Social relations as determinant of onset of disability in aging

Environmental influences on healthy and active ageing: a systematic review

This paper explores the evidence for environmental influences on older adult health and activity participation, identifies current knowledge gaps and limitations within this literature, and offers recommendations for future research via a systematic appraisal of 83 quantitative and qualitative studies. A Cochrane-type review procedure was followed, which incorporated structured database searches, inclusion and exclusion criteria, quality appraisal of included studies, and peer review. The review findings identify support for both personal and environmental influences on health and activity participation in later life. Reported personal influences include ethnicity and cultural norms, energy and motivation, sex, age, education, genetic heritage, self-efficacy, and personal financial circumstances. Reported environmental influences on activity participation include climate, level of pollution, street lighting, traffic conditions, accessibility and appropriateness of services and facilities, socio-economic conditions, aesthetics, pedestrian infrastructure, community life, exposure to antisocial behaviour, social network participation, environmental degradation, level of urbanism, exposure to natural settings, familiarity with local environment and others. Recommendations for future research include the need for innovative research methods; involvement of older adults as research collaborators; investigation of wider aspects of the active ageing concept; in-depth assessment of the environmental characteristics of areas; investigation of the pathways leading from environment to health and activity participation; and more theoretically informed research or increased contribution of research to theory development.

Social contacts and receipt of help among older people in England: are there benefits of having more children?

OBJECTIVES

To investigate whether number of children and, among parents, having a daughter is associated with older people's likelihood of at least weekly face-to-face social contact and later receipt of help if needed.

METHOD

Multivariate analysis of data from Waves 1 and 2 of the English Longitudinal Study of Ageing (ELSA).

RESULTS

Older parents in England had higher chances of at least weekly face-to-face social contact than their childless counterparts but larger family size had only a slight additional effect. For parents, having at least one daughter was more important than number of children. Larger family size was positively associated with receipt of help from a child by parents with activities of daily living (ADL) or instrumental activities of daily living (IADL) limitations. Childless women were more likely than mothers to receive help from friends but even so had lower odds of receiving help from any informal source. Contact with a child in 2002 predicted receipt of help 2 years later.

DISCUSSION

These results show some advantages for older parents compared with childless individuals in terms of social contact and receipt of help and, among parents, an additional effect of having a daughter. Changes in family size distributions have implications for the support of older people and for planners of formal services.

The relationship between social support and functional capacity in elderly persons with cognitive alterations

The objective of this study was to identify the relationship between social support and the functional capacity of elderly persons with cognitive alterations. It is a descriptive, cross-sectional and quantitative study. The subjects were 101 elderly persons registered in Family Health Centers whose performance in the Mini-Exam for Mental Status was below a certain specified level in a previous study. The Medical Outcomes Study questionnaire, Katz Index and Pfeffer Questionnaire were applied. The dimensions of material, affective, emotional, informational and positive social interaction support resulted in an average final score of 74.32 points, indicating a better level of material and affective support in relation to the other dimensions of support. There was a statistically significant correlation between emotional support and the Katz Index. Knowledge about this relationship favors the development of a nursing care pathway for the elderly which is capable of maintaining their functional capacity and ensuring satisfactory social relations.

Idosos com alteração cognitiva em contexto de pobreza: estudando a rede de apoio social

O objetivo deste trabalho foi analisar a estrutura e função das redes de apoio social de idosos com alterações cognitivas, residentes em contexto de alta e muito alta vulnerabilidade social, além de identificar associações entre as características das redes e a capacidade funcional. Os sujeitos estudados foram 38 idosos, residentes em contexto de alta e muito alta vulnerabilidade social, que apresentaram resultado no Mini Exame do Estado Mental abaixo da nota de corte. Todos os cuidados éticos foram observados. Aplicaram-se o Mini Exame do Estado Mental, o Diagrama de Escolta, o Índice de Katz e o Questionário de Pfeffer. Os resultados demonstraram que os idosos avaliados possuem rede social grande, com predomínio de integrantes no círculo interno, porém poucos integrantes desempenham papéis funcionais. Observou-se correlação entre a variável sexo e o número de integrantes das redes sociais. Não foi observada correlação significativa entre as características das redes e a capacidade funcional dos idosos.

Determinants of social participation of visually impaired older adults

PURPOSE

To assess determinants of social participation among visually impaired older adults.

