Performance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations

Exploring the collective hospice caregiving experience

BACKGROUND

Collective caregiving, performed by caregivers working in pairs (informal primary and secondary caregivers working together), is common in the hospice setting. Research suggests that caregiving pairs may experience different caregiver outcomes. However, little is known about how caregiving pairs differ from solo caregivers (informal primary caregivers) on outcome measures.

OBJECTIVE

The goal of this study was to determine whether being in a caregiver pair affected caregiver anxiety and depression and how outcomes changed over time.

DESIGN

A mixed model analysis was used.

SETTING/SUBJECTS

Hospice caregivers (260 solo caregivers and 44 caregivers in 22 pairs) who participated in a larger, randomized controlled trial completed caregiver measures upon hospice admission and periodically until the death of the patient or hospice decertification.

MEASUREMENTS

Measured were caregiver quality of life, social support, anxiety, and depression.

RESULTS

Caregiver pairs had higher anxiety and depression scores than solo caregivers. Emotional, financial, and physical quality of life were associated with decreased depression, whereas only emotional and financial quality of life were correlated with lower levels of anxiety. Social support was associated with lower levels of depression and anxiety.

CONCLUSIONS

Despite assumptions that social support is positively facilitated vis-a-vis collective caregiving, caregiving pairs may be at higher risk for anxiety and depression. Future research is needed to address why individuals become anxious and/or depressed when working as part of a caregiving pair.

Recognition of depression and anxiety and their association with quality of life, hospitalization and mortality in primary care patients with heart failure - study protocol of a longitudinal observation study

BACKGROUND

International disease management guidelines recommend the regular assessment of depression and anxiety in heart failure patients. Currently there is little data on the effect of screening for depression and anxiety on the quality of life and the prognosis of heart failure (HF). We will investigate the association between the recognition of current depression/anxiety by the general practitioner (GP) and the quality of life and the patients' prognosis.

METHODS/DESIGN

In this multicenter, prospective, observational study 3,950 patients with HF are recruited by general practices in Germany. The patients fill out questionnaires at baseline and 12-month follow-up. At baseline the GPs are interviewed regarding the somatic and psychological comorbidities of their patients. During the follow-up assessment, data on hospitalization and mortality are provided by the general practice. Based on baseline data, the patients are allocated into three observation groups: HF patients with depression and/or anxiety recognized by their GP (P+/+), those with depression and/or anxiety not recognized (P+/-) and patients without depression and/or anxiety (P-/-). We will perform multivariate regression models to investigate the influence of the recognition of depression and/or anxiety on quality of life at 12 month follow-up, as well as its influences on the prognosis (hospital admission, mortality).

DISCUSSION

We will display the frequency of GP-acknowledged depression and anxiety and the frequency of installed therapeutic strategies. We will also describe the frequency of depression and anxiety missed by the GP and the resulting treatment gap. Effects of correctly acknowledged and missed depression/anxiety on outcome, also in comparison to the outcome of subjects without depression/anxiety will be addressed. In case results suggest a treatment gap of depression/anxiety in patients with HF, the results of this study will provide methodological advice for the efficient planning of further interventional research.

Targeting Socially Isolated Older Adults: A Process Evaluation of the Senior Centre Without Walls Social and Educational Program

The Seniors Centre Without Walls (SCWOW) program provides free social and educational programming for older adults via telephone. The target population for SCWOW is socially isolated older adults, a hard to reach population. The aim of this process evaluation was to examine whether SCWOW was reaching its target population and to gather participant feedback about program implementation and the perceived satisfaction and impact of the program. Telephone interviews were conducted with 26 participants (92% females; aged 57-85 years). Forty-two percent of the sample was socially isolated and more than half reported being lonely. Participants reported having no difficulty using the telephone system. On average, participants were very satisfied with the program and reported that SCWOW had several positive effects (e.g., connecting to the larger community, affecting mental well-being). Importantly, no barriers to participation were identified. The study suggests that telephone-based programs can successfully reach socially isolated older adults.

Comparing homeless smokers to economically disadvantaged domiciled smokers

We compared characteristics of homeless smokers and economically disadvantaged domiciled smokers (Dallas, TX; August 2011-November 2012). Although findings indicated similar smoking characteristics across samples, homeless smokers (n = 57) were exposed to more smokers and reported lower motivation to quit, lower self-efficacy for quitting, more days with mental health problems, and greater exposure to numerous stressors than domiciled smokers (n = 110). The sample groups reported similar scores on measures of affect, perceived stress, and interpersonal resources. Results may inform novel cessation interventions for homeless smokers.

Moderate/heavy alcohol use and HCV infection among injection drug users in two Russian cities

BACKGROUND

In Russia, injection drug use and transmission of blood-borne pathogens such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are inextricably linked, however the burden of alcohol use remains unexplored among injection drug users (IDUs).

METHODS

Individuals who were 18 years of age and older and had injected drugs in the previous 30 days were recruited in the cities of Novosibirsk and Ivanovo by respondent driven sampling. Consenting individuals were administered a quantitative survey instrument and provided blood samples for serological testing.

RESULTS

In Novosibirsk and Ivanovo, 29% and 35% of respondents were categorized as moderate/heavy drinkers, respectively. Individuals reported problems related to alcohol use that affected their physical health (23%), family (55%), and induced financial hardships (43%). In the multivariate analysis, we found that methamphetamine injection in the past 12 months was a strong and significant correlate of moderate/heavy drinking in Novosibirsk (aOR=5.63 95% CI: [1.01-31.47]) and Ivanovo (aOR=3.81 95% CI: [2.20-6.62]). There was poor agreement between self-reported HCV status and HCV test results (κ=-0.05 and 0.26 in Novosibirsk and Ivanovo, respectively). IDUs who correctly knew their HCV seropositive status in Novosibirsk and IDUs who correctly knew their HCV seronegative status in Ivanovo were significantly more likely to be moderate/heavy drinkers.

CONCLUSION

Alcohol use is problematic among IDUs who are at high risk for HCV. Future interventions should target IDUs who are moderate/heavy drinkers in order to prevent liver complications resulting from HCV infection.

The effects of care management on depression treatment in a psychiatric clinic: a randomized controlled trial

OBJECTIVE

This study aims to examine whether care management has an effect on adherence to depression treatment in a psychiatric clinic in Korea.

METHODS

Fifty-seven patients with depression aged 60 years or over participated in the study. They were all low-income patients screened in the community and treated in a psychiatric clinic. The study design was a double-blind randomized controlled trial. The patients were randomly assigned to intervention (n = 29) or usual care (n = 28) groups. Intervention patients received depression care management for 6 months. Primary endpoint was an increase in remission rate as assessed using the 17-item Hamilton Depression Rating Scale score at 6 months. Secondary endpoints included improvement in treatment adherence, improvement in health-related quality of life, and a reduction in feelings of hopelessness.

RESULTS

Patients in the care management intervention group showed a higher remission rate than those in the usual care group (55% vs. 29%, p = 0.0421). Intervention patients were significantly more likely to adhere to the treatment (59% vs. 18%, p = 0.0016). The hopelessness score at the 6-month assessment was significantly lower in the intervention group than the usual care group (23.5 vs. 25.7, p = 0.0443). However, there was not a significant group difference in the quality of life.

