Loneliness Increases the Risk of All-Cause Dementia and Alzheimer's Disease

Change in long‐term care service usage in Japan following the COVID ‐19 pandemic: A survey using a nationwide statistical summary in 2018–2021

Aim

Social restrictions due to the coronavirus disease (COVID‐19) pandemic forced many long‐term care (LTC) service‐users to refrain from using services. We aimed to evaluate the degree of change in the use of LTC services.

Methods

We retrospectively analyzed data from the publicly distributed nationwide statistics summarizing the monthly number of public LTC insurance users in Japan between April 2018 and March 2021. The degree of decline was quantified as a ratio, where the ratio of a certain month to the reference month was divided by the ratio in the previous year.

Results

The use of LTC services started to decline in March 2020 and reached its largest decline in May 2020. Thereafter, it recovered but insufficiently, even as of late 2020. The degree of decline was particularly large for services provided in facilities for community‐dwelling elderly individuals [Ratio to the previous year = 0.717 (95% CI: 0.645–0.796) in short‐stay services, and Ratio = 0.876 (95% CI: 0.802–0.957) in outpatient services], but was non‐significant in other types of services, including those provided for elderly individuals living in nursing homes.

Conclusions

Community‐dwelling elderly individuals who had used outpatient or short‐stay services were especially affected by the COVID‐19 pandemic in 2020. This underlines the need for further investigation of the medium‐ or long‐term influence of the decline in service usage on the mental and physical health of the LTC service‐users and their caregivers. Geriatr Gerontol Int 2022; 22: 803–809.

Sentinel fall presenting to the emergency department (SeFallED) - protocol of a complex study including long-term observation of functional trajectories after a fall, exploration of specific fall risk factors, and patients' views on falls prevention

BACKGROUND

Falls are a leading cause for emergency department (ED) visits in older adults. As a fall is associated with a high risk of functional decline and further falls and many falls do not receive medical attention, the ED is ideal to initiate secondary prevention, an opportunity generally not taken. Data on trajectories to identify patients, who would profit the most form early intervention and to examine the impact of a fall event, are lacking. To tailor interventions to the individual's needs and preferences, and to address the whole scope of fall risks, we developed this longitudinal study using an extensive assessment battery including dynamic balance and aerobic fitness, but also sensor-based data. Additionally, participative research will contribute valuable qualitative data, and machine learning will be used to identify trips, slips, and falls in sensor data during daily life.

METHODS

This is a mixed-methods study consisting of four parts: (1) an observational prospective study, (2) a randomized controlled trial (RCT) to explore whether a diagnostic to measure reactive dynamic balance influences fall risk, (3) machine learning approaches and (4) a qualitative study to explore patients' and their caregivers' views. We will target a sample size of 450 adults of 60 years and older, who presented to the ED of the Klinikum Oldenburg after a fall and are not hospitalized. The participants will be followed up over 24 months (within four weeks after the ED, after 6, 12 and 24 months). We will assess functional abilities, fall risk factors, participation, quality of life, falls incidence, and physical activity using validated instruments, including sensor-data. Additionally, two thirds of the patients will undergo intensive testing in the gait laboratory and 72 participants will partake in focus group interviews.

DISCUSSION

The results of the SeFallED study will be used to identify risk factors with high predictive value for functional outcome after a sentinel fall. This will help to (1) establish a protocol adapted to the situation in the ED to identify patients at risk and (2) to initiate an appropriate care pathway, which will be developed based on the results of this study.

TRIAL REGISTRATION

DRKS (Deutsches Register für klinische Studien, DRKS00025949 ). Prospectively registered on 4^th November, 2021.

Use of digital technologies to combat loneliness and social isolation: a cross-sectional study in Swiss outpatient care during COVID-19 pandemic

Background

There is limited data on the use of digital technologies in outpatient care in Switzerland. Our objectives were therefore to determine which digital technologies are used and whether they had an impact on loneliness and social isolation in the wake of the COVID-19 pandemic.

Methods

A cross-sectional survey design was used with a convenience sample of 1272 outpatient care providers in Switzerland. The questionnaire used is based on an unsystematic literature review and a previous qualitative study with six outpatient caregivers and two caring relatives, based on which the 30 items for this questionnaire were developed. Data were analyzed descriptively, and group comparisons were made using the Kruskal Wallis test. Changes over time were measured using Friedman test with Bonferroni post hoc tests and Wilcoxon test for paired samples.

Results

The impact of the COVID-19 pandemic was evident both on the part of the health care system, e.g., inadequate protective equipment; on the part of health care providers, e.g., increasing fatigue in keeping abreast of the virus as the pandemic progressed; and on the part of clients, who reduced services of care, e.g., out of fear of infection. According to the assessment of the outpatient caregivers, loneliness and social isolation of the clients was high in spring 2020 and increased strongly in the following winter. Alternative solutions, such as digital technologies, were hardly used or not used at all by the clients.

Conclusions

The results suggest that the pandemic is dramatically impacting clients. This highlights the urgent need to invest in the development of appropriate digital technologies reducing the impact of social isolation and loneliness and the associated long-term costs to the healthcare system.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00946-7.

Ayurvedic Herbal Therapies: A Review of Treatment and Management of Dementia

Dementia has been characterized by atypical neurological syndromes and several cognitive deficits, such as extended memory loss, strange behavior, unusual thinking, impaired judgment, impotence, and difficulty with daily living activities. Dementia is not a disease, but it is caused by several neurodegenerative diseases, such as Alzheimer's, Parkinson's, and Lewy's bodies. Several drugs and remedies are indicated for alleviating unusual cognitive decline, but no effective pharmacological treatment regimens are available without side effects. Herbal drugs or traditional medicines like Ayurveda have been known for facilitating and corroborating the balance between mind, brain, body, and environment. Ayurvedic therapy comprises 600 herbal formulas, 250 single plant remedies, and natural and holistic health-giving treatments that relieve dementia in patients and increase vitality. Ayurvedic Rasayana herbs [rejuvenating elements] strengthen the brain cells, enhance memory, and decrease stress. The current medicine scenario in the treatment of dementia has prompted the shift in exploring the efficacy of ayurvedic medicine, its safety, and its efficiency. This review presents the literature on several herbal treatments for improving dementia symptomatology and patients' quality of life.

Actor and Partner Effect of Loneliness on Episodic Memory and Verbal Fluency: A Dyadic Multilevel Analysis of Romantic Couples Across 28 Countries

OBJECTIVES

There is evidence that loneliness is detrimental to cognitive health. Most studies, however, do not consider the association between loneliness and cognition in the context of close relationships, such as a spouse or romantic partner. This study examines loneliness, experienced by both the individual and their romantic partner, and cognitive performance.

METHODS

Data were from 24,689 opposite-sex couples (49,378 participants) from 28 countries in the Survey of Health, Aging and Retirement in Europe. Each couple participant reported loneliness and completed memory and verbal fluency tasks. A multilevel sex-stratified analysis was used to account for the nested data structure and evaluate actor and partner effects of loneliness on cognitive performance for male and female partners.

RESULTS

Consistent with the literature, there were small actor effects of loneliness on memory and verbal fluency for both males and females: A person's own loneliness was associated negatively with their cognitive performance on both tasks. There were also small partner effects: A person with a partner who was lonely tended to have worse cognitive performance above and beyond their own loneliness. Actor and partners effects were similar for male and female partners, replicated in most countries, and generally held controlling for age, education, household size, and disease burden. For memory, loneliness effects were slightly stronger among older participants.

DISCUSSION

Both the experience of loneliness and loneliness of a partner have a negative association with cognitive health.

A Narrative Review of Loneliness and Brain Health in Older Adults: Implications of COVID-19

Purpose of Review

This narrative review highlights important factors contributing to loneliness in older adults prior to and during the COVID-19 pandemic and effects on brain health.

Recent Findings

We characterize risk factors for loneliness in older adulthood and the impact of COVID-19. Furthermore, we discuss the implications of loneliness for older adults’ brain health.