METHODS

This cross-sectional study included visually impaired persons (≥55 years; n = 173) who were referred to a low-vision rehabilitation center. Determinants (i.e., sociodemographic, physical, social and psychological factors, and personal values) of participation were identified in four domains of participation: (1) domestic life; (2) interpersonal interactions and relationships; (3) major life areas; and (4) community, social, and civic life. Study participants completed telephone interviews.

RESULTS

Age, physical fitness, and helplessness were determinants of participation in domestic life. Social network size was associated with participation in major life areas. The personal value attached to participation (i.e., perceived importance) was a determinant of participation in interpersonal interactions and relationships, major life areas, and community, social and civic life. Vision-related characteristics (i.e., self-perceived vision and degree of visual impairment) were not associated with participation.

CONCLUSIONS

Across the participation domains, perceived importance is a major determinant of social participation among visually impaired older adults. Physical health along with social and psychological status, also affect participation. Knowing how participation is determined can be used to develop rehabilitation interventions to enhance participation of visually impaired older adults.

Do positive or negative experiences of social support relate to current and future health? Results from the Doetinchem Cohort Study

Background

Cross-sectional studies have reported associations between social support and health, but prospective evidence is less conclusive. This study aims to investigate the associations of positive and negative experiences of social support with current and future lifestyle factors, biological risk factors, self-perceived health and mental health over a 10-year period.

Methods

Data were from 4,724 Dutch men and women aged 26-65 years who participated in the second (1993-1997) and in the third (1998-2002) or fourth (2003-2007) study round of the Doetinchem Cohort Study. Social support was measured at round two using the Social Experiences Checklist. Health was assessed by several indicators such as smoking, alcohol consumption, physical activity, fruit and vegetable intake, overweight, hypertension, hypercholesterolemia, self-perceived health and mental health. Tertiles of positive and negative experiences of social support were analysed in association with repeated measurements of prevalence and incidence of several health indicators using generalised estimating equations (GEE).

Results

Positive and negative experiences of social support were associated with prevalence and incidence of poor mental health. For the lowest tertile of positive support, odds ratios were 2.74 (95% CI 2.32-3.23) for prevalent poor mental health and 1.86 (95% CI 1.39-2.49) for incident poor mental health. For the highest tertile of negatively experienced support, odds ratios for prevalent and incident poor mental health were 3.28 (95% CI 2.78-3.87) and 1.60 (95% CI 1.21-2.12), respectively. Low levels of positive experiences of social support were also associated with low current intake of fruits and vegetables, but not with future intake. Negative experiences of social support were additionally associated with current smoking, physical inactivity, overweight and poor self-perceived health. Furthermore, high levels of negative experiences of social support were associated with future excessive alcohol consumption (OR 1.42; 95% CI 1.10-1.84), physical inactivity (95% CI 1.28; 1.03-1.58) and poor self-perceived health (OR 1.36; 95% CI 1.01-1.82).

Conclusions

This study showed that social support might have a beneficial effect on lifestyle and health, with negative experiences of social support affecting lifestyle and health differently from positive experiences of social support.

Capacidade funcional e fatores associados em idosos: estudo populacional

OBJETIVO: Analisar a associação do comprometimento da capacidade funcional com condições de saúde e fatores sociodemográficos e comportamentais entre idosos residentes em comunidade do interior do Nordeste brasileiro. MÉTODOS: Estudo transversal de base populacional realizado com 316 idosos residentes em Lafaiete Coutinho-BA. A capacidade funcional foi avaliada por escala hierárquica, verificando associação com condições de saúde e fatores sóciodemográficos e comportamentais pela técnica de regressão logística multinomial. RESULTADOS: A dependência nas atividades independentes da vida diária (AIVD) foi associada ao grupo etário > 80 anos, uso de dois ou mais medicamentos e comprometimento cognitivo. A dependência nas atividades básicas da vida diária e AIVD foi associada ao grupo etário > 80 anos, falta de participação em atividades religiosas, hospitalização nos últimos 12 meses, comprometimento cognitivo e sobrepeso. CONCLUSÃO: Houve associação com comprometimento da capacidade funcional e condições de saúde e fatores sociodemográficos entre idosos residentes em comunidade no Nordeste brasileiro.