CONCLUSIONS

We found that care management not only contributed to reducing depressive symptoms in geriatric patients suffering from depression but also increased the treatment adherence rate, which in turn increased the remission rate. Care management intervention is both feasible and effective in psychiatric clinics in Korea.

Health risk appraisal in older people 6: factors associated with self-reported poor vision and uptake of eye tests in older people

BACKGROUND

Although free eye testing is available in the UK from a nation-wide network of optometrists, there is evidence of unrecognised, tractable vision loss amongst older people. A recent review identified this unmet need as a priority for further investigation, highlighting the need to understand public perceptions of eye services and barriers to service access and utilisation. This paper aims to identify risk factors for (1) having poor vision and (2) not having had an eyesight check among community-dwelling older people without an established ophthalmological diagnosis.

METHODS

Secondary analysis of self-reported data from the ProAge trial. 1792 people without a known ophthalmological diagnosis were recruited from three group practices in London.

RESULTS

Almost two in ten people in this population of older individuals without known ophthalmological diagnoses had self-reported vision loss, and more than a third of them had not had an eye test in the previous twelve months. In this sample, those with limited education, depressed mood, need for help with instrumental and basic activities of daily living (IADLs and BADLs), and subjective memory complaints were at increased risk of fair or poor self-reported vision. Individuals with basic education only were at increased risk for not having had an eye test in the previous 12 months (OR 1.52, 95% CI 1.17-1.98 p=0.002), as were those with no, or only one chronic condition (OR 1.850, 95% CI 1.382-2.477, p<0.001).

CONCLUSIONS

Self-reported poor vision in older people without ophthalmological diagnoses is associated with other functional losses, with no or only one chronic condition, and with depression. This pattern of disorders may be the basis for case finding in general practice. Low educational attainment is an independent determinant of not having had eye tests, as well as a factor associated with undiagnosed vision loss. There are other factors, not identified in this study, which determine uptake of eye testing in those with self-reported vision loss. Further exploration is needed to identify these factors and lead towards effective case finding.

Translation and validation of the 18-item Lubben Social Network Scale with older adults in Mongolia

BACKGROUND

In Mongolia, social, demographic, and geographic factors have heightened the need for a reliable means to assess social isolation of older adults. The purpose of this study was to identify, translate, and validate such a measure.

METHODS

The study was conducted in two phases: translation and back translation of the 18-item Lubben Social Network Scale to Mongolian (LSNS-18-M) and field testing to establish reliability and validity and to explore potential cut-off points. The sample comprised 198 Mongolians aged ≥ 55 years selected from six hospitals in Ulaanbaatar, Mongolia.

RESULTS

Internal consistency and intraclass correlations for the LSNS-18-M were excellent, indicating high reliability. The scale showed strong convergence with social disconnectedness and perceived isolation scales and with the Geriatric Depression Scale. It was also inversely related to self-rated health status, but not to the physical or mental health subscales of the Short Form-12 (SF-12) survey. The LSNS-18-M scores discriminated among three levels of social disconnectedness and three levels of perceived isolation. Regarding content validity, the 18 items loaded cleanly on the same three factors as the original LSNS-18, inter-factor correlations were good, all factors were correlated with the LSNS-18-M, and they accounted for two-thirds of variance in scores.

CONCLUSIONS

The LSNS-18-M had excellent reliability and good validity with a sample of older Mongolians and should be useful for screening, assessment, and monitoring social isolation. Future studies should examine lack of association with the SF-12 and should assess the scale's use with non-hospitalized and non-urban older adults in Mongolia and with Mongolian speakers outside the country.

Does social isolation predict hospitalization and mortality among HIV+ and uninfected older veterans?

OBJECTIVES

To compare levels of social isolation in aging veterans with and without the human immunodeficiency virus (HIV) and determine associations with hospital admission and mortality.

DESIGN

Longitudinal data analysis.

SETTING

The Veterans Aging Cohort Study (VACS), at eight VA Medical Centers nationally.

PARTICIPANTS

Veterans aged 55 and older enrolled in VACS from 2002 to 2008 (N = 1,836).

MEASUREMENTS

A Social Isolation Score (SIS) was created using baseline survey responses about relationship status; number of friends and family and frequency of visits; and involvement in volunteer work, religious or self-help groups, and other community activities. Scores were compared according to age and HIV status, and multivariable regression was used to assess effects of SIS on hospital admission and all-cause mortality.

RESULTS

Mean SIS was higher for HIV-positive (HIV+) individuals, with increasing difference according to age (P = .01 for trend). Social isolation was also more prevalent for HIV+ (59%) than uninfected participants (51%, P < .001). In multivariable regression analysis of HIV+ and uninfected groups combined, adjusted for demographic and clinical features, isolation was independently associated with greater risk of incident hospitalization (hazard rate (HR) = 1.25, 95% confidence interval (CI) = 1.09-1.42) and risk of all-cause mortality (HR=1.28, 95% CI = 1.06-1.54). Risk estimates calculated for HIV+ and uninfected groups separately were not significantly different.

CONCLUSION

Social isolation is associated with greater risk of hospitalization and death in HIV+ and uninfected older veterans. Despite similar effects in both groups, the population-level effect of social isolation may be greater in those who are HIV+ because of the higher prevalence of social isolation, particularly in the oldest individuals.

The AMEL study, a cross sectional population-based survey on aging and malnutrition in 1200 elderly Lebanese living in rural settings: protocol and sample characteristics

Background

Lebanon is faced with a particular challenge because of large socioeconomic inequality and accelerated demographic transition. Rural residents seem more vulnerable because of limited access to transport, health and social services. No information is available regarding health, nutrition and living conditions of this specific population. The purpose of the AMEL (Aging and Malnutrition in Elderly Lebanese) study is to assess the nutritional status of community dwelling elderly people, aged 65 years and above, living in a rural settings in Lebanon, in line of socioeconomic factors, health and living conditions. The present paper will describe the gender specific characteristics of the study population.

Methods

AMEL is a cross-sectional population based study conducted between April 2011 and April 2012 including 1200 elderly individuals living in the 24 rural Caza (districts) of Lebanon. People aged greater than or equal to 65 y were randomly selected through multistage cluster sampling. Subjects were interviewed at their homes by trained interviewers. The questionnaire included the following measures: socio-demographic factors, nutritional status (Mini Nutritional Assessment, MNA), health related characteristics, functional ability, cognitive status, mood and social network.

Results

The sample included 591 men (49.3%) and 609 women (50.8%). Mean age was 75.32 years and similar between genders. Malnutrition (MNA < 17) and risk of malnutrition (MNA between 17 and 23.5) were present in 8.0% (95%CI 4.9%-11.1%) and 29.1% (95%CI 24.0%-34.2%) respectively of the participants, and more frequent in women (9.1% and 35.3% respectively). Regarding socio-demographic status, among women the level of illiteracy and poor income was significantly higher than in men. Moreover, chronic diseases, poor self perceived health, frailty, functional disability, depressive symptoms and cognitive impairment were particularly high and significantly more frequent in women than in men.

