). Para caracterização das redes sociais utilizou-se as seguintes variáveis: número de integrantes da rede; arranjo domiciliar; sexo e idade dos integrantes; co-residência com criança ou apenas com idosos; satisfação com a relação; recebimento e oferecimento de apoio social (financeiro, material, emocional, realização de tarefas dentro e fora de casa, companhia e cuidados pessoais). Utilizou-se regressão logística para a análise dos dados. Todos os cuidados éticos foram observados. Resultados: As redes sociais dos idosos possuem, em média, 8,15 integrantes e são constituídas predominantemente por familiares com idade entre 15 e 59 anos. Idosos dependentes recebem mais apoio material, para realização de tarefas domésticas, fora de casa e cuidados pessoais, enquanto os idosos independentes recebem mais apoio emocional e companhia. Oferecer apoio social (OR = 0,32; IC95% 0,14-0,71) diminuiu as chances de desenvolver dependência, independente de condições sociodemográficas e de saúde. Conclusão: Deve-se estimular o fortalecimento das redes sociais na velhice, uma vez que a confiança no cuidado informal, oferecido, principalmente pelas famílias, pode não ser a melhor opção para lidar com a demanda de cuidado crescente que acompanha o envelhecimento da população brasileira.

Social Frailty Is Associated with Physical Functioning, Cognition, and Depression, and Predicts Mortality

OBJECTIVES

Social frailty is related to adverse health-related outcomes. However, the measurement thereof is controversial and research into the relationship between social frailty and physical functioning remains limited. This study aimed to determine social frailty status via developing a simple self-reported screening tool, termed the HALFT scale, and to examine the association between social frailty and physical functioning, cognition, depression, and mortality among community-dwelling older adults.

DESIGN

Prospective cohort study.

SETTING

Community.

PARTICIPANTS

1697 community-dwelling adults aged ≥60 years from Beijing Longitudinal Study of Aging were included.

MEASUREMENTS

The HALFT scale was developed based on 5 items: unhelpful to others, limited social participation, loneliness, financial difficulty, and not having anyone to talk to. Socioeconomic and demographic data were collected, and physical functioning, frailty index, cognition, and depression were assessed.

RESULTS

The prevalence of social frailty was 7.7% (weighted, 4.5%). Participants with physical frailty, low levels of physical activity, and poor physical functioning had a higher prevalence of social frailty. Social frailty was associated with dementia, subjective memory decline, depression, cognitive impairment, and having experienced a recent significant life event. After adjusting for age and sex, the 8-year mortality hazard ratios were 2.5-4.3 and 1.6-2.3, respectively, for those with social frailty or pre-social frailty. Each component of the HALFT scale predicted 8-year mortality.

CONCLUSIONS

Social frailty is associated with physical functioning, cognition, and depression, and predicts mortality. The HALFT scale could be a useful screening tool for determining social frailty in older adults. Interventions aimed at preventing or delaying social frailty are warranted.

The association between Act-Belong-Commit indicators and problem drinking among older Irish adults: Findings from a prospective analysis of the Irish Longitudinal Study on Ageing (TILDA)

The Act-Belong-Commit campaign is the world's first comprehensive, population-wide, community-based program to promote mental health. However, its potential for preventing substance use disorders is unknown. Further, a literature gap is evident concerning behavioral modification strategies to prevent such disorders. The aim of this study was to prospectively assess the association between indicators of the Act-Belong-Commit behavioral domains and the development of problem drinking. Data from two waves of the Irish Longitudinal Study on Ageing (TILDA) were analyzed. The sample consisted of 3950 adults aged ≥50years. A validated scale for problem drinking was used. The number of social/recreational activities engaged in was used as an indicator of Act, social network integration as an indicator of Belong, and frequency of participation in these social/recreational activities as an indicator of Commit. Multivariable logistic regression analyses were conducted to assess associations between baseline indicators of Act-Belong-Commit and the development of problem drinking at two-year follow-up. Each increase in the number of social/recreational activities (Act) inversely predicted the onset of problem drinking. Similarly, being well integrated into social networks (Belong) was negatively associated with the development of problem drinking. Finally, frequency of participation in social/recreational activities (Commit) also inversely predicted the onset of problem drinking. These associations were apparent regardless of the presence of baseline common mental disorders. Act-Belong-Commit indicators are shown to be associated with a reduced risk for problem drinking. This lends further support to the Act-Belong-Commit domains and has wide-ranging implications for preventing substance use disorders in the aging community.

Association between disability and social capital among community-dwelling elderly

Objective

To assess the prevalence of disability and its association with social capital among community-dwelling elderly.

Methods

The study was based on 2nd Health Survey of Belo Horizonte Metropolitan Region - 2010, that included 1,995 community-dwelling elderly, randomly sampled. The exposure of interest was social capital, measured by confidence in neighborhood, perception of the physical environment, sense of cohesion in housing, and neighborhood perception of help. Socio-demographic variables, health conditions and use of health services were considered in the analysis with the purpose of adjustment.

Results

Approximately one third of participants (32.6%) were unable to at least one instrumental activity of daily living (IADL) and/or basic activity of daily living (ADL); the prevalence of disability in ADL/IADL was 18.1%, and only in IADL was 14.6%. Elderly with functional disabilities had higher odds of poor social capital, but only the sense of cohesion in housing neighborhood showed to be independently associated with functional disability (OR = 1.80; 95%CI 1.12 - 2.88).

Conclusions

Our results show the importance of social capital in research on associated factors of functional disability and indicate the need to implement public policies for social and environmental areas, since the needs of the elderly require measures beyond those typical of the health sector.

Negotiations between health and social goals over the lifespan: The role of future time perspective

The interplay between health and social goals in relation to age and future time perspective was examined among 131 older and 131 younger adults via surveys and future time manipulations (limited, unchanged, and expansive). Being older was associated with weaker physical activity intentions and social activity intentions as mediated by a limited future time perspective. Physical activity intentions decreased in the limited condition and increased in the expansive condition, social activity intentions increased in all conditions, and preference toward health (over social) goals decreased in both the limited and expansive conditions. The results suggest that anticipated endings may become salient in all conditions and favor social goals, which are emotionally relevant.