Effects of comprehensive geriatric assessment and targeted intervention on mobility in persons aged 75 years and over: a randomized controlled trial

OBJECTIVE

To assess the effect of a comprehensive geriatric assessment and individually tailored intervention on mobility in older people. In addition, the effectiveness of the geriatric intervention was evaluated among a subgroup of persons with musculoskeletal pain.

DESIGN

Three-year geriatric development project with randomized assignment to intervention and control group.

SETTING

Research centre, community and assisted living facilities.

PARTICIPANTS

Seven hundred and eighty-one Finnish persons aged 75-98 years were assigned to an intervention (n = 404) or control (n = 377) group.

INTERVENTION

A comprehensive geriatric assessment with a multifactorial intervention lasting two years. The intervention included individualized referrals, recommendations, physical activity counselling and supervised resistance training.

MEASUREMENTS

Perceived limitation in walking 400m was gathered annually during the intervention and at the one-year post-intervention follow-up.

RESULTS

The proportion of persons with mobility limitation at the beginning, at the two-year intervention and at the one-year post-intervention follow-up was 16%, 15%, 12% and 14%, respectively, in the intervention group. In the control group, the corresponding proportions were 19%, 18%, 23% and 26%. The treatment effect was significant at the end of the two-year intervention (odds ratio 0.82, 95% confidence interval 0.70-0.96, P = 0.013), and at the one-year post-intervention follow-up (0.84, 0.75-0.94, P = 0.002). The parallel positive effect of the intervention on mobility was even greater among persons with musculoskeletal pain.

CONCLUSION

The comprehensive geriatric assessment and individually tailored multifactorial intervention had a positive effect on mobility, underlining their importance in health promotion and disability prevention in older people.

Nested social groups within the social environment of a dementia care assisted living setting

The social environments of people with dementia are complex and still not fully understood. Investigating how residents in a dementia care setting navigate and participate within social groups is critical as the therapeutic benefits of social engagement are unequivocal. An ethnographic study of social environments within a dementia care residence revealed that there is active socialization and even strong and lasting friendships formed between people with dementia. Many of these relationships were observed to be a part of groups, ‘nested’ within the larger social environment. These ‘nested social groups’ had unique dynamics and their structuring was often influenced by outside factors (e.g. physical environment and staff preferences). The existence of these groups has implications for the experiences and quality of life of the residents in long-term care. Nested social groups will be defined and their function within the social environment will be discussed.

Onset of mobility limitations in old age: the combined effect of socioeconomic position and social relations

PURPOSE

to examine the combined effect of cohabitation status and social participation, respectively, and socioeconomic position on onset of mobility limitations in a prospective study among older Danes.

DESIGN AND METHODS

logistic regression analyses with combined exposure variables were performed in a study population of 2,839 older men and women from the Danish Intervention Study on Preventive Home Visits.

RESULTS

among men low financial assets, living alone or having low social participation significantly increased the odds ratios (OR) for onset of mobility limitations. Among women only low financial assets and low social participation significantly increased the ORs for onset of mobility limitations. Analyses with combined exposure variables showed that simultaneous exposure to low financial assets and poor social relations significantly increased the ORs for onset of mobility limitations among both genders, yet the tendencies appeared stronger for males. In particular, men with simultaneous exposure to low financial assets and low social participation had increased odds ratios for onset of mobility limitations, OR = 5.36 (2.51-11.47), compared with the non-exposed.

CONCLUSION

the study suggests that future interventions to increase social participation might alleviate the negative effects on mobility experienced by older people in low socioeconomic position, perhaps especially among older males.

Gender, social engagement, and limitations in late life

This study examines gender differences in the pathways among social engagement, physical limitations and cognitive limitations among U.S. older adults. It improves upon previous literature by longitudinally testing both social benefit and selection hypotheses, examining gender differences in these relationships, gaining modeling advantages through structural equation modeling, and by incorporating the frequency of participation in social activities as an important source of social integration that may influence health among older adults. This study uses U.S. panel data of adults aged 60 and older from the Americans' Changing Lives survey (N = 1642) from 1986, 1989, and 1994 in a cross-lagged panel design to better understand these relationships. For women, the flow is from greater social engagement to lower levels of subsequent physical and cognitive limitations, whereas for men the flow is from greater physical and cognitive limitations to lower levels of subsequent social engagement.