Summary

Understanding the multifactorial causes of loneliness in different subpopulations of older adults both before and during the COVID-19 pandemic will provide insights for the development of interventions targeted to reduce loneliness in older adults based on their specific risk factors.

COVID-19, loneliness, social isolation and risk of dementia in older people: a systematic review and meta-analysis of the relevant literature

OBJECTIVES

During the COVID-19 lockdown, social isolation and feelings of loneliness (SIFL) in the older population have increased, and they can be a risk of dementia, especially in vulnerable older people. The current research is a systematic review meta-analysis of the studies that approach the risk of dementia in older people with SIFL.

METHODS

The ten studies selected for meta-analysis utilised an opportunistic sample of older people in the community from age 50 to above with no dementia and enrolment. The populations consisted of cohorts of an average of 8,239 people, followed for a mean period of 6.41 years. Random effect meta-analysis summarised the Cox Proportional Hazard Ratios and Relative Risks of the individual studies.

RESULTS

Results of the meta-analysis show that in older people, the risk of developing dementia because of the impact of prolonged loneliness and social isolation is about 49 to 60% [HR/HR = 1.49; CI₉₅=1.37-1.61] higher than in those who are not lonely and socially isolated.

CONCLUSION

The biopsychosocial model of dementia supports the need for more integrated social programs and reduced risks for the older persons who, during the COVID-19 lockdown, have suffered from deprivation of support from primary carers and restricted social interactions.KeypointsDuring the COVID-19 lockdown, social isolation and feelings of loneliness in the general population have increased.Older persons are more vulnerable to social isolation and feelings of loneliness (SIFL).SIFL in older people has been associated with an increased risk of dementia.The current study's findings suggest the need to improve healthcare policies to reduce the impact of SIFL in older persons during the COVID-19 pandemic.

Preventive Measures against the Development of Dementia in Old Age

Dementia is a neurological condition characterized by numerous types of central nervous system diseases, which gradually deteriorates an individual’s reasoning, rational thinking, and judgment abilities. As a serious public health concern that currently affects more than 50 million older adults, dementia is one of the most significant causes of incapacity, disability, and dependency among older adults. As new cases are expected to increase exponentially in the next three decades, dementia, which is not a normal feature of healthy aging despite the fact that it generally affects older adults disproportionately, requires enormous management and care efforts due to its associated socioeconomic, psychological, and physical burdens that involve the patient, their caregivers, guardians, family members, and society at large. Presently, there is no cure for dementia; however, this condition could be prevented. This narrative review aimed to provide a broad overview of studies detailing the alternative lifestyle modification-centered preventive measures against dementia. A comprehensive search of key databases to find articles related to this topic revealed that participating in regular physical activities, healthy eating and dieting, avoiding all forms of smoking, avoiding air pollutants, halting or reducing alcohol consumption, exercising the mind and being socially dynamic, getting enough rest and establishing good sleeping habits, infection prevention, stress prevention, avoidance of injuries, preventing the effects of social isolation and lockdowns, continuing education, and depression prevention are protective measures against the development of dementia.

Perceived social isolation is correlated with brain structure and cognitive trajectory in Alzheimer’s disease

Both objective and perceived social isolations were associated with future cognitive decline and increase risk of Alzheimer’s disease (AD). However, the impacts of perceived social isolation depending on different clinical stages of AD have not been elucidated. The aim of this study was to investigate the influence of perceived social isolation or loneliness on brain structure and future cognitive trajectories in patients who are living with or are at risk for AD. A total of 176 elderly patients (mean age of 78 years) who had complaint of memory problems (39 subjective cognitive decline [SCD], 53 mild cognitive impairment [MCI], 84 AD) underwent structural MRI and neuropsychological testing. Loneliness was measured by one binary item question “Do you often feel lonely?.” Voxel-based morphometry was conducted to evaluate regional gray matter volume (rGMV) difference associated with loneliness in each group. To evaluate individual differences in cognitive trajectories based on loneliness, subgroup analysis was performed in 51 patients with AD (n = 23) and pre-dementia status (SCD-MCI, n = 28) using the longitudinal scores of Alzheimer’s Disease Assessment Scale-cognitive component-Japanese version (ADAS-Jcog). Whole brain VBM analysis comparing lonely to non-lonely patients revealed loneliness was associated with decreased rGMV in bilateral thalamus in SCD patients and in the left middle occipital gyrus and the cerebellar vermal lobules I − V in MCI patients. Annual change of ADAS-Jcog in patients who reported loneliness was significantly greater comparing to these non-lonely in SCD-MCI group, but not in AD group. Our results indicate that perceived social isolation, or loneliness, might be a comorbid symptom of patients with SCD or MCI, which makes them more vulnerable to the neuropathology of future AD progression.

Motivation to Participate in Intergenerational Programs: A Comparison across Different Program Types and Generations

Much research has attested to the benefits of intergenerational programs (IGPs) for older and younger participants, but there is a lack of understanding about what motivates them to participate and to persevere. We conducted structured interviews with 83 older (mean age = 77) and 96 younger (mean age = 23) participants who participated in 13 IGPs in Israel, some involving specific topics, and some providing assistance to older adults. Using a mixed-methods approach, we analyzed differences in motivation across generations and program types and compared initial and ongoing motivation to participate. We found differences regarding motivation by age group and program type: Among older participants, interest in the specific subject was a more prevalent motivation in topic-focused groups, while receiving support was more common in assistance groups. Among young persons, motivations relating to obligation, such as receipt of a financial scholarship, and the wish to help others were the most prevalent motivators. Ongoing motivation was often explained by positive intergenerational relationships and enjoyment. For older adults, offering more diverse topic-focused activities may motivate greater participation. For young adults, integrating IGPs within more and different settings, and promoting IGPs as opportunities to help others are potential motivators.

Relationships between social withdrawal and facial emotion recognition in neuropsychiatric disorders

BACKGROUND

Emotion recognition constitutes a pivotal process of social cognition. It involves decoding social cues (e.g., facial expressions) to maximise social adjustment. Current theoretical models posit the relationship between social withdrawal factors (social disengagement, lack of social interactions and loneliness) and emotion decoding.

OBJECTIVE

To investigate the role of social withdrawal in patients with schizophrenia (SZ) or probable Alzheimer's disease (AD), neuropsychiatric conditions associated with social dysfunction.

METHODS

A sample of 156 participants was recruited: schizophrenia patients (SZ; n = 53), Alzheimer's disease patients (AD; n = 46), and two age-matched control groups (SZc, n = 29; ADc, n = 28). All participants provided self-report measures of loneliness and social functioning, and completed a facial emotion detection task.

RESULTS

Neuropsychiatric patients (both groups) showed poorer performance in detecting both positive and negative emotions compared with their healthy counterparts (p < .01). Social withdrawal was associated with higher accuracy in negative emotion detection, across all groups. Additionally, neuropsychiatric patients with higher social withdrawal showed lower positive emotion misclassification.

CONCLUSIONS

Our findings help to detail the similarities and differences in social function and facial emotion recognition in two disorders rarely studied in parallel, AD and SZ. Transdiagnostic patterns in these results suggest that social withdrawal is associated with heightened sensitivity to negative emotion expressions, potentially reflecting hypervigilance to social threat. Across the neuropsychiatric groups specifically, this hypervigilance associated with social withdrawal extended to positive emotion expressions, an emotional-cognitive bias that may impact social functioning in people with severe mental illness.

Psychological Effects of Social Isolation During the COVID-19 Pandemic 2020

Abstract. The SARS-CoV2 pandemic meant considerable restrictions in the social life of many people. Older people belong to the high-risk group for a severe to fatal course of the SARS-CoV2 disease, which is why these groups received special protection. This protection included drastic restrictions on their personal and social contacts, including the suspension of psychosocial therapies. This study examines the cognitive and emotional effects of social isolation on older people. A group of 49 participants who lived in nursing homes was tested before and after social isolation in 2020. The results of the present study provide empirical evidence for the negative effects of social isolation of older people in nursing homes regarding cognitive performance, anxiety, depressive symptoms, and quality of life.