Conclusion

The present study provides unique information about nutritional status, health and living conditions of community dwelling rural residents of Lebanon. These findings may alert policy makers to plan appropriate intervention in order to improve the quality of life and increase successful aging.

Confidant network types and well-being among older europeans

PURPOSE OF THE STUDY

To derive a typology of confidant networks among older adults in Europe and to examine them in relation to country differences and well-being (CASP-12).

DESIGN AND METHODS

The study population was composed of persons aged 65 and older in 16 countries from the 4th wave of the Survey of Health, Ageing and Retirement in Europe (N = 28,697). K-means cluster analysis was applied to data from a newly implemented name-generating network inventory. CASP-12 scores were regressed on network type controlling for country and potential sociodemographic and health confounders.

RESULTS

Six prototypical confidant network types were discerned, including proximal and distal family-based networks of varying configurations, as well as friend-based and other-based network types. Regional country differences in network type constellations were observed. Better well-being was found to be associated with network types with greater social capital. Respondents with no named confidants had the lowest CASP-12 scores, and those embedded in "other" network types also exhibited a negative association with well-being.

IMPLICATIONS

The study demonstrates the utility of name-generating network inventories in understanding the social capital of older persons. It also shows that accessible family ties are strong correlates of well-being in this population. Finally, it documents the importance of improving the means to detect the small but significant subgroup of isolated older people-those who have no confidants on whom they may rely.

Social isolation in older Malaysians: prevalence and risk factors

BACKGROUND

Social isolation is one of the most important emerging issues among ageing populations, as it reduces well-being, health and quality of life. The purpose of this study was to identify prevalence and risk factors of social isolation in older Malaysians.

METHODS

The sample for this study was drawn from a national survey entitled 'Patterns of Social Relationships and Psychological Well-Being among Older Persons in Peninsular Malaysia'. Social isolation was measured with the Lubben Social Network Scale.

RESULTS

The findings from the present study showed that 49.8% of older Malaysians are at risk for social isolation. The results of logistic regression analysis revealed that the number of sons, number of brothers, number of sisters, household size, self-rated health, place of residence, home ownership, sex and ethnicity were significantly associated with social isolation.

CONCLUSION

These findings may have some implications for social and health-care policymakers in planning and developing new and effective interventions such as educational programmes to reduce social isolation among this vulnerable population.

Can social dancing prevent falls in older adults? a protocol of the Dance, Aging, Cognition, Economics (DAnCE) fall prevention randomised controlled trial

BACKGROUND

Falls are one of the most common health problems among older people and pose a major economic burden on health care systems. Exercise is an accepted stand-alone fall prevention strategy particularly if it is balance training or regular participation in Tai chi. Dance shares the 'holistic' approach of practices such as Tai chi. It is a complex sensorimotor rhythmic activity integrating multiple physical, cognitive and social elements. Small-scale randomised controlled trials have indicated that diverse dance styles can improve measures of balance and mobility in older people, but none of these studies has examined the effect of dance on falls or cognition. This study aims to determine whether participation in social dancing: i) reduces the number of falls; and ii) improves cognitive functions associated with fall risk in older people.

METHODS/DESIGN

A single-blind, cluster randomised controlled trial of 12 months duration will be conducted. Approximately 450 participants will be recruited from 24 self-care retirement villages that house at least 60 residents each in Sydney, Australia. Village residents without cognitive impairment and obtain medical clearance will be eligible. After comprehensive baseline measurements including physiological and cognitive tests and self-completed questionnaires, villages will be randomised to intervention sites (ballroom or folk dance) or to a wait-listed control using a computer randomisation method that minimises imbalances between villages based on two baseline fall risk measures. Main outcome measures are falls, prospectively measured, and the Trail Making cognitive function test. Cost-effectiveness and cost-utility analyses will be performed.

DISCUSSION

This study offers a novel approach to balance training for older people. As a community-based approach to fall prevention, dance offers older people an opportunity for greater social engagement, thereby making a major contribution to healthy ageing. Providing diversity in exercise programs targeting seniors recognises the heterogeneity of multicultural populations and may further increase the number of taking part in exercise.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12612000889853The trial is now in progress with 12 villages already have been randomised.

Validating the Polish Adaptation of the 11-Item De Jong Gierveld Loneliness Scale

The aim of this study was to translate into Polish and establish the psychometric properties of the 11-item De Jong Gierveld Loneliness Scale (DJGLS). The translation process followed the recent guidelines for the crosscultural adaptation of questionnaires and was tested through analysis of differential item functioning (DIF) by the use of the Poly-SIBTEST method and bilingual groups. The essential unidimensionality was checked by bifactor analysis. Reliability was assessed by internal consistency and homogeneity analysis, and external construct validity by correlation with several external scales. The research indicated no differences in item performance between the final Polish and English versions, and confirmed the earlier findings indicating that the DJGLS measures two dimensions of loneliness (social and emotional) which generalize into a higher-order factor of a general sense of loneliness (bifactor structure). Reliability (α = .89) and homogeneity (H = .47) proved to be high. Research showed that the instrument has a satisfactory validity criterion: Correlation with the UCLA Loneliness Scale r = .82; with Rosenberg’s Self-Esteem Scale r = –.56; and with the Beck Depression Inventory r = .46 (all p < .01). The Polish adaptation of the DJGLS thus presents a bifactor structure, with good levels of internal consistency, homogeneity, and construct validity.

European project on osteoarthritis: design of a six-cohort study on the personal and societal burden of osteoarthritis in an older European population

Background

Osteoarthritis (OA), the most common form of arthritis, is a major contributor to functional impairment and loss of independence in older persons. The European Project on OSteoArthritis (EPOSA) is a collaborative study involving six European cohort studies on ageing. This project focuses on the personal and societal burden and its determinants of osteoarthritis. This paper describes the design of the project, and presents some descriptive analyses on selected variables across countries.

Methods/design

EPOSA is an observational study including pre-harmonized data from European cohort studies (Germany, Italy, the Netherlands, Spain, Sweden and the United Kingdom) on older community-dwelling persons aged 65 to 85 years. In total, 2942 persons were included in the baseline study with a mean age of 74.2 years (SD 5.1), just over half were women (51,9%). The baseline assessment was conducted by a face-to-face interview followed by a clinical examination. Measures included physical, cognitive, psychological and social functioning, lifestyle behaviour, physical environment, wellbeing and care utilisation. The clinical examination included anthropometry, muscle strength, physical performance and OA exam. A follow-up assessment was performed 12–18 months after baseline.

Discussion

The EPOSA study is the first population-based study including a clinical examination of OA, using pre-harmonized data across European countries. The EPOSA study provides a unique opportunity to study the determinants and consequences of OA in general populations of older persons, including both care-seeking and non care-seeking persons.