Effects of walking speed and results of timed get-up-and-go tests on quality of life and social participation in elderly individuals with a history of osteoporosis-related fractures

OBJECTIVE

To investigate the relationships between physical performance, quality of life (QoL), and social participation among elderly men and women with a history of osteoporosis-related fractures.

METHOD

The study was a population-based cross-sectional study including 155 participants aged 60 to 93 years from the Swedish longitudinal investigation, "Good Aging in Skåne." The participants had suffered fracture of the vertebrae, hip, pelvis, or ankle. Physical performance was expressed as walking speed (WS) and timed get-up-and-go (TUG). QoL was measured as using the Health Related Quality of Life (HRQoL) and Life Satisfaction (LS) scales. Social participation was defined as taking part in social, cultural, and leisure activities.

RESULTS

Lower WS and/or TUG were associated with lower HRQoL, lower LS, and a reduction in social participation, after adjustment for confounding factors.

DISCUSSION

Measurements of WS and TUG could be used to determine QoL and social participation in elderly people having sustained fractures.

Protective effects of social networks on disability among older adults in Spain

The loss of autonomy at advanced ages is not only associated with ageing, but also with the characteristics of the physical and social environment. Recent investigations have shown that social networks, social engagement and participation act like predictors of disability among the elderly. The aim of this study is to determine whether social networks are related to the development and progression of disability in the early years of old age. The source of data is the first wave of the survey "Processes of Vulnerability among Spanish Elderly", carried out in 2005 to a sample of 1244 individuals. The population object of study is the cohort aged 70-74 years in metropolitan areas (Madrid and Barcelona) and not institutionalized. Disability is measured by the development of basic activities of daily life (ADL), and instrumental activities of daily life (IADL). The structural aspects of the social relationships are measured through the diversity of social networks and participation. We used the social network index (SNI). For each point over the SNI, the risk of developing any type of disability decreased by 49% (HR=0.51, 95%CI=0.31-0.82). The SNI was a decisive factor in all forecasting models constructed with some hazard ratios (HR) that ranged from 0.29 (95%CI=0.14-0.59) in the first model to 0.43 (95%CI 0.20-0.90) in the full model. The results of the present study showed a strong association between an active social life, emotional support provided by friends and confidents and disability. These findings suggest a protective effect of social networks on disability. Also, these results indicate that some family and emotional ties have a significant effect on both the prevalence and the incidence of disability.

Relation of late-life social activity with incident disability among community-dwelling older adults

BACKGROUND

We tested the hypothesis that a higher level of social activity was associated with decreased risk of incident disability in older adults.

METHODS

Data came from older adults in the Rush Memory and Aging Project, an ongoing longitudinal cohort study of aging. Analyses were restricted to persons without clinical dementia and reporting no need for help performing any task in the particular functional domain assessed. Participants were followed for an average of 5.1 years (SD = 2.5). Social activity, based on 6 items (visiting friends or relatives; going to restaurants, sporting events, or playing games; group meetings; church/religious services; day or overnight trips; unpaid community/volunteer work), was assessed at baseline. Disability in basic activities of daily living, mobility disability, and instrumental activities of daily living was assessed annually. Proportional hazard models adjusted for age, sex, and education were used to examine the association between social activity and incident disability. Fully adjusted models included terms for depression, vascular diseases and risk factors, body mass index, social networks, and self-reported physical activity.

RESULTS

In fully adjusted models, among 954 persons without baseline disability, the risk of developing disability in activities of daily living decreased by 43% (hazard ratio = 0.57, 95% confidence interval = 0.46, 0.71) for each additional unit of social activity. Social activity was also associated with decreased risk of developing mobility disability (hazard ratio = 0.69, 95% confidence interval = 0.54, 0.88) and disability in instrumental activities of daily living (hazard ratio = 0.71, 95% confidence interval = 0.55, 0.93).

CONCLUSIONS

Social activity is associated with a decreased risk of incident disability in activities of daily living, mobility, and instrumental activities of daily living, among community-dwelling older adults.