Association of social isolation, loneliness and genetic risk with incidence of dementia: UK Biobank Cohort Study

BACKGROUND

Social isolation and loneliness have been associated with increased risk of dementia, but it is not known whether this risk is modified or confounded by genetic risk of dementia.

METHODS

We used the prospective UK Biobank study with 155 070 participants (mean age 64.1 years), including self-reported social isolation and loneliness. Genetic risk was indicated using the polygenic risk score for Alzheimer's disease and the incident dementia ascertained using electronic health records.

RESULTS

Overall, 8.6% of participants reported that they were socially isolated and 5.5% were lonely. During a mean follow-up of 8.8 years (1.36 million person years), 1444 (0.9% of the total sample) were diagnosed with dementia. Social isolation, but not loneliness, was associated with increased risk of dementia (HR 1.62, 95% CI 1.38 to 1.90). There were no interaction effects between genetic risk and social isolation or between genetic risk and loneliness predicting incident dementia. Of the participants who were socially isolated and had high genetic risk, 4.4% (95% CI 3.4% to 5.5%) were estimated to developed dementia compared with 2.9% (95% CI 2.6% to 3.2%) of those who were not socially isolated but had high genetic risk. Comparable differences were also in those with intermediate and low genetic risk levels.

CONCLUSIONS

Socially isolated individuals are at increased risk of dementia at all levels of genetic risk.

No Association Between Loneliness, Episodic Memory and Hippocampal Volume Change in Young and Healthy Older Adults: A Longitudinal European Multicenter Study

Background

Loneliness is most prevalent during adolescence and late life and has been associated with mental health disorders as well as with cognitive decline during aging. Associations between longitudinal measures of loneliness and verbal episodic memory and brain structure should thus be investigated.

Methods

We sought to determine associations between loneliness and verbal episodic memory as well as loneliness and hippocampal volume trajectories across three longitudinal cohorts within the Lifebrain Consortium, including children, adolescents (N = 69, age range 10-15 at baseline examination) and older adults (N = 1468 over 60). We also explored putative loneliness correlates of cortical thinning across the entire cortical mantle.

Results

Loneliness was associated with worsening of verbal episodic memory in one cohort of older adults. Specifically, reporting medium to high levels of loneliness over time was related to significantly increased memory loss at follow-up examinations. The significance of the loneliness-memory change association was lost when eight participants were excluded after having developed dementia in any of the subsequent follow-up assessments. No significant structural brain correlates of loneliness were found, neither hippocampal volume change nor cortical thinning.

Conclusion

In the present longitudinal European multicenter study, the association between loneliness and episodic memory was mainly driven by individuals exhibiting progressive cognitive decline, which reinforces previous findings associating loneliness with cognitive impairment and dementia.

Research Hotspots and Trends in Music Therapy Intervention for Patients With Dementia: A Bibliometrics and Visual Analysis of Papers Published From 2010 to 2021

BACKGROUND

As a serious public health problem, dementia has placed a heavy burden on society and families. Evidence suggests that the use of music therapy as a non-pharmacological intervention has certain advantages with respect to reducing the behavioral and psychological symptoms of dementia (BPSD) and improving the cognition and mental status of dementia patients. However, research trends and hotspots regarding music therapy intervention for dementia analysis have not been systematically studied via bibliometric analysis.

METHODS

We searched the Web of Science Core Collection (WoSCC) for texts published between January 1, 2010, and October 31, 2021, and visualized country, institution, journal, keyword co-occurrence, keyword emergence and keyword clustering.

RESULTS

A total of 217 articles from the WoSCC database were analyzed. In this research field, the annual number of publications has generally shown a slowly increasing trend, and the United States has the most publications and the most frequent cooperation among countries. University College London (UCL) has the most extensive influence among research institutions. Among articles, those published in the JOURNAL OF ALZHEIMER'S DISEASE were the most numerous, with 20 such articles being published, accounting for 9.22% (20/217) of the total. Comprehensive analysis of five clusters via biclustering shows that the research hotspots in this field during the past 11 years have mainly focused on the autobiographical memory, cognitive function, mental state and BPSD of dementia patients.

CONCLUSION

This study conducted a bibliometric and visual analysis of relevant studies concerning music therapy intervention for dementia patients. Psychological problems faced by dementia patients and the topics of quality of life, individualized music therapy, the mental state of caregivers and other related topics may be important research directions in the future. Therefore, the question of how to develop standardized research protocols and identify unified efficacy evaluation indicators should be a focus of and difficulty for future research.

Affective Neuroscience of Loneliness: Potential Mechanisms underlying the Association between Perceived Social Isolation, Health, and Well-Being

Loneliness, or the subjective feeling of social isolation, is an important social determinant of health. Loneliness is associated with poor physical health, including higher rates of cardiovascular disease and dementia, faster cognitive decline, and increased risk of mortality, as well as disruptions in mental health, including higher levels of depression, anxiety, and negative affect. Theoretical accounts suggest loneliness is a complex cognitive and emotional state characterized by increased levels of inflammation and affective disruptions. This review examines affective neuroscience research on social isolation in animals and loneliness in humans to better understand the relationship between perceptions of social isolation and the brain. Loneliness associated increases in inflammation and neural changes consistent with increased sensitivity to social threat and disrupted emotion regulation suggest interventions targeting maladaptive social cognitions may be especially effective. Work in animal models suggests the neural changes associated with social isolation may be reversible. Therefore, ameliorating loneliness may be an actionable social determinant of health target. However, more research is needed to understand how loneliness impacts healthy aging, explore the role of inflammation as a potential mechanism in humans, and determine the best time to deliver interventions to improve physical health, mental health, and well-being across a diverse array of populations.

Relationship Between Psychological Impacts of COVID-19 and Loneliness in Patients With Dementia: A Cross-Sectional Study From Iran

OBJECTIVES

Although the COVID-19 pandemic has affected people all around the world, the elderly is at a higher risk of suffering from its consequences. One of the serious concerns is developing loneliness and post-traumatic stress symptoms, which may contribute to cognitive decline at older ages. This study aimed to examine the psychological responses and loneliness in elderly patients diagnosed with dementia.

METHODS

Twenty-one patients diagnosed with dementia, with ages older than 40, and 19 caregivers were enrolled in the study. The patients have undergone a comprehensive neuropsychiatric interview and were assessed with De Jong Gierveld Scale for loneliness and Impact of Event Scale-Revised (IES-R). The severity of dementia was assessed by Functional Assessment Staging Tool (FAST Scale) and the Montreal Cognitive Assessment (MoCA).

RESULTS

No significant difference was seen in patients and caregivers in the IES-R and loneliness scales. A higher level of avoidance and social and total loneliness were seen in higher FAST levels (p-value: 0.046). There was a negatively significant correlation between MoCA score and avoidance. Hyperarousal was significantly correlated with emotional loneliness in patients.

CONCLUSION

We found a direct relationship between cognitive decline and the psychological impacts of COVID-19. Our results highlight the need for more comprehensive studies to further investigate the influence of the pandemic on the worsening of cognitive impairment and loneliness in patients with dementia.

Perceived Stress in Older Dementia Caregivers: Mediation by Loneliness and Depression

Coupled with aging, chronic stress experienced by dementia caregivers often leads to deteriorating health. Comparing caregivers and non-caregivers, we tested whether depression and loneliness mediate the relationship between caregiver status and a measure of chronic stress, the Perceived Stress Scale. Seventy-six cognitively normal older adults (mean age 72.7) were identified as caregivers or non-caregivers based on the functional independence of a paired family member. Caregivers reported more perceived stress, depression, and loneliness than non-caregivers. Using multiple mediation analyses, we found that loneliness and depression mediated the relationship of caregiver status with perceived stress. The loneliness effect on perceived stress was both direct and via its relationship with depressive symptoms. The findings suggest loneliness as a likely point of intervention to reduce caregiver stress. Initiatives to enable caregivers to maintain or develop social relationships apart from caregiver responsibilities may mitigate stress and its negative impact on mental and physical health.