Social needs of older people: a systematic literature review

Social needs are important basic human needs. When social needs are not satisfied, this can lead to mental and physical health problems. With a growing population of older adults and the need for them to stay healthy and community-dwelling, satisfying social needs is important. The aim of this review is to give more insight into the social needs of older people and subsequently into the characteristics of effective interventions for satisfying older people's social needs. A systematic review of the existing literature on quantitative, qualitative and mixed empirical studies on the social needs of older people was conducted. The themes that emerged were diversity, proximity, meaning of the relationship and reciprocity. These themes offered several intervention implications. Participation in hobbies and in volunteer work and being connected were among the main findings. The social needs of older people are diverse. They focus on both the intimate and the peripheral members of their networks. When satisfying social needs, reciprocity is important. The feeling of connectedness to others and to a community or neighbourhood contributes to wellbeing as well as a feeling of independence. Staying active by doing volunteer work or participating in (leisure) social activities satisfies social needs. Therefore, interventions should focus especially on the connectedness, participation and independence of the older adult.

Trajectories of social participation in old age: a systematic literature review

Abstract Objective: the present study aimed to identify patterns of social participation in old age and the theories used to explain them. Method: A systematic review was performed using the Medical Literature Analysis and Retrieval System Online (MEDLINE / PUBMED), Scientific Electronic Library Online (Scielo) and Web of Science (ISI Web of Knowledge) databases. The keywords used were: social participation, social engagement, social involvement and social activities; combined with seniors, the elderly, older adults, older people and aging. Research was performed between January and February. Results: thirty-one longitudinal studies on social participation among old and healthy middle-aged adults were included for analysis. In three studies social engagement levels increased, especially at the beginning of old age (up to 75 years). Twenty-one studies presented results that described the reduction of social engagement levels in old age, and five studies found that there was no change in levels of social involvement. The most used theories were: the activity theory, the social disengagement theory, the continuity theory and the theory of socioemotional selectivity. Conclusion: the results point to the need for reflection on what is envisioned and what is practiced in terms of policies and practices aimed at achieving successful aging. Future attempts should include not only incentives to remain active, but a description of factors that influence the social disengagement associated with poor adaptation in old age.

Psychosocial Well-Being Associated With Activity of Daily Living Stages Among Community-Dwelling Older Adults

Objectives: Activity of daily living (ADL) stages demonstrated ordered associations with risk of chronic conditions, hospitalization, nursing home use, and mortality among community-living elderly. This article explores the association of stages with psychosocial well-being. We hypothesized that higher ADL stages (greater ADL limitation) are associated with more restricted social networks, less perceived social support, greater social isolation, and poorer mental health. Methods: Cross-sectional data from the National Social Life, Health, and Aging Project (N = 3,002) were analyzed in regression models and latent factor models. Results: Although ADL stages had a nearly monotonic relationship with most mental health measures (e.g., Center for Epidemiologic Studies Depression Scale [CES-D]), only the complete limitation stage (Stage IV) showed significant disadvantage in the majority of social network measures. Discussion: The study may aid clinicians and policy makers to better understand the social and mental health needs of older adults at different ADL stages and provide well-planned social and mental health care.

The protective properties of Act-Belong-Commit indicators against incident depression, anxiety, and cognitive impairment among older Irish adults: Findings from a prospective community-based study

The Act-Belong-Commit campaign is the world's first comprehensive, population-wide, community-based program designed to promote mental health. The campaign targets individuals to engage in mentally healthy activities, while at the same time, encouraging community organizations that offer such activities, to increase participation in their activities. Using nationally-representative data from Ireland, the aim of this study was to prospectively assess the association between indicators of the Act-Belong-Commit behavioral domains and incident depression, anxiety, and cognitive impairment. Data from two consecutive waves of the Irish Longitudinal Study on Ageing (TILDA) were analyzed. The analytical sample consisted of 6098 adults aged ≥50years. Validated scales for depression, anxiety, and cognitive impairment were used. The number of social/recreational activities engaged in was used as an indicator of Act, social network integration as an indicator of Belong, and frequency of participation in these social/recreational activities as an indicator of Commit. Multivariable logistic regression analyses were conducted to assess associations between baseline indicators of Act-Belong-Commit and incident depression, anxiety, and cognitive impairment at two-year follow-up. The adjusted model showed that each increase in the number of social/recreational activities (Act) inversely predicted the onset of depression, anxiety, and cognitive impairment. The same was the case for social network integration (Belong); that is, being well integrated into social networks was a significant protective factor against all mental health outcomes. Finally, frequency of participation in social/recreational activities (Commit) significantly and inversely predicted the onset of depression and anxiety, while the protective effect against cognitive impairment was only marginally significant. Act-Belong-Commit indicators are shown to be protective against mental disorders and cognitive impairment among older Irish adults. This provides further evidence for the campaign's potential efficacy and has potentially wide-ranging implications for preventing the deterioration of mental health and cognitive decline in the aging community.

Relationship between Social Isolation and Indoor and Outdoor Physical Activity in Community-Dwelling Older Adults in Germany: Findings from the ActiFE Study

The purpose of this study was to establish the feasibility of using an aerobics class to produce potentially bone protective vertical impacts of ≥ 4g in older adults and to determine whether impacts can be predicted by physical function. Participants recruited from older adult exercise classes completed an SF-12 questionnaire, short physical performance battery, and an aerobics class with seven different components, performed at low and high intensity. Maximum g and jerk values were identified for each activity. Forty-one participants (mean 69 years) were included. Mean maximal values approached or exceeded the 4g threshold for four of the seven exercises. In multivariate analyses, age (–0.53; –0.77, –0.28) (standardized beta coefficient; 95% CI) and 4-m walk time (–0.39; –0.63, –0.16) were inversely related to maximum g. Aerobics classes can be used to produce relatively high vertical accelerations in older individuals, although the outcome is strongly dependent on age and physical function.

Barriers and Facilitators for Participation in People with Parkinson's Disease

BACKGROUND

Activity performance is marked by the degenerative nature of Parkinson's disease (PD), but few qualitative studies have focused on how people with PD perceive participation in life situations.

OBJECTIVE

To identify and describe barriers and facilitators for participation from the perspective of people with PD.