The biopsycho-ecological paradigm: a foundational theory for medicine

The current biomedical and psychosocial frameworks that form the conceptual basis of medicine today are insufficient to address the needs of the medically complex and environmentally challenged populations of patients often cared for by physical medicine and rehabilitation specialists. The expanded biopsycho-ecological model of health, illness, injury, and disability operating through mechanisms of Health Environmental Integration (HEI) encourages a more complete understanding of illness, injury, activity limitation, and participation restriction as arising at the interface between the person and the environment. HEI recognizes complex interacting multilevel functional hierarchies beginning at the cellular level and ending at the individual's experience of the environment. Although the foci of illness and injury are within the body and mind, the physical and social environments contain elements that can cause or exacerbate disease and barriers that interact in ways that lead to injuries and disabilities. Furthermore, these environments hold the elements from which treating agents, facilitators, and social supports must be fashioned. The highly integrative biopsycho-ecological framework provides an expanded basis for understanding the objective causes and subjective meanings of disabilities. Disabilities are reduced through HEI by seeking to maximally integrate the body and mind (the self) with both the surrounding physical environment and other people in society. HEI offers mechanisms for interdisciplinary research, an expanded framework for education and empowerment, and a blueprint for optimizing day-to-day clinical care at both the individual patient and treatment population levels in the ever-changing scientific, political, and policy environments.

Transportation Use in Community-Dwelling Older Adults: Association with Participation and Leisure Activities

Les objectifs de cette étude étaient de comparer la participation selon les moyens de transport utilisés, et d’estimer l’association entre le transport, les facteurs personnels et environnementaux avec la participation chez les personnes âgées habitant dans la communauté. Les participants incluaient 90 adultes âgés de 65 ans et plus (moyenne d’âge = 76.3 ans ; ET = 7.7). Ils étaient classifiés selon le moyen de transport utilisé le plus souvent: conducteur, passager, transport en commun, marche, ou transport adapté/taxi. La participation a été mesuré avec le « Craig Handicap Assessment and Reporting Technique (CHART) » et le « Nottingham Leisure Questionnaire (NLQ) ». Somme toute, les résultats ont indiqué que les conducteurs, utilisateurs de transport en commun et ceux qui utilisaient la marche avaient des niveaux de participation plus élevés comparativement aux passagers et utilisateurs de transport adapté/taxi. Cette étude suggère que les cliniciens devraient considérer l’utilisation du transport chez les personnes âgées afin d’encourager et de maximiser leur participation.

Gender and incidence of functional disability in the elderly: a systematic review

This systematic review aimed to assess the effect of gender on the incidence of functional disability in the elderly. The search for publications in the MEDLINE, EMBASE, and ProQuest electronic databases from January 1990 to March 2008 identified 879 publications, from which 21 cohort studies were selected that evaluated gender as an independent variable and incidence of functional disability in elderly as the outcome. Review of the studies found that after adjusting for socioeconomic, health, and social relations indicators, incidence of functional disability was similar between genders. The main risk factors for functional disability in the elderly, regardless of gender, were: lack of schooling, living in rental housing, chronic diseases, arthritis, diabetes, visual impairment, body mass index above 25, poor self-perceived health, cognitive impairment, depression, slow gait, sedentary lifestyle, tiredness while performing daily activities, and limited diversity in social relations.

Mobility Adaptations of Older Adults: A Secondary Analysis

The purpose of this secondary study was to describe the mobility adaptations of community—living older adults. The primary study, designed to understand weakness and aging from the perspective of older adults, revealed that older adults viewed weakness as a progression from inability to an end point of ‘giving up,’ which prompted the use of adaptation strategies to preserve mobility and to counter a self-identity of being weak. A qualitative descriptive design guided the primary study of 15 community—living older adults, who participated in in-depth interviews. A systematic secondary analysis using Baltes and Baltes’ theory of Selective Optimization with Compensation (SOC) showed that older adults used selection, optimization, and compensation adaptations across a range of mobility behaviors. The SOC model offered a framework for profiling older adults’ agency and motivations in meeting mobility challenges as they age and provided the basis for targeted interventions to maximize mobility with aging.