Association between marital status and cognitive impairment based on a cross-sectional study in China

BACKGROUND

Marital status may have an impact on the elderly population's health, but few studies in China discussed about the association between marital status and cognitive impairment.

OBJECTIVE

To investigate the relationship between marital status and cognitive impairment. To compare the influences of marital status on dementia between men and women.

METHODS

This study was based on a representative national cross-sectional epidemiological survey in China. We randomly selected 13 provinces and municipalities and included 19,276 participants aged 65 years or older in our study. Data was collected by interviewing the participants about their sociodemographic characteristics, and neuropsychological testing was administered to the participants by neurologists. To analyze the association between marital status and cognitive impairment, multiple logistic regression was based on a series of models.

RESULTS

Among the 19,276 subjects, about 77.2% were married, 1.6% were single, 21.2% were divorced/separated or widowed. The odds ratios (OR) of dementia were higher in single (OR: 2.13, CI: 1.53-2.97; p < 0.001), divorced/separated/widowed when they were ≤55 years old (OR: 1.75, CI: 1.30-2.35; p < 0.001), and divorced/separated/widowed when they were >55 years old (OR: 1.16, CI: 1.03-1.31; p < 0.001) participants than in married ones. Divorced/separated/widowed ≤55 men had about 2.75 times increase in dementia risk than married men.

CONCLUSION

People with long-term divorced/separated/widowed status would be associated to cognitive impairment more than those with short-term divorced/separated/widowed status. Men may be affected by marriage disruption more than women in terms of increasing the risk of dementia.

The Impact of Marital Quality as Older Couples Adjust to Dementia Onset

OBJECTIVES

A burgeoning literature links being married to better cognitive health, but less attention has been paid to how couples view their marital relationships. Couples do not always concur in their assessments, and such discrepancies affect both partners' health. We present a dyadic study on whether and how overall and discrepant views of marital quality predicted (a) dementia onset and (b) changes in older adults' depressive symptoms with spousal dementia.

METHODS

A pooled sample of couples aged 50+ (dyad N = 3,936) from the Health and Retirement Study rated positive and negative marital quality at baseline (2006/2008). Each participant reported whether they had been told of having dementia and their depressive symptoms once every other year (2006/2008-2014/2016).

RESULTS

Cox proportional hazards regression revealed that older adults who rated their marriages either more positively or more negatively than their spouses were more likely to develop dementia. We applied multiphase growth curve modeling to older adults whose spouses developed dementia, finding that those in marriages that were more negative overall reported more depressive symptoms but exhibited a smaller increase in these symptoms in response to spousal dementia.

DISCUSSION

This study adds to the literature by showing how discrepant marital assessments shape cognitive aging and offers new insights into identifying older adults with greater dementia risk. Findings also revealed the impact of overall negative marital quality on older adults' psychological adjustment to spousal dementia, which could inform interventions intended to help couples better cope with early-stage dementia from a relational perspective.

Automatic Assessment of Loneliness in Older Adults Using Speech Analysis on Responses to Daily Life Questions

Loneliness is a perceived state of social and emotional isolation that has been associated with a wide range of adverse health effects in older adults. Automatically assessing loneliness by passively monitoring daily behaviors could potentially contribute to early detection and intervention for mitigating loneliness. Speech data has been successfully used for inferring changes in emotional states and mental health conditions, but its association with loneliness in older adults remains unexplored. In this study, we developed a tablet-based application and collected speech responses of 57 older adults to daily life questions regarding, for example, one's feelings and future travel plans. From audio data of these speech responses, we automatically extracted speech features characterizing acoustic, prosodic, and linguistic aspects, and investigated their associations with self-rated scores of the UCLA Loneliness Scale. Consequently, we found that with increasing loneliness scores, speech responses tended to have less inflections, longer pauses, reduced second formant frequencies, reduced variances of the speech spectrum, more filler words, and fewer positive words. The cross-validation results showed that regression and binary-classification models using speech features could estimate loneliness scores with an R 2 of 0.57 and detect individuals with high loneliness scores with 95.6% accuracy, respectively. Our study provides the first empirical results suggesting the possibility of using speech data that can be collected in everyday life for the automatic assessments of loneliness in older adults, which could help develop monitoring technologies for early detection and intervention for mitigating loneliness.

Processes and structures in intergenerational programs: a comparison across different types of programs

OBJECTIVES

Given the widely acknowledged benefits of intergenerational programs (IGPs), we compared processes and structures across different IGP types and explored potential areas for improvement.

DESIGN

Thirteen IGPs were classified into three types: arts, learning, and assistance programs. Data were collected through direct structured interviews and analyzed quantitatively and qualitatively.

SETTING

Participants were recruited from community-based IGPs in the greater Tel Aviv area of Israel.

PARTICIPANTS

Eighty-four older participants (OPs), 97 younger participants (YPs), and 21 organizers were interviewed.

MEASUREMENTS

Questions included participant demographics as well as closed- and open-ended questions regarding processes based on the Impact of Intergenerational Programs Questionnaire (IIPQ).

ANALYSIS

Responses to closed-ended questions were compared among IGP types and age groups using two-way ANOVAs for ordinal data, and chi-squares for nominal data. Responses to open-ended questions by OP, YP, and program organizers about potential areas for improvement were analyzed using thematic analysis.

RESULTS

Processes in need of improvement were preparation and guidance, length of program participation, and monitoring of activities, which differed across IGP types and age groups. These processes were related to broader structural problems such as lack of resources, organizers' poor employment conditions, and inadequate public services for older persons in Israel.

CONCLUSIONS

Our study highlights the complex relationships between IGP types, processes, and structures. IGP processes and goals can be hindered by structural variables such as insufficient funding, infrastructure, and public services for older adults.

Loneliness mediates the relationships between perceived neighborhood characteristics and cognition in middle-aged and older adults

OBJECTIVES

We aimed to examine whether loneliness mediates these associations between perceived neighborhood characteristics and cognition among middle-aged and older adults.

METHODS

Data from wave 10 (2010-2012) to wave 13 (2016-2017) of the Health and Retirement Study were analyzed. Perceived neighborhood characteristics were self-reported. Loneliness was measured by Revised University of California Los Angeles (R-UCLA) Loneliness Scale. Cognition was evaluated by the modified version of Telephone Interview for Cognitive Status. Baron and Kenny's causal steps and multiple linear regression models based on Karlson/Holm/Breen (KHB) method were used to examine the mediating effect.

RESULTS

At baseline, 15,142 participants had no cognitive impairment, and 11,413 individuals were finally included in our analysis after 6-year follow-up. Multiple linear regression models suggested that lower perceived neighborhood physical disorder (β = 0.073, p = 0.033) and greater perceived neighborhood safety (β = 0.350, p = 0.009) were associated with better cognition. KHB test identified the significant mediating effect of loneliness on the relationships between perceived neighborhood physical disorder (β = 0.011, p = 0.016) and perceived neighborhood safety (β = 0.023, p = 0.026) and cognition.

CONCLUSIONS

Perceived neighborhood characteristics are associated with cognition among middle-aged and older American adults. Loneliness mediated associations between perceived neighborhood physical disorder and perceived neighborhood safety and cognition.

Loneliness, Not Social Support, Is Associated with Cognitive Decline and Dementia Across Two Longitudinal Population-Based Cohorts

Background:

Poor social health is likely associated with cognitive decline and risk of dementia; however, studies show inconsistent results. Additionally, few studies separate social health components or control for mental health.

Objective:

To investigate whether loneliness and social support are independently associated with cognitive decline and risk of dementia, and whether depressive symptoms confound the association.

Methods:

We included 4,514 participants from the population-based Rotterdam Study (RS; aged 71±7SD years) followed up to 14 years (median 10.8, interquartile range 7.4–11.6), and 2,112 participants from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K; aged 72±10SD years) followed up to 10 years (mean 5.9±1.6SD). At baseline, participants were free of major depression and scored on the Mini-Mental State Examination (MMSE) ≥26 for RS and ≥25 for SNAC-K. We investigated loneliness, perceived social support, and structural social support (specifically marital status and number of children). In both cohorts, dementia was diagnosed and cognitive function was repeatedly assessed with MMSE and a global cognitive factor (g-factor).