Perceived discrimination and health-related quality of life: testing the Reserve Capacity Model in Hispanic Americans

This study tested aspects of the Reserve Capacity Model (Gallo & Matthews, 2003; Gallo, Penedo Espinosa de los Monteros, & Arguelles, 2009) as a means of understanding disparities in health-related quality of life appraisals among Hispanic Americans. Questionnaire data were collected from 236 Hispanic participants, including measures of perceived discrimination, optimism, social support, symptoms of trait anxiety, and physical and mental health-related quality of life. Path analysis indicated direct, negative associations between perceived discrimination and both forms of health-related quality of life. Results also showed that these relationships were partially mediated by the reserve capacity variable of optimism and by symptoms of anxiety, though evidence for mediation by anxiety was stronger than for optimism. Findings suggest that perceived discrimination depletes intrapersonal reserves in Hispanic Americans, which, in turn, induces negative emotions. Implications for community-level interventions are discussed.

Social support differentially moderates the impact of neuroticism and extraversion on mental wellbeing among community-dwelling older adults

BACKGROUND

Personality affects psychological wellbeing, and social support networks may mediate this effect. This may be particularly pertinent in later life, when social structures change significantly, and can lead to a decline in psychological wellbeing.

AIM

To examine, in an older population, whether the relationships between neuroticism and extraversion and mental wellbeing are moderated by available social support networks.

METHOD

We gathered information from 536 community-dwelling older adults, regarding personality, social support networks, depressive symptomatology, anxiety and perceived stress, as well as controlling for age and gender.

RESULTS

Neuroticism and extraversion interacted with social support networks to determine psychological wellbeing (depression, stress and anxiety). High scores on the social support networks measure appear to be protective against the deleterious effects of high scores on the neuroticism scale on psychological wellbeing. Meanwhile, individuals high in extraversion appear to require large social support networks in order to maintain psychological wellbeing.

CONCLUSION

Large familial and friendship social support networks are associated with good psychological wellbeing. To optimise psychological wellbeing in older adults, improving social support networks may be differentially effective for different personality types.

The brain-in-motion study: effect of a 6-month aerobic exercise intervention on cerebrovascular regulation and cognitive function in older adults

BACKGROUND

Aging and physical inactivity are associated with declines in some cognitive domains and cerebrovascular function, as well as an elevated risk of cerebrovascular disease and other morbidities. With the increase in the number of sedentary older Canadians, promoting healthy brain aging is becoming an increasingly important population health issue. Emerging research suggests that higher levels of physical fitness at any age are associated with better cognitive functioning and this may be mediated, at least in part, by improvements in cerebrovascular reserve. We are currently conducting a study to determine: if a structured 6-month aerobic exercise program is associated with improvements or maintenance of both cerebrovascular function and cognitive abilities in older individuals; and, the extent to which any changes seen persist 6 months after the completion of the structured exercise program.

METHODS/DESIGN

Two hundred and fifty men and women aged 55-80 years are being enrolled into an 18-month combined quasi-experimental and prospective cohort study. Participants are eligible for enrollment into the study if they are inactive (i.e., not participating in regular physical activity), non-smokers, have a body mass index <35.0 kg/m(2), are free of significant cognitive impairment (defined as a Montreal Cognitive Assessment score of 24 or more), and do not have clinically significant cardiovascular, cerebrovascular disease, or chronic obstructive pulmonary airway disease. Repeated measurements are done during three sequential six-month phases: 1) pre-intervention; 2) aerobic exercise intervention; and 3) post-intervention. These outcomes include: cardiorespiratory fitness, resting cerebral blood flow, cerebrovascular reserve, and cognitive function.

DISCUSSION

This is the first study to our knowledge that will examine contemporaneously the effect of an exercise intervention on both cerebrovascular reserve and cognition in an older population. This study will further our understanding of whether cerebrovascular mechanisms might explain how exercise promotes healthy brain aging. In addition our study will address the potential of increasing physical activity to prevent age-associated cognitive decline.

The relationships among family, friends, and psychological well-being for Thai elderly

OBJECTIVES

The extent to which family and friends contribute to psychological well-being (PWB) may be subject to cultural variability. This study examines the mechanisms by which relationships with family and friends contribute to PWB among Thai elders.

METHOD

Interviews were conducted with 469 men and women aged 60 and older in Nan Province, Thailand. The data were analyzed using structural equation modeling, controlling for age, gender, education, income, marital status, and health status.

RESULTS

Family and friendship networks have a significant direct effect on family and friendship support. However, family and friendship networks do not have a significant direct effect on PWB, but rather an indirect effect via social support. Similarly, friendship support mediates the relationship between friendship networks and family support. Both family support and friendship support are significantly related to PWB but family support is the stronger predictor.

CONCLUSION

Using an adapting theoretical framework developed by Berkman, Glass, Brissette, & Seeman (2000) allows researchers to map the various pathways by which relationships with family and friends may contribute to PWB among older Thai adults.

A review of social isolation: an important but underassessed condition in older adults

Social isolation is a major and prevalent health problem among community-dwelling older adults, leading to numerous detrimental health conditions. With a high prevalence, and an increasing number of older persons, social isolation will impact the health, well-being, and quality of life of numerous older adults now and in the foreseeable future. For this review, a series of literature searches of the CINAHL, PsycINFO, and Medline databases were conducted, using the key words "social isolation," "social networks," "older adults," "elderly," "belonging," "perceived isolation," "social engagement," "social contacts," and "social integration," for the period of 1995-2010. The results show that there is an overabundance of evidence demonstrating numerous negative health outcomes and potential risk factors related to social isolation. However, there is scarce evidence that public health professionals are assessing social isolation in older persons, despite their unique access to very socially isolated, homebound older adults. Additionally, few viable interventions were found; therefore, it is advisable to focus on the prevention of social isolation in older adults. Public health professionals can take steps toward increasing the early assessment of social isolation and referring at-risk individuals to available community resources in order to prevent social isolation or further isolation, which would serve to reduce the numerous negative health outcomes associated with this condition.

Social Isolation and Cognitive Function in Appalachian Older Adults

Objective:

Investigating the relation between social isolation and cognitive function will allow us to identify components to incorporate into cognitive interventions.

Method:

Data were collected from 267 Appalachian older adults ( M = 78.5, range 70–94 years). Overall cognitive functioning and specific cognitive domains were assessed from data of a self-assembled neuropsychological battery of frequently used tasks. Social isolation, social disconnectedness, and perceived isolation were measured from the Lubben Social Network scale-6.

Results:

Results indicated a significant positive association between all predictor variables (e.g., social isolation, social disconnectedness, and perceived isolation) and outcome variables (e.g., overall cognitive function, memory, executive functioning, attention, and language abilities). Perceived isolation accounted for nearly double the amount of variance in overall cognitive functioning than social disconnectedness (10.2% vs. 5.7%).

Discussion:

Findings suggest that social isolation is associated with poorer overall cognitive functioning and this remains true across varied cognitive domains.

Individual and Area Level Socioeconomic Status and Its Association with Cognitive Function and Cognitive Impairment (Low MMSE) among Community-Dwelling Elderly in Singapore

Background/Aims

Neighborhood socioeconomic status (SES) can affect cognitive function. We assessed cognitive function and cognitive impairment among community-dwelling elderly in a multi-ethnic urban low-SES Asian neighborhood and compared them with a higher-SES neighborhood.