METHODS

Qualitative data was obtained by the focus group method using a semi-structured interview guide. Participants were recruited by purposeful sampling until saturation was reached. Homogeneity within each focus group was based on self-rated PD severity (mild, moderate, severe). Nine focus groups (three per PD severity level) included a total of 29 participants.

RESULTS

Complex dynamics between the individual and the physical and social environment create barriers and facilitators for participation as described in the four categories which emerged out of the focus group discussions. The category Ambiguity of attitudes and the support of others describes how attitudes and support of other people act both as facilitators and barriers for participation. PD specific complexity of the body and physical environment interaction describes barriers for participation. Facilitators emerged in the two categories PD expertise in health care and social services and Information and education foster PD specific understanding.

CONCLUSIONS

Our findings imply several potential means to facilitate participation for people with PD, taking the person as well as the environment into account in person-centred interventions. This involves aspects such as having access to PD specific expertise, increasing the knowledge and thereby the understanding of PD as well as providing support for maintained work-life.

Association Between Social Participation and 3-Year Change in Instrumental Activities of Daily Living in Community-Dwelling Elderly Adults

OBJECTIVES

To investigate whether social participation (SP) in older adults is associated with ability to perform instrumental activities of daily living (IADLs).

DESIGN

Prospective cohort study.

SETTING

Two local municipalities of Nara, Japan.

PARTICIPANTS

Individuals aged 65 to 96 (n = 2,774 male, n = 3,586 female) free of IADL disability at baseline.

MEASUREMENTS

SP and IADLs were assessed using self-administered questionnaires. SP was categorized into five types and assessed using the number and type of social activities. IADLs were evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Logistic regression analysis stratified according to sex was used to examine change in IADLs according to SP, with nonparticipation as a reference.

RESULTS

During the 3-year follow-up, 13.6% of men and 9.0% of women reported IADL decline. After adjusting for age, family structure, body mass index, pension, occupation, medical treatment, self-rated health, drinking, smoking, depression, cognitive function, and activities of daily living, participation in various social activities was inversely associated with change in IADLs in women but not men. Participation in the following types of social activities had significant inverse associations with IADL disability: hobby clubs (odds ratio (OR) = 0.68, 95% confidence interval (CI) = 0.49-0.94) for men and local events (OR = 0.68, 95% CI = 0.48-0.95), hobby clubs (OR = 0.53, 95% CI = 0.36-0.79), senior citizen clubs (OR = 0.74, 95% CI = 0.56-0.97), and volunteer groups (OR = 0.56, 95% CI = 0.32-0.99) for women.

CONCLUSION

Participation in a variety of different types of social activities was associated with change in IADLs over the 3 years of this study in women, and participation in hobby clubs was associated with change in IADLs in men and women. Recommending that community-dwelling elderly adults participate in social activities appropriate for their sex may promote successful aging.

Preventive home visits to older people in Southern Sweden

Background: It seems urgent to further develop and modify models of preventive measures in order to prolong a healthy functional and social situation for older people, as this population is increasing globally. The aim of the study was to describe a Swedish model of preventive home visits for persons aged 78 years with the focus on the effect on physical and social well-being, and the participants' and the visitors' experience of the home visits. Method: Three annual visits were performed and included 150 persons, 78 years old at the first visit. Data were collected in the form of a structured interview with the persons who received the visits and as a questionnaire for their visitors. Results: Differences over time could be seen for the participants' physical and social activity, indicating that there was a deterioration between year one and two that was not seen in year three. The results further showed that the participants felt more secure and well informed as a result of the visits. The visitors said that they had gained a new, more positive view of older people and increased job satisfaction as a result of the visits and emphasized the impact on their own professional development. Conclusion: As no control group was used, the interpretation of effects concerning health factors has to be interpreted with caution. The visits did, however, have a positive impact on the participants and the visitors.

Hearing impairment and incident disability and all-cause mortality in older British community-dwelling men

Background and objective: hearing impairment is common in older adults and has been implicated in the risk of disability and mortality. We examined the association between hearing impairment and risk of incident disability and all-cause mortality.

Design and setting: prospective cohort of community-dwelling older men aged 63–85 followed up for disability over 2 years and for all-cause mortality for 10 years in the British Regional Heart Study.

Methods: data were collected on self-reported hearing impairment including hearing aid use, and disability assessed as mobility limitations (problems walking/taking stairs), difficulties with activities of daily living (ADL) and instrumental ADL (IADL). Mortality data were obtained from the National Health Service register.

Results: among 3,981 men, 1,074 (27%) reported hearing impairment. Compared with men with no hearing impairment, men who could hear and used a hearing aid, and men who could not hear despite a hearing aid had increased risks of IADL difficulties (age-adjusted OR 1.86, 95% CI 1.29–2.70; OR 2.74, 95% CI 1.53–4.93, respectively). The associations remained after further adjustment for covariates including social class, lifestyle factors, co-morbidities and social engagement. Associations of hearing impairment with incident mobility limitations, incident ADL difficulties and all-cause mortality were attenuated on adjustment for covariates.

Conclusion: this study suggests that hearing problems in later life could increase the risk of having difficulties performing IADLs, which include more complex everyday tasks such as shopping and light housework. However, further studies are needed to determine the associations observed including the underlying pathways.

Purpose in Life is Associated with a Reduced Risk of Incident Physical Disability in Aging U.S. Military Veterans

OBJECTIVES

The current study evaluated the incidence and determinants of physical disability in a contemporary, nationally representative sample of U.S. military veterans.

DESIGN, SETTING, PARTICIPANTS

Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative, prospective cohort study of 1,686 veterans aged 55 years and older. Waves 1 and 2 were conducted in 2011 and 2013, respectively.

MEASUREMENTS

Potential determinants of incident disability in activities of daily living (ADL; e.g., bathing, dressing) and instrumental activities of daily living (IADL; e.g., food preparation, medication adherence) were assessed at Wave 1, and included sociodemographic characteristics, and risk (e.g., medical conditions, psychiatric distress), and protective psychosocial (e.g., psychological resilience, purpose in life) factors.