Results:

Loneliness was prospectively associated with a decline in the MMSE in both cohorts. Consistently, persons who were lonely had an increased risk of developing dementia (RS: HR 1.34, 95%CI 1.08–1.67; SNAC-K: HR 2.16, 95%CI 1.12–4.17). Adjustment for depressive symptoms and exclusion of the first 5 years of follow-up did not alter results. Neither perceived or structural social support was associated with cognitive decline or dementia risk.

Conclusion:

Loneliness, not social support, predicted cognitive decline and incident dementia independently of depressive symptoms.

Emotional Loneliness Is Associated With a Risk of Dementia in a General Japanese Older Population: The Hisayama Study

OBJECTIVES

To investigate the association of loneliness and its component subscales with the risk of dementia in a general Japanese older population.

METHOD

A total of 1,141 community-dwelling Japanese residents aged ≥65 years without dementia were prospectively followed up for a median 5.0 years. We evaluated any loneliness and its component subscales-namely, social and emotional loneliness-by using the 6-item de Jong Gierveld Loneliness Scale. Cox proportional hazards models were used to estimate hazard ratios (HRs) of each loneliness type on the risk of dementia controlling for demographic factors, lifestyle factors, physical factors, social isolation factors, and depression.

RESULTS

During the follow-up, 114 participants developed dementia. The age- and sex-adjusted incidence rate of dementia was significantly greater in participants with any loneliness and emotional loneliness than those without. The multivariable-adjusted HRs (95% confidence intervals) of participants with any loneliness and emotional loneliness on incident dementia were 1.61 (1.08-2.40) and 1.65 (1.07-2.54), respectively, as compared to those without. However, there was no significant association between social loneliness and dementia risk. In subgroup analyses of social isolation factors, excess risks of dementia associated with emotional loneliness were observed in participants who had a partner, lived with someone, or rarely communicated with relatives or friends, but such association was not significant in participants who had no partner, lived alone, or frequently communicated with friends or relatives.

DISCUSSION

The present study suggested that loneliness, especially emotional loneliness, was a significant risk factor for the development of dementia in the general older population in Japan.

What we need as we get older: needs assessment for the development of a community geriatrics service in an Australian context

Background

The aim of this study was to inform the development of a Community Geriatrics Service (CGS) that addressed the healthcare and social needs of community dwelling older people in an Australian context.

Methods

Stakeholders (N = 108) took part in a ‘needs assessment’ involving 30-min semi-structured interviews with general practitioners (GPs; N = 49), and three 2-h focus groups (community engagement meetings; N = 59) with older people, informal caregivers, allied healthcare workers, and nursing home directors. Data were transcribed and thematically coded, mapped to source and weighted to the frequency that the theme was raised across sources.

Results

Five themes informing CGS development and delivery emerged: active health conditions (management of behavioural and psychological symptoms of dementia, falls, multimorbidity, and other relevant conditions), active social challenges (patient non-compliance, need for aged care social workers, caregiver stress, elder abuse, social isolation, and stigma), referrals (availability of specialists, communication, specialist input, and advance care directives), access (lack of transport options, and inaccessibility of local geriatrics clinics and specialists), and awareness (lack of awareness, knowledge, and resources).

Conclusions

The CGS will need to address access, referral processes and health system navigation, which were perceived by stakeholders as significant challenges. These findings warrant the development of a CGS with an integrated approach to aged care, pertinent for the health and social needs of the elderly.

Social Isolation in Dementia: The Effects of COVID-19

The aim of this literature review is to identify the effects of social isolation and lonliness on persons with dementia and to highlight interventions for private homes and long-term care facilities. It includes articles published in the last 5 years for a total of 45 articles. Social isolation and/or lonliness is linked to reduced quality of life, neuropsychiatric symptoms, and psychotropic drug use in people living with demential. Interventions, including physical activity, should be individualized and patient centered.

The relationship between fertility history and incident dementia in the US Health and Retirement Study

OBJECTIVES

An emerging literature suggests that fertility history, which includes measures of parity and birth timing, may influence cognitive health in older ages, especially among women given their differential exposure to pregnancy and sex hormones. Yet, few studies have examined associations between measures of fertility history and incident dementia in population-based samples.

METHODS

We examined the associations between parity, younger age at first birth, and older age at last birth with incident dementia over a 16-year period in a prospective sample of 15,361 men and women aged 51-100 years at baseline drawn from the Health and Retirement Study. We used Cox regression and the Fine and Gray model to obtain cause-specific (csHRs) and subdistribution hazard ratios (sdHRs) for incident dementia from gender-stratified models in which we accounted for the semi-competing risk of death.

RESULTS

During the follow-up period (median 13.0 years), the crude incidence rate for dementia was 16.6 and 19.9 per 1,000 person-years for men and women, respectively. In crude models estimating csHRs, higher parity (vs. parity 2) and younger age at first birth were associated with increased risk of dementia for both genders. These associations did not persist after full covariate adjustment. Across all models in which we estimated sdHRs, we observed a positive relationship between older age at last birth and incident dementia for women only.

DISCUSSION

In this population-based, multi-ethnic cohort, we observed limited evidence for an association between measures of fertility history and incident dementia among men and women after adjusting for potential confounders.

A Genetically Informed Longitudinal Study of Loneliness and Dementia Risk in Older Adults

Although several studies have shown small longitudinal associations between baseline loneliness and subsequent dementia risk, studies rarely test whether change in loneliness predicts dementia risk. Furthermore, as both increase with advancing age, genetic and environmental selection processes may confound the putative causal association between loneliness and dementia risk. We used a sample of 2,476 individual twins from three longitudinal twin studies of aging in the Swedish Twin Registry to test the hypothesis that greater positive change in loneliness predicts greater dementia risk. We then used a sample of 1,632 pairs of twins to evaluate the hypothesis that effects of change in loneliness on dementia risk would remain after adjusting for effects of genetic and environmental variance. Phenotypic model results suggest that mild levels of baseline loneliness predict greater dementia risk. Contrary to our hypothesis, change in loneliness did not correlate with dementia risk, regardless of whether genetic and environmental selection confounds were taken into account. Worsening loneliness with age may not confer greater dementia risk.

Loneliness in Old Age, the Related Factors, and Its Association with Demographics and Districts of Residence

Loneliness among older people has now become a serious public health issue. There have been few previous studies conducted among Chinese populations on the correlations between loneliness, self-rated health, and instrumental activities of daily living (IADL), and their association with demographic characteristics. In this study, data were collected using quota sampling through survey interviews. Older people living in representative districts were recruited. Of the participants, 60.1% rated their health as average and 58.1% showed a high level of loneliness. IADL and self-rated health (SRH) were found to be moderately positively correlated, with r = 0.357, p < 0.001. A low negative correlation was found between the level of loneliness and IADL, with r = −0.276; and SRH, with r = −0.288, p < 0.05. Ordinal Regression results showed that subjects with higher IADL scores (OR: 0.64, 95% CI: 0.39–1.05) were less lonely, while those with a less desirable economic status (OR: 3.34, 95% CI: 1.40–7.96) and living in the central business district were more likely to have a higher loneliness score (OR: 21.33, 95% CI: 4.81–95.41). It is essential to screen for loneliness, and interventions should be focused on improving social connections and support for older people to overcome their feelings of loneliness.

Prevalence of Loneliness and Related Factors Among Older Adults in Taiwan: Evidence From a Nationally Representative Survey

BACKGROUND

Loneliness is a common problem among older populations, and very few studies have examined loneliness among older adults in Taiwan.

AIM

This study aimed to understand the prevalence of loneliness and factors associated with it among older adults in Taiwan.