Positive and negative experiences of social support and long-term mortality among middle-aged Dutch people

This study investigated the relation between positive and negative experiences of social support and mortality in a population-based sample. Data were derived from Dutch men and women aged 20-59 years who participated in the Doetinchem Cohort Study in 1987-1991. Social support was measured at baseline and after 5 years of follow-up by using the Social Experiences Checklist indicating positive (n = 11,163) and negative (n = 11,161) experiences of support. Mortality data were obtained from 1987 until 2008. Cox proportional hazards regression models, adjusted for age and sex, showed that low positive experiences of support at baseline were associated with an increased mortality risk after, on average, 19 years of follow-up (hazard ratio = 1.26, 95% confidence interval: 1.04, 1.52). Even after additional adjustment for socioeconomic factors, lifestyle factors, and indicators of health status, the increased mortality risk remained statistically significant (hazard ratio = 1.23, 95% confidence interval: 1.01, 1.49). For participants with repeated measurements of social support at 5-year intervals, a stable low level of positive experiences of social support was associated with a stronger increase in age- and sex-adjusted mortality risk (hazard ratio = 1.57, 95% confidence interval: 1.03, 2.39). Negative experiences of social support were not related to mortality.

Participation of the elderly after vision loss

PURPOSE

To assess the degree of participation of the visually impaired elderly and to make a comparison with population-based reference data.

METHOD

This cross-sectional study included visually impaired elderly persons (≥55 years; n = 173) who were referred to a low-vision rehabilitation centre. Based on the International Classification of Functioning, Disability and Health (ICF) participation in: (1) domestic life, (2) interpersonal interactions and relationships, (3) major life areas, and (4) community, social and civic life was assessed by means of telephone interviews. In addition, we assessed perceived participation restrictions.

RESULTS

Comparison with reference data of the elderly showed that visually impaired elderly persons participated less in heavy household activities, recreational activities and sports activities. No differences were found for the interpersonal interactions and relationships domain. Participants experienced restrictions in household activities (84%), socializing (53%), paid or voluntary work (92%), and leisure activities (88%).

CONCLUSIONS

Visually impaired elderly persons participate in society, but they participate less than their peers. They experience restrictions as a result of vision loss. These findings are relevant, since participation is an indicator for successful aging and has a positive influence on health and subjective well-being.

Can the higher risk of disability onset among older people who live alone be alleviated by strong social relations? A longitudinal study of non-disabled men and women

PURPOSE

to investigate if the increased risk of disability onset among older people who live alone could possibly be moderated by either high social participation or by being satisfied with the social relations.

DESIGN AND METHODS

logistic regression models were tested using two waves in a study population of 2,697 non-disabled older men and women from The Danish Longitudinal Study on Preventive Home Visits.

RESULTS

living alone and low social participation were significant risk factors for later male disability onset. Not being satisfied with the social relations was significantly associated with onset of disability for both genders. Among men who lived alone low social participation was a significant predictor of disability onset [odds ratio, OR = 2.30 (1.00-5.29)]; for cohabiting men social participation was not associated with disability onset, [adjusted OR = 0.91 (0.49-1.71)]. Similar results were present concerning satisfaction with the social relations among men. There was no significant interaction for women.

CONCLUSIONS

the study suggests that men who live alone can possibly alleviate their risk of disability onset by being socially active and by having access to satisfactory social relations. Women do not seem to benefit as much from cohabitation as men, although women who live alone and who are not satisfied with their social relations also constitute a significant risk category.

Disability and depressive symptoms in later life: the stress-buffering role of informal and formal support

BACKGROUND

Despite the increasing utilization of formal services by older adults in many nations, there is a paucity of research that has examined the relationships between disability, formal support and depressive symptoms in later life.

OBJECTIVE

We investigated whether support received for daily activities, either from formal and/or informal sources, weakened the deleterious relationship between disability and depression symptoms in later life and whether these stress-buffering effects were stronger in later years of older adulthood.

METHODS

Participants were 1,359 community-dwelling older adults drawn from Wave 1 of the Australian Longitudinal Study of Ageing. Hierarchical multiple regression was used.

RESULTS

Individuals receiving support from (1) informal sources only and (2) both informal and formal sources had weaker relationships between disability and depressive symptoms, relative to those receiving no support. The interaction between informal and formal support and disability also revealed that for individuals with above average functional limitations, receipt of this support type was associated with fewer depressive symptoms. However, for individuals with no functional limitations, receipt of both informal and formal support was not associated with depressive symptoms. The stress-buffer age variation hypothesis received no support.