RESULTS

The two-year incidence of any physical disability (ADL or IADL) among veterans aged 55 years and older was 11.5%, and the incidence of ADL and IADL disability was 3.0% and 11.4%, respectively. Older age, being married/cohabiting, and number of medical conditions-specifically, diabetes, heart attack, and chronic pain-were associated with an increased risk of any incident physical disability and incident IADL disability (adjusted odds ratio [AOR] range: 1.10-3.10). Retirement was associated with an increased risk of incident ADL disability (AOR: 7.53, 95% CI: 1.37-41.51). Purpose in life was found to be protective for incident IADL disability (AOR: 0.93, 95% CI: 0.87-0.99).

CONCLUSIONS

Although greater medical burden is associated with increased incidence of physical disability in U.S. veterans, results of this study suggest that initiatives designed to foster greater purpose in life may help protect against the development of physical disability in this rapidly growing segment of the population.

Anticipated Support From Neighbors and Physical Functioning During Later Life

This study has two main objectives: (1) to assess age variations in perceived support from neighbors among a nationally representative sample of adults aged 25 to 74 and (2) to examine the association between anticipated support from neighbors and physical functioning within a subsample of older adults. The findings suggest that anticipated support from neighbors is stronger among older adults, primarily because of more frequent contact with neighbors and residential stability. Within the older subsample, an inverse association between perceived support from neighbors and functional limitations is evident. Further analyses show that this association is strongest among those with infrequent contact with family members. No differences in this association were found with respect to marital status. Taken together, it appears that anticipated support from neighbors facilitates the maintenance of functional ability among some older adults. Interventions aiming to promote successful aging by enhancing this source of support should be developed and evaluated.

Association Between Social Participation and Instrumental Activities of Daily Living Among Community-Dwelling Older Adults

Background

Population-based data examining the relationship between social participation (SP) and instrumental activities of daily living (IADL) are scarce. This study examined the cross-sectional relationship between SP and IADL in community-dwelling elderly persons.

Methods

Self-administered questionnaires were mailed to 23 710 residents aged ≥65 years in Nara, Japan (response rate: 74.2%). Data from 14 956 respondents (6935 males and 8021 females) without dependency in basic activities of daily living (ADL) were analyzed. The number, type, and frequency of participation in social groups (SGs) were used to measure SP. SGs included volunteer groups, sports groups, hobby groups, senior citizens’ clubs, neighborhood community associations, and cultural groups. IADL was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Logistic regression models stratified by gender were used.

Results

After adjustment for putative confounding factors, including demographics, health status, life-style habits, ADL, depression, cognitive function, social networks, social support, and social roles, participation in various SGs among both genders was inversely associated with poor IADL, showing a significant dose-response relationship between an increasing number of SGs and a lower proportion of those with poor IADL (P for trend <0.001). A significant inverse association between frequent participation and poor IADL was observed for all types of SGs among females, whereas the association was limited to sports groups and senior citizens’ clubs among males.

Conclusions

Our results show that participation in a variety of SGs is associated with independent IADL among the community-dwelling elderly, regardless of gender. However, the beneficial effects of frequent participation on IADL may be stronger for females than for males.

Factors associated with participation frequency and satisfaction among people applying for a housing adaptation grant

BACKGROUND

People applying for a housing adaptation (HA) grant are at great risk of participation restrictions due to declining capacity and environmental barriers.

AIM

To investigate the association of person-, environment-, and activity-related factors with participation frequency and satisfaction among people applying for a housing adaptation grant.

MATERIAL AND METHODS

Baseline cross-sectional data were collected during home visits (n = 128). The association between person-, environment-, and activity-related factors and participation frequency and satisfaction was analysed using logistic regressions.

RESULTS

The main result is that frequency of participation outside the home is strongly associated with dependence in activities of daily living (ADL) and cognitive impairments, while satisfaction with participation outside the home is strongly associated with self-reported health. Moreover, aspects of usability in the home were associated with frequency of participation outside the home and satisfaction with participation in the home and outside the home alone.

CONCLUSION

Dependence in ADL, cognitive impairments, self-rated health, and aspects of usability are important factors contributing to participation frequency and satisfaction among people applying for a housing adaptation grant, particularly outside the home.

SIGNIFICANCE

Our findings indicate that more attention should be directed towards activity-related factors to facilitate participation among HA applicants, inside and outside the home.

The impact of social networks on the relationship between functional impairment and depressive symptoms in older adults

BACKGROUND

To examine the role of meaningful relationship characteristics, defined here as social network type, in relation to the association between functional impairment and depressive symptoms.

METHODS

The sample included respondents aged 65 years and older (n = 26,401) from the fourth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). Respondents were classified into one of seven relationship network types (Distal Children (living at a distance), Proximal Family (living nearby), Spouse, Other Family, Friend, Other, and No Network) according to the predominant characteristics of their most meaningful relationships. A two-stage regression analysis was performed in which the number of depressive symptoms was first regressed on the extent of functional impairment and network type, controlling for sociodemographic characteristics, cognition, health, and country. In the second stage, variables representing the interactions between functional impairment and network type were considered.

RESULTS

The compositional characteristics of respondents' relationships in later life, as defined by social network type, were associated with depressive symptoms. In particular, when experiencing functional impairment, those without any meaningful relationships were found to have more depressive symptoms when compared to all other network types. The findings underscore the importance of meaningful relationships for the mental health of older adults experiencing functional impairment as well as the risk of experiencing depression among those who maintain no personal social network.

CONCLUSIONS

The study shows that differing constellations of meaningful relationships in later life yield different associations with mental health, especially when taking functional limitations into account.

Socio-Spatial Integration of Older Adults in Four Types of Residential Environments in Israel

The socio-spatial integration of older people in different types of residential environments is a key factor affecting the well-being of older people. This study, which included a convenience sample of 565 participants, examined the socio-spatial integration of older people living in two different regional areas (central and peripheral) and four different residential environments (metropolitan hub, city, and town and rural settlements) in Israel. Willing participants were asked to complete a self-administered questionnaire. Socio-spatial integration was assessed by recognition of their neighbors and sense of belonging to the residential environment. The findings show that older adults who resided in the town and in rural settlements were more socio-spatially integrated in their living environments compared with their counterparts who resided in cities. The best predictors of socio-spatial integration were a combination of personal characteristics and characteristics of the environment (perceived accessibility) except for rural settlements, where none of the variables predicted socio-spatial integration.