METHODS

Data from the Taiwan Longitudinal Study of Aging collected in 2015 were analyzed and involved 4588 participants aged ≥65 years. The outcome variable was a self-reported loneliness question, and independent variables included demographic characteristics, a self-reported health status, physical function, number of comorbidities, cognitive function, and social support. A multivariate logistic regression was used to identify predictors of loneliness.

RESULTS

The prevalence of loneliness among older adults in Taiwan was 10.5%. The multivariate logistic regression showed that old persons who were male, lived alone, perceived that they had a poor health condition, had no spouse, had no job, and had poor emotional support had higher likelihood of feeling lonely.

CONCLUSIONS

This study investigated loneliness in a nationally representative sample of older adults and revealed that one-tenth of this older population might experience loneliness which requires immediate action. Special attention should be given to the aforesaid factors in older adults to identify problems and provide interventions as early as possible in order to prevent loneliness and thus reduce the resultant negative effects on physical and mental conditions. Appropriate interventions should be developed to prevent or ameliorate feelings of loneliness among older populations using rigorous research designs such as randomized controlled trials.

Purpose in Life, Loneliness, and Protective Health Behaviors During the COVID-19 Pandemic

Background and Objectives

Social distancing, while effective in slowing the spread of the coronavirus disease 2019 (COVID-19), can increase social isolation. The current preregistered study examined purpose in life as a psychological resource that may buffer against loneliness and increase intentions to engage in health-protective behaviors.

Research Design and Methods

During the COVID-19 pandemic, 517 adults (mean = 37.71, SD = 11.30; range = 19–73) reported their levels of purpose in life, current and prepandemic levels of loneliness, and degrees to which they intended to engage in behaviors known to prevent the spread of COVID-19.

Results

Across age, having a stronger sense of purpose in life was associated with lower loneliness, as well as greater intentions to engage in COVID-protective behaviors. Higher loneliness was associated with lower intentions to maintain social distance and engage in additional health promotion behaviors such as handwashing. However, this link was not present at higher levels of purpose in life. Older age was also associated with less loneliness, but not for individuals with lower levels of purpose in life.

Discussion and Implications

Results suggest that psychological resources such as purpose in life are associated with increased protective health behaviors. Furthermore, purpose in life may reduce loneliness and counteract the negative effects of stressors that diminish the willingness to engage in health-protective behaviors. Our data also highlight resilience among older individuals in times of isolation during a global pandemic.

Prominent health problems, socioeconomic deprivation, and higher brain age in lonely and isolated individuals: A population-based study

Loneliness is linked to increased risk for Alzheimer's disease, but little is known about factors potentially contributing to adverse brain health in lonely individuals. In this study, we used data from 24,867 UK Biobank participants to investigate risk factors related to loneliness and estimated brain age based on neuroimaging data. The results showed that on average, individuals who self-reported loneliness on a single yes/no item scored higher on neuroticism, depression, social isolation, and socioeconomic deprivation, performed less physical activity, and had higher BMI compared to individuals who did not report loneliness. In line with studies pointing to a genetic overlap of loneliness with neuroticism and depression, permutation feature importance ranked these factors as the most important for classifying lonely vs. not lonely individuals (ROC AUC = 0.83). While strongly linked to loneliness, neuroticism and depression were not associated with brain age estimates. Conversely, objective social isolation showed a main effect on brain age, and individuals reporting both loneliness and social isolation showed higher brain age relative to controls - as part of a prominent risk profile with elevated scores on socioeconomic deprivation and unhealthy lifestyle behaviours, in addition to neuroticism and depression. While longitudinal studies are required to determine causality, this finding may indicate that the combination of social isolation and a genetic predisposition for loneliness involves a risk for adverse brain health. Importantly, the results underline the complexity in associations between loneliness and adverse health outcomes, where observed risks likely depend on a combination of interlinked variables including genetic as well as social, behavioural, physical, and socioeconomic factors.

Can Neighborhood Social Infrastructure Modify Cognitive Function? A Mixed-Methods Study of Urban-Dwelling Aging Americans

Objectives: Socialization predicts cognitive aging outcomes. Neighborhoods may facilitate socially engaged aging and thus shape cognition. We investigated places where older adults socialized and whether availability of these sites was associated with cognitive outcomes. Methods: Qualitative analysis of interviews and ethnography with 125 older adults (mean age 71 years) in Minneapolis identified where participants socialized outside of home. This informed quantitative analysis of a national sample of 21,151 older Americans (mean age at baseline 67 years) from the Reasons for Geographic and Racial Differences in Stroke study. Multilevel generalized additive models described associations between access to key social places and cognitive function and decline. Results: Qualitative analysis identified eateries, senior centers, and civic groups as key places to socialize. We identified significant positive associations between kernel density of senior centers, civic/social organizations, and cognitive function. Discussion: Specific neighborhood social infrastructures may support cognitive health among older adults aging in place.

The Long-Term Public Health Impact of Social Distancing on Brain Health: Topical Review

Social distancing has been a critical public health measure for the COVID-19 pandemic, yet a long history of research strongly suggests that loneliness and social isolation play a major role in several cognitive health issues. What is the true severity and extent of risks involved and what are potential approaches to balance these competing risks? This review aimed to summarize the neurological context of social isolation and loneliness in population health and the long-term effects of social distancing as it relates to neurocognitive aging, health, and Alzheimer’s disease and related dementias. The full scope of the underlying causal mechanisms of social isolation and loneliness in humans remains unclear partly because its study is not amenable to randomized controlled trials; however, there are many detailed experimental and observational studies that may provide a hypothesis-generating theoretical framework to better understand the pathophysiology and underlying neurobiology. To address these challenges and inform future studies, we conducted a topical review of extant literature investigating associations of social isolation and loneliness with relevant biological, cognitive, and psychosocial outcomes, and provide recommendations on how to approach the need to fill key knowledge gaps in this important area of research.

Effect of Group Cognitive Behavioural Therapy on Loneliness in a Community Sample of Older Adults: A Secondary Analysis of a Randomized Controlled Trial

OBJECTIVES

Research suggests a link between loneliness, depression, and anxiety. Multiple studies have examined treatment programs for loneliness; however, none have examined the efficacy of Cognitive Behavioral Therapy (CBT) for depression and anxiety in reducing loneliness.

METHODS

Change in loneliness in sixty-two older adults (≥60 yrs; 65% female) who took part in a previously reported randomized controlled trial for the treatment of comorbid depression and anxiety was examined. Older adults were randomized to a 12-week group CBT or waitlist control condition. Participants who took part in CBT were followed-up three months later.

RESULTS

Linear Mixed Model analyses indicated that after controlling for baseline cognition, depression, and anxiety, participants who completed CBT experienced a significant decrease in loneliness while the control group did not. This reduction was maintained at follow-up.

CONCLUSIONS

CBT programs for depression and anxiety are likely to be effective at reducing loneliness. This may be due to shared underlying cognitive and behavioral mechanisms between loneliness, depression, and anxiety such as sensitivity to perceived threat and social withdrawal. Further research is needed to understand if specific loneliness interventions are more effective.

CLINICAL IMPLICATIONS

CBT may be effective at reducing loneliness among older adults with depression and anxiety.

The link between social and emotional isolation and dementia in older black and white Brazilians

OBJECTIVE

To examine the link between social and emotional isolation and likelihood of dementia among older black and white Brazilians.

DESIGN

Cross-sectional clinical-pathological cohort study.

SETTING

Medical center in Sao Paulo, Brazil.

PARTICIPANTS

As part of the Pathology, Alzheimer's and Related Dementias Study, we conducted uniform structured interviews with knowledgeable informants (72% children) of 1,493 older (age > 65) Brazilian decedents.

MEASUREMENTS

The interview included measures of social isolation (number of family and friends in at least monthly contact with decedent), emotional isolation (short form of UCLA Loneliness Scale), and major depression plus the informant portion of the Clinical Dementia Rating Scale to diagnose dementia and its precursor, mild cognitive impairment (MCI).