CONCLUSIONS

Findings suggest that receiving a combination of informal and formal support may be sufficient to offset the harmful association between disability and depressive symptoms in later life. In addition, findings further emphasized the importance of informal support in later life. In contrast, formal support in isolation may not be sufficient to confer a protective effect. Given the expected increase in utilization of formal services among older adults in the coming decades, it is essential that future research investigates the possible factors that underlie this null result.

Social Inequality in Onset of Mobility Disability Among Older Danes: The Mediation Effect of Social Relations

Objective: This article investigates social inequality in onset of mobility disability and in measures of social relations and whether social relations mediated the effect of socioeconomic status on mobility. Method: A total of 2,825 nondisabled older men and women, enrolled in the Danish Intervention Study on Preventive Home Visits, constituted the study population. Data were obtained by mailed questionnaires in 1998-1999 and 2001-2002 and by merging analyses to registers at Statistics Denmark. Results: There was a social gradient in onset of mobility disability, with odds ratio of 1.11 (1.07-1.15) per step down the deciles of financial assets and in cohabitation status, social participation, and network diversity. Social relations did not mediate the effect of financial assets on onset of mobility disability. Discussion: The negative effects of low financial assets and poor social relations on mobility appear to be independent. More longitudinal studies on possible mediators of the social gradient in mobility among older people are needed.

The challenges experienced by Iranian war veterans living with chemical warfare poisoning: a descriptive, exploratory study

This exploratory, descriptive study investigates the experiences of Iranian war veterans living with chronic disease acquired as a result of chemical warfare. Sulphur mustard (SM) is considered one of the most important agents of chemical warfare and was widely used during the Iran-Iraq conflict in 1980-1988. There are approximately 100 000 Iranian SM casualties who suffer from serious long-term progressive health problems involving their respiratory organs, eyes and skin. Seventeen male Iranian war veterans aged between 30 and 59 years and four victims' family members participated in the study. Data was generated during individual in-depth interviews that used open-ended questions. Grounded theory techniques, including the constant comparative method of concurrent data generation and analysis, were employed in the analysis of data. Preliminary results indicate two main thematic categories: social isolation and physical disability. It is argued that a lack of knowledge about the outcomes of SM poisoning, physical restrictions and difficulty in adjusting socially decreases war veterans' functional capacity and levels of independence.

The significance of social engagement in relocated older adults

Social networks and social support are recognized as important determinants of health. Relocation is a common transition in older adults' lives that can disrupt existing social networks and challenge seniors to reconstitute these networks. Social engagement is a required component of the process of reconstituting social relationships and of feeling connected. The purpose of this focused ethnographic study was to develop an understanding of the experience of social engagement in relocated residents of a senior-designated apartment building. Data generation included interviews with 19 older adults. Transcribed interviews were analyzed using thematic analysis. Seniors developed four types of relationships for provision of feelings of security, casual interactions, opportunity to be supportive, and friendship. The findings of this research provide a better understanding of the relationships seniors developed in a new community as a result of the process of social engagement.

Modeling transition rates using panel current-status data: how serious is the bias?

Studies of disability dynamics and active life expectancy often rely on transition rates or probabilities that are estimated using panel survey data in which respondents report on current health or functional status. If respondents are contacted at intervals of one or two years, then relatively short periods of disability or recovery between surveys may be missed. Much published research that uses such data assumes that there are no unrecorded transitions, applying event-history techniques to estimate transition rates. In recent years, a different approach based on embedded Markov chains has received growing use. We assessed the performance of both approaches, using as a criterion their ability to reproduce the parameters of a "true" model based on panel data collected at one-month intervals. Neither of the widely used approaches performs particularly well, and neither is uniformly superior to the other.

Predictors for institutionalization and prosthetic ambulation after major lower extremity amputation during an eight-year follow-up

BACKGROUND AND AIMS

Major lower extremity amputation (LEA) leads to great loss in mobility, exposing old people to the risk of losing their independent living status. This study applies predictors for institutionalization and considers prosthesis use by major lower leg amputees with peripheral arterial disease (PAD).

METHODS

119 PAD patients admitted from home (mean age 73.6, SD 11.5 years, 48% men) underwent their first major LEA, 1998- 2002, and survived at least one month after the operation. Logistic regression analysis was run to clarify institutionalization predictors. Prosthesis use and ambulatory capacity were recorded during the follow-up.