Social Frailty in Community-Dwelling Older Adults as a Risk Factor for Disability

OBJECTIVE

To determine social frailty status using simple questions and to examine the association between social frailty and disability onset among community-dwelling older adults.

DESIGN

Prospective cohort study.

SETTING

Japanese community.

PARTICIPANTS

A total of 4304 adults age ≥65 years living in the community participated in a baseline assessment from 2011 to 2012. They were followed monthly for incident certification of care needs during the 2 years after the baseline assessment.

MEASUREMENTS

Care-needs certification in the national long-term care insurance system of Japan; a self-reported questionnaire including 7 items to define social frailty status, adjustment for several potential confounders such as demographic characteristics; and Kaplan-Meier survival curves for disability incidence by social frailty.

RESULTS

During the 2 years, 144 participants (3.3%) were certified as requiring long-term care insurance in accordance with incident disability. Five of the 7 items in the self-reported questionnaire were significantly associated with disability incidence. In the adjusted model including potential covariates, participants who were defined as having social frailty (≥2/5) (hazard ratio 1.66, 95% confidence interval 1.00-2.74) and prefrailty (=1/5) (hazard ratio 1.53, 95% confidence interval 1.02-2.531), based on 5 items at the baseline assessment, had an increased risk of disability compared with nonfrail participants (=0/5).

CONCLUSIONS

Social frailty, assessed using simple questions regarding living alone, going out less frequently compared with the prior year, visiting friends sometimes, feeling helpful to friends or family, and talking with someone every day, has a strong impact on the risk of future disability among community-dwelling older people.

Social Participation and the Prevention of Decline in Effectance among Community-Dwelling Elderly: A Population-Based Cohort Study

BACKGROUND

We examined the association between a decline in effectance and social participation (SP) from the perspective of the number and the type of SP in a prospective cohort study.

METHODS

Included in this analysis were community-dwelling elderly aged ≥ 65 without dependency on the basic activities of daily living and reporting a perfect baseline effectance score (n = 4,588; mean age 72.8 ± 5.7). SP was categorized into 5 types: neighborhood associations, hobby groups, local event groups, senior citizen clubs, and volunteer groups. Effectance was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Using logistic regression analysis, odds ratio (OR) and a 95% confidence interval (CI) for a decline in effectance were calculated. Age, family, BMI, pensions, medical history, medications, alcohol, smoking, cognitive function, depression, social support, ADL, and IADL were used as covariates.

RESULTS

During the 3-year follow-up, 17.8% of eligible participants reported a decline in effectance. After adjustment for covariates, participation in various groups was associated with the preservation of effectance for both genders. Regarding the type of SP, among females, participation in neighborhood associations (OR: 0.62, 95%CI: 0.48-0.81), hobby groups (0.58, 0.43-0.77), local event groups (0.63, 0.47-0.86), and volunteer groups (0.53, 0.35-0.82) was inversely associated with a decline in effectance. Among males, the beneficial effect was more likely limited to hobby groups (0.59, 0.43-0.81) and volunteer groups (0.57, 0.39-0.83).

CONCLUSIONS

Our results suggest that participation in a variety of social groups is effective for maintenance of older people's effectance, while the beneficial effect of each type of SP on effectance is stronger for females than for males. Recommending community-dwelling elderly to participate in social groups appropriate for their gender may be effective for successful aging.

Eating Alone as Social Disengagement is Strongly Associated With Depressive Symptoms in Japanese Community-Dwelling Older Adults

OBJECTIVES

Depression in later life poses a grave challenge for the aging countries. The reported key risk factors include social disengagement, but the lack of social companionship during mealtimes, namely eating alone, has not been examined extensively, especially in relation to living arrangement. Past studies on changes along geriatric trajectories in the association between social engagement and depression also remain inadequate. This study aims to examine the association between social engagement and depressive symptoms with a particular focus on eating alone and how the association changes along the aging and mental frailty trajectories.

DESIGN

A cross-sectional study.

SETTING

Kashiwa-city, Chiba-prefecture in Japan.

PARTICIPANTS

A total of 1856 community-dwelling older adults.

MEASUREMENTS

The 15-item Geriatric Depression Scale was used to measure depressive symptoms. The indicators used to assess social engagement included eating alone, living arrangement, reciprocity of social support, social participation, social stressors and social ties.

RESULTS

Social engagement was significantly associated with depressive symptoms. Those who live with their families yet eat alone were found to be at particular risk (odds ratio = 5.02, 95% confidence interval 2.5-9.9 for young-old; odds ratio = 2.41, 95% confidence interval 1.2-4.8 for old-old). Younger and less mentally frail populations showed stronger associations.

CONCLUSIONS

Eating alone was a key risk factor for depressive symptoms in community-dwelling older adults. The living arrangement in which they eat alone is important in identifying those with the greatest risk. Mental health management for older adults requires comprehensive assessment of their social relations that takes into account their companionship during mealtimes. Social preventive measures need to involve early interventions in order to augment their effectiveness against mental frailty.

Work-related stress in midlife is associated with higher number of mobility limitation in older age-results from the FLAME study

The aim of this study is to investigate whether work-related stress symptoms in midlife are associated with a number of mobility limitations during three decades from midlife to late life. Data for the study come from the Finnish Longitudinal Study of Municipal Employees (FLAME). The study includes a total of 5429 public sector employees aged 44-58 years at baseline who had information available on work-related stress symptoms in 1981 and 1985 and mobility limitation score during the subsequent 28-year follow-up. Four midlife work-related stress profiles were identified: negative reactions to work and depressiveness, perceived decrease in cognition, sleep disturbances, and somatic symptoms. People with a high number of stress symptoms in 1981 and 1985 were categorized as having constant stress. The number of self-reported mobility limitations was computed based on an eight-item list of mobility tasks presented to the participants in 1992, 1997, and 2009. Data were analyzed using joint Poisson regression models. The study showed that depending on the stress profile, persons suffering from constant stress in midlife had a higher risk of 30-70 % for having one more mobility limitation during the following 28 years compared to persons without stress after adjusting for mortality, several lifestyle factors, and chronic conditions. A less pronounced risk increase (20-40 %) was observed for persons with occasional symptoms. The study suggests that effective interventions aiming to reduce work-related stress should focus on both primary and secondary prevention.