RESULTS

Decedents had a median social network size of 8.0 (interquartile range = 9.0) and a median loneliness score of 0.0 (interquartile range = 1.0). On the Clinical Dementia Rating Scale, 947 persons had no cognitive impairment, 122 had MCI, and 424 had dementia. In a logistic regression model adjusted for age, education, sex, and race, both smaller network size (odds ratio [OR] = 0.975; 95% confidence interval [CI]: 0.962, 0.989) and higher loneliness (OR = 1.145; 95% CI: 1.060, 1.237) were associated with higher likelihood of dementia. These associations persisted after controlling for depression (present in 10.4%) and did not vary by race. After controlling for depression, neither network size nor loneliness was related to MCI.

CONCLUSION

Social and emotional isolation are associated with higher likelihood of dementia in older black and white Brazilians.

Neighborhood cognitive amenities? A mixed-methods study of intellectually-stimulating places and cognitive function among older Americans

Neighborhoods structure health and wellbeing in later life. Local spaces can encourage physically active and socially engaged aging in place, and may also nurture opportunities for cognitively-stimulating creative and complex activities such as reading; playing and listening to music; learning; and engagement in galleries, performing arts, and museums. These activities are associated with better cognitive health outcomes. In this exploratory sequential mixed-methods study, thematic analysis of interviews and ethnographic fieldwork with 125 diverse older adults in the Minneapolis (MN) metropolitan area (mean age 71 years) explored how and where older adults participated in intellectually-stimulating neighborhood activities. Thematic analysis indicated that libraries, higher education campuses, and sites of arts and culture were frequented intellectually-stimulating places, with racial differences in perception and usage. The qualitative findings informed quantitative investigation of associations between these amenities and cognitive function in a large national sample of aging Black and white Americans (n=21,165, mean age 67 years) in the Reasons for Geographic and Racial Differences in Stroke Study. We used multilevel linear regression models to examine whether living in a neighborhood with higher kernel densities of libraries, higher education campuses, and arts/cultural sites had a net positive effect on cognitive function. Analysis identified statistically significant positive associations between arts/cultural sites and cognitive function, with a significantly larger effect size for white versus Black participants. The study contributes new evidence to the emerging ecological model of cognitive health. It critically considers racial disparities in access to health-promoting neighborhood infrastructure and opportunities to age well in place.

Cognitive Impairment and the Trajectory of Loneliness in Older Adulthood: Evidence from the Health and Retirement Study

Objective: To examine whether the trajectory of facets of loneliness-emotional and social-varied by cognitive impairment status in older adulthood. Methods: Data came from the Health and Retirement Study 2008-2018 waves (N = 15,352). Cognitive impairment was assessed using standard cutoffs for cognitive impairment no dementia (CIND) and dementia. The 11-item UCLA loneliness scale was used to measure emotional and social loneliness. Results: Using multilevel modeling, we found that CIND and dementia status were associated with higher overall, emotional, and social loneliness, controlling for physical health, social contact, and depressive symptoms. The trajectory of loneliness did not vary by cognitive status. There were modest variations by sociodemographic factors. Discussion: Persons with CIND and dementia experience heightened emotional and social loneliness, but cognitive impairment does not contribute to the worsening of loneliness. Older adults' social integration may be maintained early in cognitive impairment.

A Primary Care Agenda for Brain Health: A Scientific Statement From the American Heart Association

A healthy brain is critical for living a longer and fuller life. The projected aging of the population, however, raises new challenges in maintaining quality of life. As we age, there is increasing compromise of neuronal activity that affects functions such as cognition, also making the brain vulnerable to disease. Once pathology-induced decline begins, few therapeutic options are available. Prevention is therefore paramount, and primary care can play a critical role. The purpose of this American Heart Association scientific statement is to provide an up-to-date summary for primary care providers in the assessment and modification of risk factors at the individual level that maintain brain health and prevent cognitive impairment. Building on the 2017 American Heart Association/American Stroke Association presidential advisory on defining brain health that included "Life's Simple 7," we describe here modifiable risk factors for cognitive decline, including depression, hypertension, physical inactivity, diabetes, obesity, hyperlipidemia, poor diet, smoking, social isolation, excessive alcohol use, sleep disorders, and hearing loss. These risk factors include behaviors, conditions, and lifestyles that can emerge before adulthood and can be routinely identified and managed by primary care clinicians.

Is Loneliness a Cause or Consequence of Dementia? A Public Health Analysis of the Literature

Loneliness has been reframed from a 'social problem of old age' into a major public health problem. This transformation has been generated by findings from observational studies of a relationship between loneliness and a range of negative health outcomes including dementia. From a public health perspective, key to evaluating the relationship between loneliness and dementia is examining how studies define and measure loneliness, the exposure variable, and dementia the outcome. If we are not consistently measuring these then building a body of evidence for the negative health outcomes of loneliness is problematic. Three key criteria had to meet for studies to be included in our analysis. To test the proposition that loneliness is a cause of dementia we only included longitudinal studies. For inclusion studies had to measure loneliness at baseline, have samples free of dementia and assess dementia at follow up (specified as a minimum of 12 months). We identified 11 papers published between 2000 and 2018 that meet these criteria. These studies included seven different countries and only one was specifically focused upon dementia: all other studies were cohort studies focused upon ageing and health and wellbeing. There was extensive heterogeneity in how studies measured loneliness and dementia and in the use of co-variates. Loneliness was measured by either self-rating scales (n = 8) or scales (n = 3). Dementia was assessed by clinical tests (n = 5), diagnostic/screening tools (n = 3), cognitive function tests (n = 1), and self-reported doctor diagnosis (n = 2). Substantial variation in loneliness prevalence (range 5-20%) and dementia incidence (5-30 per 1000 person years at risk). Six studies did not report a statistically significant relationship between loneliness and dementia. Significant excess risk of dementia among those who were lonely ranged from 15% to 64%. None of these studies are directly comparable as four different loneliness and dementia measures were used. We suggest that the evidence to support a relationship between loneliness and dementia is inconclusive largely because of methodological limitations of existing studies. If we wish to develop this evidence base, then using a consistent set of loneliness and dementia outcome measures in major longitudinal studies would be of benefit.

Social modulation of ageing: mechanisms, ecology, evolution

Human life expectancy increases, but the disease-free part of lifespan (healthspan) and the quality of life in old people may not show the same development. The situation poses considerable challenges to healthcare systems and economies, and calls for new strategies to increase healthspan and for sustainable future approaches to elder care. This call has motivated innovative research on the role of social relationships during ageing. Correlative data from clinical surveys indicate that social contact promotes healthy ageing, and it is time to reveal the causal mechanisms through experimental research. The fruit fly Drosophila melanogaster is a prolific model animal, but insects with more developed social behaviour can be equally instrumental for this research. Here, we discuss the role of social contact in ageing, and identify lines of study where diverse insect models can help uncover the mechanisms that are involved. This article is part of the theme issue 'Ageing and sociality: why, when and how does sociality change ageing patterns?'

Prevalence, Lifestyle Correlates, and Psychosocial Functioning Among Multi-Ethnic Older Adults with Mild Cognitive Impairment in Singapore: Preliminary Findings from a 10/66 Population Study

Asia, which has the highest increase in dementia prevalence, is unfortunately lacking recent up-to-date research, with regions of Southeast Asia being the most inadequate. Preventive approaches, such as the understanding of Mild Cognitive Impairment (MCI), are currently the most effective approach in reducing the risk or delaying the onset of dementia but are not adequately understood. Additionally, there is a paucity of research examining lifestyle and sociodemographic correlates of MCI that are relevant to the local population of Singapore. To address these gaps, this study aimed to explore: 1) the prevalence of MCI and Amnestic Mild Cognitive Impairment (aMCI), 2) the psychosocial and lifestyle correlates of MCI and aMCI. Data were drawn from the Well-being of the Singapore Elderly (WiSE) population study, which is a single-phase cross-sectional household survey conducted among older adult residents aged 60 years and above. Analyses revealed that the weighted MCI prevalence (1.2%) was lower than global figures. Few sociodemographic and lifestyle habits were related to MCI prevalence, as only age and physical activeness emerged as significant correlates. Despite the low prevalence of MCI, individuals with MCI experienced marked disability, clinical levels of depression and anxiety, which are all concerning finds. Due to the exploratory and cross-sectional nature of the study, future longitudinal research could further refine our understanding of MCI and confirm the present findings.