Methods

The study population involved all residents aged ≥60 years in two housing estates comprising owner-occupied housing (higher SES) and rental flats (low SES) in Singapore in 2012. Cognitive impairment was defined as <24 on the Mini Mental State Examination. Demographic/clinical details were collected via questionnaire. Multilevel linear regression was used to evaluate factors associated with cognitive function, while multilevel logistic regression determined predictors of cognitive impairment.

Results

Participation was 61.4% (558/909). Cognitive impairment was found in 26.2% (104/397) of residents in the low-SES community and in 16.1% (26/161) of residents in the higher-SES community. After adjusting for other sociodemographic variables, living in a low-SES community was independently associated with poorer cognitive function (β = −1.41, SD = 0.58, p < 0.01) and cognitive impairment (adjusted odds ratio 5.13, 95% CI 1.98–13.34). Among cognitively impaired elderly in the low-SES community, 96.2% (100/104) were newly detected.

Conclusion

Living in a low-SES community is independently associated with cognitive impairment in an urban Asian society.

Conducting the ACTIVE randomized trial in hospice care: keys to success

BACKGROUND

Untreated pain is common for patients at the end of life. Informal caregivers, often family or friends of patients, are responsible for working with hospice staff to provide pain management. Interdisciplinary team meetings conducted in hospices every 2 weeks provide an opportunity for hospice staff to communicate about pain management with informal caregivers of hospice patients.

PURPOSE

We present challenges, solutions, and keys strategies for carrying out a randomized trial in the hospice setting.

METHODS

We are conducting the Assessing Caregivers for Team Intervention through Video Encounters (ACTIVE) study to determine whether regular videoconferencing between hospice patients' informal caregivers and the hospice care team alters caregivers' perceptions of pain management and patients' pain. Participants must be primary caregivers for a hospice patient, at least 18 years of age, capable of providing informed consent, and have access to a computer with a high-speed Internet connection or a telephone. We randomized caregivers to participate in biweekly team meetings through video or phone conferencing (intervention) or to receive usual care from the hospice. All patients receive standard hospice care regardless of the group assignment of their informal caregiver.

RESULTS

As of 1 July 2012, there have been 1038 new admissions to the participating hospices. Of 391 cases in which no contact was made, 233 patients had died or had life expectancy less than 14 days. Home visits were made to 271 interested and eligible caregivers; 249 caregivers of 233 patients were randomly assigned to the usual care or intervention arm. Enrollment is on pace to meet recruitment goals. Lessons Learned Thorough pilot testing of instruments and procedures helped us overcome barriers to conducting research in this vulnerable population. Keys to success included obtaining support from hospice medical directors, including hospice staff in study preparation, minimizing the burden on hospice staff, housing research staff in each participating hospice, using newsletters to enhance communication, developing and maintaining a detailed procedural manual, producing regular data quality reports, developing a secure site to facilitate coding videos for qualitative studies, and holding regular teleconferences with key staff.

LIMITATIONS

Late enrollment of many patients in hospice left little to no time for their caregivers to take part in the intervention. Assisting caregivers of patients with very short life expectancy may require different methods.

CONCLUSIONS

The challenges of conducting randomized trials with hospice patients and caregivers can be addressed with appropriate study design, well-tested research methods, and proactive monitoring of any issues or problems.

Physical activity and other health-related factors predict health care utilisation in older adults: the ActiFE Ulm study

BACKGROUND

Health care utilisation (HCU) can be a useful outcome for estimating costs and patient needs. It can also be used as a surrogate parameter for healthy ageing. The aim of this study was to analyse the associations of formerly described and potentially new parameters influencing health care utilisation in older adults in Germany.

PATIENTS AND METHODS

The ActiFE Ulm (Activity and Function in the Elderly in Ulm) study is a population-based study in 1,506 community dwelling older adults aged 65-90 years in Ulm and surrounding areas in southwestern Germany. Between March 2009 and April 2010 a full geriatric assessment was performed including accelerometer-based average daily walking duration, comorbidity, medication, physical and psychological functioning, health care utilisation, sociodemographic factors etc. The association between above named measures and health care utilisation, represented by the number of drugs, the days in hospital and the number of physician contacts over one year was calculated in multiple regression models. Analysis was conducted among subjects with complete information (n = 1,059, mean age 76 years, 55% male).

RESULTS

The average number of drugs was 4.5 and over 95% of participants visited a physician at least once a year while still more than 65% contacted their physician more than twice a year. Reduced physical activity, BMI, self-rated health and/or comorbidity and male sex were the best predictors of health care utilisation in community dwelling older adults when looking at both the number of drugs and the number of physician contacts over 12 months together. With regard to single diseases entities the best predictors of both the number of drugs and the number of physician contacts were asthma, chronic obstructive pulmonary disease (COPD)/chronic bronchitis and chronic neurological diseases (mostly Parkinson's disease). The number of drugs was most strongly associated with coronary heart disease, diabetes, and high blood pressure.

CONCLUSION

Reduced walking activity, self-rated health and/or comorbidity and male sex are the best predictors of health care utilisation as measured by the number of drugs and number of physician contacts over 12 months. Walking activity could be regarded as the most promising modifiable predictor of HCU in older adults.

Transitions, Risks, and Actions in Coronary Events--Center for Outcomes Research and Education (TRACE-CORE): design and rationale

BACKGROUND

Cardiovascular disease continues to cause significant morbidity, mortality, and impaired quality of life, with unrealized health gains from the underuse of available evidence. The Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education (TRACE-CORE) aims to advance the science of acute coronary syndromes by examining the determinants and outcomes of the quality of transition from hospital to community and by quantifying the impact of potentially modifiable characteristics associated with decreased quality of life, rehospitalization, and mortality.

METHODS AND RESULTS

TRACE-CORE comprises a longitudinal multiracial cohort of patients hospitalized with acute coronary syndromes, 2 research projects, and development of a nucleus of early stage investigators. We are currently enrolling 2500 adults hospitalized for acute coronary syndromes at 6 hospitals in the northeastern and southeastern United States. We will follow these patients for 24 months after hospitalization through medical record abstraction and 5 patient interviews focusing on quality of life, cardiac events, rehospitalizations, mortality, and medical, behavioral, and psychosocial characteristics. The Transitions Project studies determinants of and disparities in outcomes of the quality of patients' transition from hospital to community. Focusing on potentially modifiable factors, the Action Scores Project will develop and validate action scores to predict recurrent cardiac events, death, and quality of life, describe longitudinal variation in these scores, and develop a dashboard for patient and provider action on the basis of these scores.

CONCLUSIONS

In TRACE-CORE, sound methodologic principles of observational studies converge with outcomes and effectiveness research approaches. We expect that our data, research infrastructure, and research projects will inform the development of novel secondary prevention approaches and underpin the careers of cardiovascular outcomes researchers.

Social isolation, vital exhaustion, and incident heart failure: findings from the Atherosclerosis Risk in Communities Study

AIMS

Prospective studies have shown that social isolation (i.e. lack of social contacts) predicts incident coronary heart disease (CHD), but it is unclear whether it predicts incident heart failure (HF) and what factors might mediate this association. HF patients may be more susceptible to social isolation as they tend to be older and may have disrupted social relationships due to life course factors (e.g. retirement or bereavement). We prospectively examined whether individuals with higher vs. low social isolation have a higher incidence of HF and determined whether this association is mediated by vital exhaustion.