A Longitudinal Examination of Social Participation, Loneliness, and Use of Physician and Hospital Services

Objective: This study examined whether social participation and loneliness predicted health care service use (physician visits, hospitalizations, length of stay in hospital). Method: Participants’ ( N = 954; 54% female; aged 45+ years) health data were tracked over 2.5 years following in-person interviews. Results: Being lonely was associated with greater number of physician visits, though this relationship was mediated by health. Neither loneliness nor social participation was associated with admission to hospital. However, for those who were hospitalized at least once over 2.5 years, being lonely was associated with a higher odds of being re-hospitalized; furthermore, greater social participation was associated with a lower odds of being in the hospital for an extended duration. These relationships held even when controlling for initial health. Discussion: Results provide evidence, using objective health care data, of the potential importance of social factors in predicting adults’ physician visits, re-hospitalization, and length of stay in hospital.

The perception of social support among U.S. Chinese older adults: findings from the PINE Study

OBJECTIVE

This study examined perceptions and correlates of both positive and negative social support among U.S. Chinese older adults.

METHOD

Data were drawn from the Population Study of Chinese Elderly in Chicago study, a population-based study of U.S. community-dwelling Chinese older adults aged 60 years and above in the Greater Chicago area.

RESULTS

The findings suggested that U.S. Chinese older adults were more likely to perceive positive and negative spouse and family support than friend support. Younger age, being female, higher levels of education, being married, living with a larger number of people, higher health status, better quality of life, and improved health over the past year were positively associated with positive social support. However, younger age, being male, higher levels of education, being married, having fewer children and grandchildren, living with more people, lower health status, and poorer quality of life were positively correlated with negative social support.

DISCUSSION

Chinese older adults perceive a high level of both positive and negative spouse and family support simultaneously. Further longitudinal studies should be conducted to better understand the factors and outcomes associated with perceived positive and negative social support.

Decline in functional capacity is unaffected by diet quality alone or in combination with physical activity among generally healthy older adults with T2D from the NuAge cohort

BACKGROUND

Both diet quality (DQ) and physical activity (PA) have been shown to play a role in the prevention of functional capacity (FC) decline. Because older adults (OA) with T2D are at a higher risk of FC decline compared to their non-diabetic counterparts, our aim was to determine if DQ alone, or combined with PA is associated with FC decline in OA with T2D over a 3-year follow-up in a secondary analysis of the NuAge cohort.

METHODS

In 159 OA with T2D (mean age=75 years), FC change was calculated as the difference in FC scores at T1 and T4 measured by the SMAF (Système de Mesure de l'Autonomie Fonctionnelle). Baseline DQ was calculated from three non-consecutive 24-h dietary recalls collected at T1 using the validated Canadian Healthy Eating Index (C-HEI). PA change was calculated from Physical Activity Scale for the Elderly (PASE) as T4-T1. Associations were evaluated between FC decline and four combinations of variables: C-HEI score < or ≥70 with PASE change < or > median and analyzed by GLM while controlling for covariates.

RESULTS

Neither DQ alone nor DQ combined with PA change were associated with FC decline over follow-up.

CONCLUSIONS

The absence of effect may be explained by characteristics of this healthy sample of OA with T2D who showed relatively good adherence to dietary recommendations (mean C-HEI=70) and were highly functional shown by minimal, clinically non-significant FC decline over 3 years. More research is needed to confirm the role of DQ in preventing FC decline in a larger diabetic sample showing clinically significant FC decline.

Social support network typologies and health outcomes of older people in low and middle income countries--a 10/66 Dementia Research Group population-based study

This study aims to assess the construct validity of the Wenger social support network typology in low and middle income countries. We hypothesize that, in comparison with the integrated network type, the non-integrated network type is associated with loneliness, depression, poor quality of life (less happiness), poor self-reported health, increased disability and higher care needs. Cross-sectional one-phase surveys were conducted of all residents aged 65 and over in catchment areas in eight low and middle income countries (India, China, Cuba, Dominican Republic, Venezuela, Mexico, Peru and Puerto Rico). Wenger's Practitioner Assessment of Network Type (PANT) was used to measure social network type. Family dependent, local self-contained, wider community-focused and private restricted network types were considered non-integrated, in comparison to the locally integrated network type. Overall, 17,031 participants were interviewed. Family dependent and locally integrated network types were the most prevalent. Adjusted pooled estimates across sites showed that loneliness, depression, less happiness, poor health, disability, and need for care were significantly associated with non-integrated network type. The findings of this study support the construct validity of Wenger's network typology in low and middle income countries. However, further research is required to test the criterion validity of Wenger typology using longitudinal data. Identifying older people who are vulnerable could inform the development of social care interventions to support older people and their families in the context of deteriorating health.

Association of self-reported hearing difficulty to objective and perceived participation outside the home in older community-dwelling adults

OBJECTIVE

To investigate whether hearing difficulty is associated with objective and perceived participation in social and leisure activities outside the home in older adults.

METHOD

Self-reported hearing difficulty, frequency of participation, perceived participation and Mini-Mental State Examination (MMSE) were obtained from 848 community-dwelling men and women aged 75 to 90.

RESULTS

Among persons with MMSE ≤ 24, hearing was not associated with participation. In persons with MMSE > 24, relative to persons who reported no difficulty hearing, participants with major hearing difficulty had a higher odds ratio [OR] for infrequent participation in group activities (OR 2.1, 95% confidence interval [CI] [1.2, 3.6]) and more restricted perceived participation (OR 2.1, 95% CI [1.2, 3.7]). Participants with and without hearing difficulty did not differ in their frequency of attending non-group activities or meeting (grand)children or acquaintances.

DISCUSSION

Hearing difficulty may restrict older adults with normal cognition from participating in social and leisure activities and living their life as they would like to outside the home.