The Impact of a Digital Intervention (Happify) on Loneliness During COVID-19: Qualitative Focus Group

BACKGROUND

Loneliness is a growing area of concern, attracting attention as a public health concern due to its association with a variety of psychological and physical health problems. However, interventions targeting loneliness are less common than interventions for other mental health problems, such as depression and anxiety, and existing interventions focus primarily on building social skills and increasing opportunities for social interaction despite research suggesting these techniques are not the most effective. Furthermore, although there is an increasing need for scalable and convenient interventions, digital interventions for loneliness are even less common.

OBJECTIVE

Using a qualitative approach, we explore how adults (18-64 years of age) who express wanting to be more connected to others experience loneliness and react to a digital mental health intervention targeting loneliness.

METHODS

A total of 11 participants were recruited from a pilot randomized controlled trial exploring the impact of a digital mental health intervention, Happify Health, on loneliness among adults aged 18-64 years who indicated wanting to feel more connected to others when signing up for the platform. Participants were invited to participate in a 3-day asynchronous focus group about their experiences with loneliness, with Happify Health, and with social distancing during the COVID-19 pandemic. All 11 participants completed the focus group in May 2020.

RESULTS

Participants' responses were coded using thematic analysis, which led to identifying five themes, each with separate subthemes, that could be applied across the 3-day focus group: loneliness, relationships, social distancing, skill acquisition, and coping. Overall, we observed variability across participants in terms of the source of their loneliness, their perceptions of their social connections, and their motivation to reduce feelings of loneliness; however, participants commonly referred to negative self-perceptions as a cause or consequence of loneliness. Participants also varied in the extent to which they felt social distancing increased or decreased feelings of loneliness. In regard to the intervention, participants showed evidence of adopting skills they used to address their loneliness, particularly mindfulness and gratitude, and then using these skills to shift toward more active coping strategies following the intervention, including during the COVID-19 pandemic.

CONCLUSIONS

The heterogeneity in participants' experiences with loneliness described during this focus group emphasizes the subjective and complex nature of loneliness. This highlights the importance of developing loneliness interventions that use a variety of strategies, including both direct and indirect strategies for reducing loneliness. However, based on our data, a key component to loneliness interventions is incorporating strategies for addressing underlying negative self-perceptions that stem from, but also contribute to, loneliness. This data also provides preliminary evidence that digital platforms may be an effective tool for disseminating loneliness interventions while providing the added benefit of offering a productive distraction when feeling lonely.

Adequacy of Web-Based Activities as a Substitute for In-Person Activities for Older Persons During the COVID-19 Pandemic: Survey Study

BACKGROUND

Senior centers and other types of clubs provide activities for older adults to address boredom, social isolation, and loneliness. Due to the COVID-19 pandemic, most of these activities have been cancelled. A limited range of web-based activities have been offered as alternatives. However, the effectiveness of these web-based group activities for older adults has scarcely been researched.

OBJECTIVE

We aimed to understand the extent to which web-based activities for older adults provide an adequate substitute for in-person activities.

METHODS

In this telephone survey, we interviewed 105 older adults in Israel who had been offered the opportunity to participate in web-based activities after routine activities closed due to the COVID-19 pandemic. Of the total sample, 49/105 (46.7%) participated in the activities and 56/105 (53.3%) did not. We inquired about the respondents' background characteristics, satisfaction with the activities, and reasons for participation or nonparticipation.

RESULTS

The respondents who participated in the web-based activities tended to be highly satisfied with at least some of them. They rated the enjoyment derived from the content of the activity as the most important motivator, followed by maintaining a routine and by enjoying the group and the presence of others. Over 50% of the participants (28/49, 57%) wished to continue with the exercise programming after the end of the COVID-19 pandemic, and 41% (20/49) wished to continue with the web-based lectures. Participants were more likely to report partaking in alternative activities than nonparticipants (P=.04). The most common reasons cited by nonparticipants were being unaware of the web-based program (24/56, 43%) despite a notification having been sent to the entire sample, lack of interest in the content (18/56, 32%), and technical issues (13/56, 23%), such as not owning or being able to fully use a computer. Both participants and nonparticipants were interested in a wide range of topics, with many being very particular about the topics they wished to access. Approximately half expressed willingness to pay for access; those who were willing to pay tended to have more years of education (P=.03).

CONCLUSIONS

Our findings suggest a need for web-based activities for countering boredom and feelings of isolation. The main factors that influence the use, efficacy, and sustainability of online activities are access, motivational and need-fulfilling factors, and whether the activities are sufficiently tailored to individuals' preferences and abilities. Challenges in substituting in-person services are promoting social relationships that are currently not sufficiently incorporated into most web-based programs, accommodating a wider range of topics, and increasing the accessibility of current programs to older adults, especially those who are homebound, both during and after the COVID-19 pandemic.

Biological and environmental predictors of heterogeneity in neurocognitive ageing: Evidence from Betula and other longitudinal studies

Individual differences in cognitive performance increase with advancing age, reflecting marked cognitive changes in some individuals along with little or no change in others. Genetic and lifestyle factors are assumed to influence cognitive performance in ageing by affecting the magnitude and extent of age-related brain changes (i.e., brain maintenance or atrophy), as well as the ability to recruit compensatory processes. The purpose of this review is to present findings from the Betula study and other longitudinal studies, with a focus on clarifying the role of key biological and environmental factors assumed to underlie individual differences in brain and cognitive ageing. We discuss the vital importance of sampling, analytic methods, consideration of non-ignorable dropout, and related issues for valid conclusions on factors that influence healthy neurocognitive ageing.

Older Adults and Covid 19: Social Justice, Disparities, and Social Work Practice

The Covid- 19 pandemic has brought immense challenges to almost every country as it spreads throughout their populations. Foremost among these challenges is the heightened awareness of inequalities in society and the immense toll that the virus has on the most vulnerable. Globally, older people are the most at risk of getting the virus and dying from the it. Yet, although age is a significant contributor, it is its interaction with other factors, chronic conditions, poverty, and race that makes it a strong determinant. These factors reflect disparities and systemic social injustices that interact to increase the vulnerability of older adults. This paper discusses the many roles that social work, with its focus on social change, injustice, and vulnerable groups can intervene at many levels of practice and with specific groups to alleviate these fundamental disparities.

Loneliness is associated with risk of cognitive impairment in the Survey of Health, Ageing and Retirement in Europe

OBJECTIVES

To test whether loneliness is associated with the risk of cognitive impairment up to 11 years later in a European sample of middle-aged and older adults. The study examines whether this association is independent of measures of social isolation, depression, and other risk factors for cognitive impairment and dementia.

METHODS

Participants (N = 14 114) from the Survey of Health, Ageing and Retirement in Europe (SHARE) answered a single item on loneliness at baseline and were assessed for cognitive impairment every 2-to-3 years for 11 years. Participants who scored at least 1.5 standard deviations below the age-graded mean on both a memory recall task and verbal fluency task were classified as impaired. A three-item measure of loneliness was available for a sample of respondents followed up to 4 years.

RESULTS

Feeling lonely was associated with increased risk of incident cognitive impairment (HR = 1.31, 95%CI = 1.19-1.44), after accounting for age, sex, education, and SHARE country strata. The association was robust but reduced in magnitude when controlling for clinical and behavioral risk factors, health-related activity limitations, social isolation, social disengagement, and depressive symptoms. The association was not moderated by socio-demographic factors and was also apparent when using the three-item loneliness scale instead of the single-item measure.

CONCLUSIONS

These findings expand the extant literature on loneliness and the risk of cognitive impairment in older adulthood. Loneliness is one modifiable factor that can be intervened prior to the development of severe impairment or dementia.