METHODS AND RESULTS

We estimated incident HF hospitalization or death among 14 348 participants from Visit 2 (1990-1992) in the Atherosclerosis Risk in Communities (ARIC) study using Cox proportional hazard models which were sequentially adjusted for age, race/study community, gender, current smoking, alcohol use, and co-morbidities. We conducted mediation analyses according to the Baron and Kenny method. After a median follow-up of 16.9 person-years, 1727 (13.0%) incident HF events occurred. The adjusted hazard of incident HF was greater for those in the higher vs. low social isolation risk group (hazard ratio 1.21, 95% confidence interval 1.08-1.35). Our data suggest that vital exhaustion strongly mediates the association between higher social isolation and incident HF (the percentage change in beta coefficient for higher vs. low social isolation groups after adjusting for vital exhaustion was 36%).

CONCLUSION

These data suggest that greater social isolation is an independent risk factor for incident HF, and this association appears to be strongly mediated by vital exhaustion.

Mental healthcare need and service utilization in older adults living in public housing

OBJECTIVES

Anxiety and depression in socioeconomically disadvantaged older adults frequently go unrecognized and untreated. This study aims to characterize mental illness and its treatment in older adult public housing residents who have many risk factors for anxiety and depression.

DESIGN

Cross-sectional study.

SETTING

Public housing high-rises in Rochester, New York.

PARTICIPANTS

One hundred ninety residents aged 60 years and older.

MEASUREMENTS

Anxiety and depression were assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, GAD-7, and Patient Health Questionnaire. We obtained information on mental healthcare from medication review and self-report.

RESULTS

Participants had a median age of 66 years, 58% were women, 80% were black, and 92% lived alone. Many participants (31%) were in need of mental healthcare: 21% had syndromal and 11% had subsyndromal anxiety or depression. Mental healthcare need was associated with younger age; intact cognitive functioning; impairments in instrumental activities of daily living (IADL); more medical illness; decreased mobility; smaller social network size; more severe life events; and increased utilization of medical, human, and informal services. Of those with mental healthcare need, most were not receiving it. Compared with residents receiving mental healthcare, residents with untreated need were more likely to be men and have less IADL impairment, medical illness, severe life events, onsite social worker use, and human services utilization.

CONCLUSIONS

Mental illness was common and largely untreated in public housing residents. Increasing collaboration between medical, mental, and human services is needed to improve identification, treatment, and ultimately prevention of late-life mental illness in this community setting.

[Factors associated with mental health well-being of urban community-dwelling elders in Japan: comparison between subjects with and without long-term care insurance certification]

AIM

The present study aimed to (1) examine the mental health well-being of urban community-dwelling elderly individuals; and (2) examine factors related to mental health well-being of those with long-term care insurance certification (LTCI+) and those without LTCI certification (LTCI-).

METHODS

We conducted a community-based, cross-sectional study that included 3,905 subjects aged 65 years or older living in Tokyo, Japan. A self-administered questionnaire was mailed to each participant. Mental health well-being was assessed using the Japanese version of the World Health Organization Mental Health Wellbeing Index--five items (WHO-5).

RESULTS

Of the 2,431 respondents (response rate, 63.5%), 1,954 who completed WHO-5 were analyzed (241 LTCI+; 1,713 LTCI-). The total score of WHO-5 was 15.61±6.08 among all subjects; when a cut-off criterion of 12/13 was used, the frequency of low mental health well-being was 29.5% among all subjects. In a stratified analysis according to LTCI certification using multivariate logistic regression analysis, small social support network, heart disease, and daytime sleepiness were independently associated with low mental health well-being for the LTCI+ group; low education level, small social support network, low subjective health, daytime sleepiness, and worries about forgetfulness were independently associated with low mental health well-being for the LTCI- group.

CONCLUSION

To improve mental health well-being of community-dwelling elderly individuals with LTCI certification, attention should be focused on those with small social network or daytime sleepiness. To improve mental health well-being of community-dwelling elderly individuals without LTCI certification, attention should be focused on those with small social network, low subjective health, or worries about forgetfulness.

Pleasant physical exercise program for prevention of cognitive decline in community-dwelling elderly with subjective memory complaints

AIM

Japan is one of the most rapidly aging societies in the world. Measures to prevent dementia are urgently required in Japan, although such strategies have not yet been established. This study investigated the effectiveness of a pleasant physical exercise intervention on the prevention of cognitive decline in community-dwelling elderly participants with subjective memory complaints. In this intervention, a pleasant atmosphere was emphasized to enhance the participants' motivation.

METHOD

We administered a 12-week intervention program consisting of pleasant physical exercise. This program for the prevention of cognitive decline was carried out as a service of Maebashi city. The service targeted elderly residents aged 65 years and older who had subjective memory complaints. After a control period of 12 weeks, 42 participants, aged between 65-86 years, received intervention once a week at community centers. Participants carried out group exercise, and were encouraged to perform home exercise and walking during the intervention period. The program was carried out by co-medical professional staff, with the help of senior citizen volunteers.

RESULTS

A total of 30 participants were included in the analysis. There was significant improvement on the Wechsler digit symbol substitution test (P = 0.01).

CONCLUSION

Participants with subjective memory complaints who continued the pleasant physical exercise programs for 12 weeks showed improvement in some aspects of cognitive function. Participation of senior citizen volunteers enabled smooth implementation of the program, and alleviated the burden on the professional staff. The pleasant physical exercise intervention described in the present study could be regarded as a community-led intervention to prevent cognitive decline.

A population-based study of attention deficit/hyperactivity disorder symptoms and associated impairment in middle-aged adults

Attention deficit/hyperactivity disorder (ADHD) is the most prevalent childhood psychiatric condition. It frequently persists into adulthood and can have serious health and other adverse consequences. The majority of previous adult ADHD studies have focused on young adults so that relatively little is known about ADHD symptoms and their effects in mid and late life. In addition, effects of subclinical levels of attention deficit and hyperactivity have not been studied in detail. In this study we investigated ADHD symptoms and related impairment in a large population-based sample of middle-aged Australian adults (n = 2091; 47% male). Applying the WHO adult ADHD Self Report Screener (ASRS) we observed that 6.2% of participants had scores that were previously associated with ADHD diagnosis. No significant gender difference in the distribution of ASRS scores was observed. Multiple regression analyses indicated strong positive correlations between symptoms of ADHD and depression/anxiety and significant negative associations (p<0.01) with employment, financial stress, relationship quality, health and well-being measures in this age group. Importantly, associations were highly significant even when few ADHD symptoms were reported. Compared to the hyperactivity component, the inattention trait was particularly strongly associated and remained significant after controlling for depression/anxiety symptoms. Our study confirms previous findings and significantly adds to existing literature especially for an age-group that has not been well-studied. Our results suggest that ADHD symptoms continue to be associated with ill-health and functional impairment in mid-life and are, therefore, likely to be a major, previously unrecognized source of late-life morbidity with associated social and economic costs. Thus, there is a compelling need for better understanding and development of age-appropriate approaches to the diagnosis and treatment of ADHD in mid- to late-life.