Functional performance and social relations among the elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil: a population-based epidemiological study

This study was conducted in a probabilistic sam- ple of 2,055 elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil, to examine components of social network (conjugal status and visits by the children, other relatives, and friends) and social support (satisfaction with personal relations and having persons on whom to rely) associated with limitations in performing basic activities of daily living (ADL). Multivariate analysis used the Hurdle model. Performance of ADL showed independent and statistically significant associations with social network (fewer meetings with friends and not having children) and personal support (dissatisfaction/indifference towards personal relations). These associations remained after adjusting for social and demographic characteristics, health status, and other indicators of social relations. Our results emphasize the need for greater attention to social network and social support for elderly with functional limitations and those with weak social networks and social support.

Autopercepção de saúde em idosos residentes em um município do interior do Rio Grande do Sul

Objetivo: Avaliar a percepção de saúde de idosos residentes em um município do interior do Rio Grande do Sul. Método: Estudo quantitativo, descritivo de corte transversal, onde foi aplicado um questionário sociodemográfico e clínico, em uma população de 274 idosos no período de agosto de 2011 a setembro de 2012. Resultados: Houve predominância do sexo feminino, na faixa etária dos 60-69 anos de idade, baixa renda e escolaridade. Em relação a patologias, 77,38% relataram possuir alguma doença associada, sendo a hipertensão a mais prevalente, acometendo 56,20% dos idosos, seguida da osteoartrite com 28,10%. Relataram ser etilistas 13,14% e tabagistas, 6,57%. Quanto à prática de atividade física, 67,52% relataram realizar atividade física de forma regular. Do total de idosos entrevistados, 47,81% consideraram sua saúde boa. Conclusão: Apesar de a maioria dos idosos ter referido boa saúde, grande número deles relatou ser portador de doenças crônicas, o que reforça a ideia de que a percepção de ser doente está mais relacionada às incapacidades do que a ser portador de danos crônicos.

Psychosocial influences in onset and progression of late life disability

OBJECTIVES

Disability in older age has been related to several psychosocial characteristics, including social networks, social engagement, and depression. However, the exact role of these characteristics in the disablement process remains uncertain.

METHOD

Data come from a population-based study of black and white adults aged ≥65 years (N = 5,306), with up to 9 yearly data on the primary outcome measure, activities of daily living (ADL) disability. We use a two-part regression model to simultaneously test the association between each psychosocial characteristic and both onset and progression of ADL disability, while controlling for demographic variables, education, and mode of interview in the first model and health status variables in the second model.

RESULTS

Social networks were negatively associated with onset of ADL disability but not associated with progression. The association became non-significant after adjustment for health status. Social engagement was negatively associated with both onset and progression of disability, even after adjustment for health status. Depression was significantly associated with onset of disability after adjustment for health status but not with progression of disability.

DISCUSSION

The results suggest a differential role for psychosocial characteristics in the disablement process, with generally stronger associations for transitions to onset of ADL disability than progression of ADL disability.

Participation in productive activities and depression among older Europeans: survey of Health, Ageing and Retirement in Europe (SHARE)

OBJECTIVE

Although engagement in productive activities is associated with favourable outcomes with respect to the health and well-being of older individuals, the association between such activities and depression in older populations remains relatively unexplored. The purpose of this study was to evaluate the association among five productive activities (paid work, formal volunteering, caregiving, informal helping and caring for grandchildren) with depression in older adults in 14 European countries.

METHODS

This cross-sectional study used the first two waves of data collected by the Survey of Health, Ageing and Retirement in Europe and analysed a total sample of 7238 relatively healthy community residents aged 60 years and older from 14 European countries. The Survey of Health, Ageing and Retirement in Europe excluded potential participants with a past history of depression, cognitive impairment and physical limitations. Depression was categorised using the EURO-D instrument, and associations with participating in productive activities were investigated.

RESULTS

Depression was less prevalent among those individuals who were employed or self-employed and those who participated in formal volunteering or informal helping, whereas caregiving was associated with a higher risk of depression. Caring for grandchildren was not associated positively or negatively with depression. Formal volunteering and caregiving remained associated with depression after adjustment for age, sex, marital status, education, economic status, country and presence of long-term illness.

CONCLUSIONS

Availability of formal volunteering may be important in reducing depression risk, whereas caregiving is associated with a higher risk of depression in older European adults. Further research is required to clarify the direction of causation and evaluate interventions.

The role of social engagement and identity in community mobility among older adults aging in place

The purpose of this study was to understand how neighbourhoods - as physical and social environments - influence community mobility. Seeking an insider's perspective, the study employed an ethnographic research design. Immersed within the daily lives of 6 older adults over an 8-month period, auditory, textual, and visual data was collected using the "go-along" interview method. During these interviews, the researcher accompanied participants on their natural outings while actively exploring their physical and social practices by asking questions, listening, and observing. Findings highlight a process of community mobility that is complex, dynamic and often difficult as participant's ability and willingness to journey into their neighborhoods were challenged by a myriad of individual and environmental factors that changed from one day to the next. Concerned in particular with the social environment, final analysis reveals how key social factors - social engagement and identity - play a critical role in the community mobility of older adults aging in place.

IMPLICATIONS FOR REHABILITATION

Identity and social engagement are important social factors that play a role in community mobility. The need for social engagement and the preservation of identity are such strong motivators for community mobility that they can "trump" poor health, pain, functional ability and hazardous conditions. To effectively promote community mobility, the social lives and needs of individuals must be addressed.

Dual sensory loss and social participation in older Europeans

The purpose of the study was to describe the prevalence of hearing difficulties, vision difficulties and dual sensory difficulties in 11 European countries, and to study whether sensory difficulties are associated with social inactivity in older Europeans. This cross-sectional study is based on the 2004 data collection of the Survey of Health, Ageing and Retirement in Europe comprising 27,536 men and women aged 50 years and older. Hearing and vision difficulties, as well as participation in seven different social activities were assessed using a structured computer-assisted personal interview. Logistic regression models were used for analyses. Altogether, 5.9 % of the participants reported both hearing and vision difficulties (dual sensory loss), 10.2 % vision difficulties only, and 13.5 % hearing difficulties only. More than two-thirds (68.6 %) of the participants with dual sensory loss were socially inactive compared to half of those who reported no sensory difficulties. The participants who reported dual sensory loss had 2.18 (95 % CI 1.83-2.59) times higher odds for social inactivity compared to persons without hearing or vision difficulties. In a model adjusted for age, gender, mobility, depressive symptoms, cognition, education and wealth the corresponding odds ratio was 1.21 (95 % CI 1.00-1.47). According to our results, sensory difficulties were associated with social inactivity, but the higher likelihood for social inactivity among persons with sensory difficulties was attenuated by other health and socio-economic indicators. Our results suggest that various preventive and rehabilitative actions targeting older persons' sensory functions may enhance their social activity.

Do mobility, cognitive functioning, and depressive symptoms mediate the association between social activity and mortality risk among older men and women?

Social activity and health correlate in old age, but less is known about what explains this association. The aim of this study was to investigate whether mobility, cognitive functioning, and depressive symptoms mediate the association between social activity and mortality risk, or whether they alternatively should be considered as prerequisites for social activity in older Finnish men and women. In 1988, 406 men and 775 women aged 65-84 years took part in face-to-face interviews about their health, socioeconomic status, and social activities. Confirmatory factor analyses were used to form latent variables describing collective and productive social activity. Latent variable models were used to investigate the possible pathways among social activity, mobility, cognitive functioning, depressive symptoms, and mortality risk. In the 21-year follow-up, 89 % of men and 81 % of women had died. Collective and productive social activity correlated with a lower risk for mortality among men and women. Part of the association between social activity and mortality was mediated by mobility. Cognitive functioning and depressive symptoms were not mediators in the association. Instead, good cognitive functioning and having less depressive symptoms were prerequisites for participating in collective social activity among men and women. Among men, good cognitive functioning, and among women, good cognitive functioning and having less depressive symptoms were prerequisites for productive social activity. The health-enhancing influences of social activity may be partly explained by better mobility among persons who are socially active. Moreover, social activity may maintain mobility and thus decreases mortality risk, as many social activities also include physical activity. Better cognitive functioning and having less depressive symptoms should be considered as prerequisites for participating in social activities.

Frailty and cognitive impairment among community-dwelling elderly

The aim was to evaluate associations between frailty status and cognitive decline and the incidence of cognitive impairment over 12-month period. Two hundred seven older adults were assessed. Frailty was defined as having at least three of the following criteria: weight loss, weakness, exhaustion, slowness, and low level of activity. Cognitive decline was assessed using the Mini Mental State Examination (MMSE) and Clinical Dementia Rating Scale (CDR). Relative risk (RR) was calculated with a 95% confidence interval (CI). Frailty was associated with subsequent cognitive decline in 12-month when assessed using the MMSE (p=;0.005; RR=;4.6; 95%CI 1.93–11.2). No association was found between frailty and cognitive decline measured by the CDR (p=;0.393; RR=;2.1; 95%CI 0.68–6.7) or between frailty and the incidence of cognitive impairment (p=;0.675; RR=;1.2; 95%CI 0.18–8.3). These findings reveal an association between frailty and subsequent cognitive decline when measured by the MMSE, even within a short period of time.

[Prevalence and factors associated with depression among institutionalized elderly individuals: nursing care support]

The objective of this study was to verify depression among institutionalized elderly individuals. The cross-section method and Yesavage's Geriatric Depression Scale were utilized in five geriatric long-term care facilities located in the Federal District to verify symptoms of depression. A total of 299 individuals were studied, 181 of whom did not meet the inclusion criteria. Sixteen individuals declined to participate. Considering the 102 individuals found suitable to participate in the study, 49.0% presented symptoms of depression; 36.3% suffered from mild to moderate depression and 12.7% showed symptoms of severe depression. Associations were found between depression symptoms and increased age, female gender, physical limitations/dependence and dissatisfaction with the institution. A significant association was also found between depression and insomnia, tachycardia, paresthesias, dizziness and excessive sweating. Depression is highly prevalent among institutionalized elderly individuals, more common among women, and correlated with a series of signs and symptoms that may help in making an early diagnosis, thus offering support to providing more effective nursing care.

Mobility, disability, and social engagement in older adults

OBJECTIVE

To examine cross sectional associations between mobility with or without disability and social engagement in a community-based sample of older adults.

METHODS

Social engagement of participants (n = 676) was outside the home (participation in organizations and use of senior centers) and in home (talking by phone and use of Internet). Logistic or proportional odds models evaluated the association between social engagement and position in the disablement process (no mobility limitations, mobility limitations/no disability, and mobility limitations/disability).

RESULTS

Low mobility was associated with lower level of social engagement of all forms (Odds ratio (OR) = 0.59, confidence intervals (CI): 0.41-0.85 for organizations; OR = 0.67, CI: 0.42-1.06 for senior center; OR = 0.47, CI: 0.32-0.70 for phone; OR = 0.38, CI: 0.23-0.65 for Internet). For social engagement outside the home, odds of engagement were further reduced for individuals with disability.

DISCUSSION

Low mobility is associated with low social engagement even in the absence of disability; associations with disability differed by type of social engagement.

Ageism and social integration of older adults in their neighborhoods in Israel

PURPOSE

The article aims to examine the extent to which ageism is connected with the social integration of older adults in their neighborhoods and to identify factors that explain social integration.

DESIGN AND METHODS

A convenience sample that included 300 older adults aged 65 and older and 300 younger people under the age of 65 who resided in 3 neighborhoods in Tel-Aviv with varied socioeconomic status were interviewed. Kogan's Attitudes toward Old People scale was used to probe ageism. Social integration index included 3 dimensions: frequency of participation in activities in the neighborhood, familiarity with neighbors, and sense of neighborhood. Hierarchical regression analyses examined 3 groups of independent variables: older adults' sociodemographic characteristics, their perceived health and outdoor mobility, and neighborhoods' characteristics including level of ageism.

RESULTS

Neighborhoods varied by levels of ageism and social integration. Higher level of social integration of older neighborhoods' residents was explained by a combination of factors: younger age, better self-rated health, and fewer limitations of outdoor mobility, lower levels of ageism reported by a sample of younger respondents, and higher socioeconomic status of the neighborhood.

IMPLICATIONS

To enable better social integration, intergeneration programs should be developed to decrease ageism, and in order to make communities more age-friendly, there is need to facilitate accessibility to services and public spaces.