[Reliability and validity of the Japanese version of the abbreviated Lubben Social Network Scale]

AIM

To investigate the reliability and validity of the Japanese version of the abbreviated Lubben Social Network Scale (LSNS-6), which is used worldwide as a screening tool for social isolation in elderly individuals.

METHODS

An interview-format questionnaire survey was given to 232 elderly community residents undergoing general health checkups. In addition to the Japanese version of the LSNS-6, other questionnaire items regarding social support, the Japanese version of the Zung Self-Rating Depression Scale (SDS), base attributes, and self-ratings of health, physical function and suicidal ideation were obtained. The internal consistency, test-retest, and interrater reliability of the Japanese version of the LSNS-6 were determined using the Cronbach α correlation, Spearman correlation, and intraclass correlation coefficients, respectively. Construct validity was investigated by comparison with the results of a previous study, while concurrent validity was determined in relation to SDS scores as well as questionnaire items on social support.

RESULTS

The Cronbach α coefficient was 0.82, the correlation coefficient for the test-retest was 0.92 (P<0.001), and the intraclass correlation coefficient for interrater reliability was 0.96 (95% confidence interval [CI] 0.90-0.99). Mean scores on the Japanese version of the LSNS-6 increased as the number of household members increased (P=0.033), but decreased among elderly individuals at risk of suicide (P=0.026), and tended to decrease among those with a poor self-rated health score (P=0.081). Scores on the Japanese version of the LSNS-6 had a significant negative correlation with SDS scores (P<0.001) On 4 of the 5 questionnaire items on social support, and those without social support had significantly lower mean scores on the Japanese version of the LSNS-6 (P<0.05) than those with social support.

CONCLUSIONS

We confirmed the reliability and validity of the Japanese version of the abbreviated LSNS-6.

Sentencing risk: history of incarceration and HIV/STD transmission risk behaviours among Black men who have sex with men in Massachusetts

This study investigated the role of incarceration in HIV/STD risk among 197 Black men who have sex with men in Massachusetts, USA. More than half (51%) reported a history of incarceration (28% < 90 days in jail/prison; 23% ≥ 90 days in jail/prison). Multivariable logistic regression models adjusted for age and sexual orientation examined associations between demographic, behavioural, social-psychological and cultural factors and incarceration history. Factors associated with < 90 days of incarceration were: unprotected sex with a man, STD history, injection drug use and substance abuse treatment. Factors associated with ≥ 90 days of incarceration were: unprotected sex with a woman, crack use during sex, STD history, injection drug use, substance abuse treatment, depressive symptoms, post-traumatic stress symptoms, HIV fatalism and social capital. Black men who have sex with men with incarceration histories may be at increased risk for HIV/STDs compared to those without such histories. HIV prevention efforts that focus on individual risk and cultural-contextual issues among Black men who have sex with men are warranted.

A comparison of specialist rehabilitation and care assistant support with specialist rehabilitation alone and usual care for people with Parkinson's living in the community: study protocol for a randomised controlled trial

BACKGROUND

Parkinson's Disease is a degenerative neurological condition that causes movement problems and other distressing symptoms. People with Parkinson's disease gradually lose their independence and strain is placed on family members. A multidisciplinary approach to rehabilitation for people with Parkinson's is recommended but has not been widely researched. Studies are needed that investigate cost-effective community-based service delivery models to reduce disability and dependency and admission to long term care, and improve quality of life.

METHODS

A pragmatic three parallel group randomised controlled trial involving people with Parkinson's Disease and live-in carers (family friends or paid carers), and comparing: management by a specialist multidisciplinary team for six weeks, according to a care plan agreed between the professionals and the patient and carer (Group A); multidisciplinary team management and additional support for four months from a trained care assistant (Group B); usual care, no coordinated team care planning or ongoing support (Group C). Follow up will be for six months to determine the impact and relative cost-effectiveness of the two interventions, compared to usual care. The primary outcomes are disability (patients) and strain (carers). Secondary outcomes include patient mobility, falls, speech, pain, self efficacy, health and social care use; carer general health; patient and carer social functioning, psychological wellbeing, health related quality of life. Semi structured interviews will be undertaken with providers (team members, care assistants), service commissioners, and patients and carers in groups A and B, to gain feedback about the acceptability of the interventions. A cost - effectiveness evaluation is embedded in the trial.

DISCUSSION

The trial investigates components of recent national policy recommendations for people with long term conditions, and Parkinson's Disease in particular, and will provide guidance to inform local service planning and commissioning.

TRIAL REGISTRATION

ISRCTN: ISRCTN44577970.

Development and validation of the HOPE prognostic index on 24-month posthospital mortality and rehospitalization: Italian National Research Center on Aging (INRCA)

BACKGROUND

A fast and simple tool is needed to test for the risk of mortality and rehospitalization in older patients.

OBJECTIVE

The aim of this study was to construct and validate a prognostic index using specific items from the Comprehensive Geriatric Assessment (CGA) in a large population of older hospitalized adults.

METHOD

This was a prospective study of a 24-month follow-up period, between 2005 to 2008 in 3,043 elderly patients (mean age, 81 ± 6) discharged from three acute geriatric wards in the Marche region of Italy. Baseline predictors of demographics and 25 items from the CGA regarding functional and cognitive status, depression, co-morbidity, social isolation, and quality of life were used to build a summary score, the Hospitalized Older Patient Examination (HOPE) Index. The HOPE index was developed in 1,533 patients and validated in 1,510 consecutively hospitalized patients. Outcome measures were 24-month mortality and rehospitalization.

RESULTS

Three risk categories of HOPE based on the best sensitivity and specificity for mortality and rehospitalization were: Low (≤4), moderate (4-8), and high (≥8). Categorizing data across the HOPE index, mortality ranged from 7.9% to 14.5% in the development cohort and 6.2% to 14.0% in the validation cohort, whereas rehospitalization ranged from 68.3% to 79.4% and 69.8% to 79.8%, respectively. Kaplan-Meier survival curves demonstrated that risk for mortality increased with a worsening across the HOPE index (p < 0.001). In the development and validation cohorts, a close agreement was found for HOPE on mortality and rehospitalization with a receiver operating characteristic (ROC) of 0.69 (95% confidence interval [CI] 0.61-0.74) vs. 0.67 (95% CI 0.57-0.70) and rehospitalization of 0.62 (95% CI 0.58-0.66) vs. 0.60 (95% CI 0.56-0.63), respectively. In the development and validation cohorts, Cox proportional hazard models showed that a high HOPE index predicted risks of 2.38 (1.34-4.23) and 2.86 (1.24-6.61) on mortality and 1.27 (1.09-1.44) and 1.37 (1.10-1.64) on rehospitalization, respectively.

CONCLUSIONS

HOPE may be useful for long-term clinical planning, discharge, and follow-up.

Mechanisms by Which Social Support Networks Influence Healthy Aging Among Thai Community-Dwelling Elderly

Objective: To examine the relationships among family, friendship networks and supports, health-promoting behaviors, and healthy aging. Method: A sample of 469 Thai elderly persons was recruited using multistage random sampling. A structural equation model based on Berkman’s conceptual model was performed. Results: Family networks did not directly influence health-promoting behaviors but rather had an indirect effect through family support. Friendship networks had both a significant direct effect on the elderly health-promoting behaviors and an indirect effect via friendship support. Interestingly, friendships had both direct and indirect influences on family support to the elderly. Health-promoting behaviors had a powerful influence on healthy aging and play a significant role in mediating the relationship between family and friendship supports and healthy aging. Discussion: Findings demonstrate the importance of family and friendship roles on health-promoting behaviors and healthy aging. Intervention programs should be designed to include a collaborative approach involving family members and friends.

Risk factors for nonvertebral fracture in obese older women

CONTEXT

A high prevalence of obesity has recently been reported in postmenopausal women with low trauma fracture, suggesting that higher bone mineral density (BMD) in obese individuals may not be protective against fracture.

OBJECTIVE

The aim of this study was to compare BMD and other risk factors for nonvertebral fracture in 1377 obese postmenopausal women.

DESIGN

Characteristics of obese women with and without incident nonvertebral fracture were investigated among the prospective cohort in the Study of Osteoporotic Fractures.

SETTING

The Study of Osteoporotic Fractures is a multicenter study of 9704 women (>99% Caucasian) aged 65 yr and over who were recruited between September 1986 and October 1988 from population-based listings at four U.S. clinical centers.

MAIN OUTCOME MEASURE

The main outcome measure was nonvertebral fracture.

RESULTS

BMD T-scores in the spine, femoral neck, and total hip were significantly lower in obese women who experienced fractures than in obese women without fracture: mean differences, -0.56 [95% confidence interval (CI) = -0.73 to -0.39], -0.46 (95% CI = -0.57 to -0.36), and -0.51 (95% CI = -0.62 to -0.39), respectively (P < 0.0001 for all). A previous history of fracture [odds ratio = 1.69 (95% CI = 1.33-2.14); P < 0.0001] and femoral neck BMD [1.62 (95% CI = 1.42-1.85) per sd decrease in BMD; P < 0.0001] were independently associated with incident nonvertebral fracture.

CONCLUSIONS

Obese postmenopausal women who sustain nonvertebral fractures have significantly lower BMD on average than obese women without fracture and are more likely to have a past history of fracture. Fractures in obese postmenopausal women thus exhibit some characteristics of fragility fractures.

Self-efficacy for managing dementia may protect against burden and depression in Alzheimer's caregivers

BACKGROUND

Self-efficacy is the belief that one can perform a specific task or behaviour and is a modifiable attribute which has been shown to influence health behaviours. Few studies have examined the relationship between self-efficacy for dementia-related tasks and symptoms of burden and depression in caregivers.

METHODS

Eighty four patient/caregiver dyads with Alzheimer's disease were recruited through a memory clinic. Patient function, cognition and neuropsychiatric symptoms were assessed together with caregiver burden, personality, depressive symptoms, coping strategies and self-efficacy for completing tasks related to dementia care.

RESULTS

33% (28) of caregivers reported significant depressive symptoms (CES-D  ≥  10). In multivariate analyses, caregiver burden was predicted by self-efficacy for symptom management, neuroticism, patient function and neuropsychiatric symptoms while caregiver depression was predicted by self-efficacy for symptom management, caregiver educational level, neuroticism, emotion-focused coping, dysfunctional coping and patient function. In patients with moderate to severe impairment (MMSE  ≤  20), self-efficacy for symptom management behaved as a mediator between patient neuropsychiatric symptoms and symptoms of burden and depression in caregivers.

CONCLUSIONS

Further longitudinal investigation is warranted to determine if self-efficacy might be usefully considered a target in future interventional studies to alleviate symptoms of burden and depression in Alzheimer's caregivers.

Health risk appraisal for older people 5: self-efficacy in patient-doctor interactions

OBJECTIVE

Enhancing self-efficacy is central to programmes promoting self-care and self-management. However, little is known about older people's self-efficacy in doctor-patient interactions. This paper investigates lifestyle, medical and demographic factors associated with self-efficacy in doctor-patient interactions in older people in general practice.

METHODS

A cross-sectional analysis of data from a randomised controlled trial of older people was conducted in a health risk appraisal study in London. Self-efficacy was measured using the Perceived Efficacy in Patient-Physician Interactions Questionnaire.

RESULTS

Older people with higher self-efficacy were significantly more likely to report having had recent preventive care measures such as recent blood pressure measurement and influenza immunisation. Women were less likely to have higher self-efficacy than men. Older people were significantly less likely to have high self-efficacy if they reported having poor memory, low mood, limited activities due to fear of falling, basic education, difficulties with at least one activity of daily living, reduced physical activity, living alone, or risk of social isolation.

CONCLUSION

A third of people had low self-efficacy in doctor-patient interactions. They appear to be a vulnerable group. Low self-efficacy in interactions with doctors may be a symptom or a characteristic of older people who experience social isolation and depression. Policies that depend on enhancing self-care and self-management need to consider the large number of older people with low self-efficacy in using medical services, and understanding characteristics in older people associated with lower confidence in doctor-patient interactions may be useful in clinical practice and research.

Determinants of the desire to institutionalize in Alzheimer's caregivers

BACKGROUND

The desire to institutionalize is an important predictor of future institutionalization. Few studies have examined potentially modifiable caregiver characteristics which might be the focus of future interventional strategies.

METHODS

A total of 102 patient/caregiver dyads with Alzheimer's disease (n = 84) or mild cognitive impairment were recruited through a memory clinic. Cross-sectional analyses of a range of patients, caregivers, and context of care-related characteristics were conducted.

RESULTS

Caregiver desire to institutionalize was significantly associated with a number of potentially modifiable variables including caregiver coping style, self-efficacy, depression, burden, and the presence of an unmet service need. In a multivariate analysis, caregiver burden, depression, and nonspousal status were the only significant independent predictors of caregiver desire to institutionalize in a model which correctly classified 80.4% of caregivers.

CONCLUSIONS

Interventions which seek to reduce caregiver desire to institutionalize should adopt a multifactorial approach to reduce symptoms of burden and depression in caregivers.

Family relations and life satisfaction of older people: a comparative study between two different hukous in China

This paper examined the relationships between family relations and life satisfaction between the two groups of older people with different hukous in Putian, Fujian, China. Five factors related to family relations: family support network, satisfaction with family support, family harmony, filial support and filial discrepancy, were included in the study. A total of 532 valid questionnaires, 263 and 269 being filled in by older people with agricultural and non-agricultural hukous, respectively, were obtained. Bivariate analyses indicated that five factors were correlated significantly with life satisfaction for both groups of older people. The results of hierarchical regression analyses showed that when controlling for socio-demographic variables, filial support was associated with life satisfaction for both groups of older people; satisfaction with family support and filial discrepancy was only associated with life satisfaction among older people with agricultural hukous; family harmony only contributed to explaining life satisfaction among older people with non-agricultural hukous. The present study confirmed some previous empirical findings, which indicated the importance of family relations to older people's lives, and extended our understanding about the correlates of life satisfaction for the two groups of older people with different hukous in China. Limitations and direction of future studies were also addressed. Meanwhile, the policy and practice implications of the study were discussed in the context of China's social and economic changes.