RESULTS

Older age, living alone, and unilateral above-knee amputation (AKA) or bilateral amputation predicted institutionalization. Of prosthesis users, 69% (27/39) were younger than 75 and 44% (17/39) were able to walk both in- and outdoors. Reasons for not receiving a prosthesis after amputation were: 1) short expected survival; 2) old age, combined with unilateral AKA or bilateral amputation; 3) unilateral AKA or bilateral amputation and a comorbid condition such as hemiparesis, paraplegia, uremia, dementia, or alcohol misuse. After one year, 72% (36/50) of amputees who were able to return home and 9% (3/32) of amputees in institutional care used a prosthesis.

CONCLUSION

The majority of amputated patients cannot return home after their first LEA. Comorbid conditions particularly influencing functional capacity also hinder ambulation with a prosthesis.

[Impact of cognitive deficit on survival among elderly residents in the community]

OBJECTIVE

To analyze cognitive deficit as a risk factor for death in elderly residents in the community and its relationship with variables related to sociodemographic factors, physical health, and functional capacity.

MATERIAL AND METHODS

A prospective study was carried out in the city of Santa Cruz, Brazil, in 310 randomly selected elderly individuals who were followed-up for 53 months. Predictive factors were sociodemographic and neuropsychiatric variables, physical health, and functional capacity. The statistical methods used were bivariate analysis (survival analysis), and Cox regression (multivariate analysis) with respective hazard ratios (HR). A value of P<.05 was considered statistically significant and 95% confidence intervals (CI) were calculated.

RESULTS

A total of 60 (20.5%) elderly residents died during the study. The main cause of death was cardiovascular disease. The mean time until death was approximately 24.8 months. The main risk factors identified in Cox analysis were cognitive deficit (HR=4.22), stroke (HR=3.08) and dependency for basic activities of daily living (HR=3.55).

CONCLUSIONS

Cognitive deficit is an independent risk factor for death. The results of the present study could be useful in formulating future health policies aiming to reduce mortality in the elderly.

Risk factors for mobility limitation in community-dwelling older adults: a social ecological perspective

Although a variety of risk factors for mobility limitation in older adults have been examined, a collective review of relevant literature has not been reported. The purposes of this review are to report the intrapersonal, interpersonal, environmental, and organizational risk factors related to mobility limitation using a social ecological perspective and to discuss the direction of future clinical practice consistent with current literature on mobility limitation of community-dwelling older adults. Intrapersonal risk factors related to mobility limitation include advanced age, female gender, low socioeconomic status, comorbidity, lack of motivation (i.e., dependent personality, decreased self-efficacy), lifestyle factors (i.e., sedentary lifestyle, smoking, obesity), and physiological factors (i.e., vitamin D deficiency, inflammation, poor nutritional status). Interpersonal risk factors related to mobility limitation include weak social networks and limited social activities. Geriatric clients may also experience a decline in mobility when they encounter environmental challenges such as an inconvenient home environment and lack of availability of services in their community, as well as lack of organizational resources stemming from social policy. Potential intervention strategies focused on modifiable risk factors may include lifestyle modifications, social networking programs, and enhancing awareness of environmental and organizational resources in the community for older adults at risk for mobility limitation.

Predictors of perceived togetherness in very old men and women: A 5-year follow-up study

Although a considerable amount of research has been carried out on older adults' social ties, most of it has focused on quantitative aspects and on cross-sectional samples. In this study, the subjective aspect of social interaction is described by the concept of perceived togetherness. The aim of this study was to examine the extent to which different factors predict perceived togetherness in men and women over a 5-year period. It also addresses the question of whether it is possible to identify different subgroups in perceived togetherness. The data were collected with structured interviews and laboratory tests from 225 elderly people at ages 80 and 85. The results showed that the predictors of perceived togetherness partly differed between sexes as well as within the groups of males and females. Predictors common to both genders were contacts with friends, less depressive symptoms, higher education level and better coping with instrumental activities of daily living (IADLs). The findings indicated the importance of friends. Widowhood and self-rated health were predictors in women but not in men. Moreover, there appeared to be two subgroups of women and men in perceived togetherness; these were labeled "socially embedded", "socially isolated", "socially active" and "solitary". The results indicate diversity in perceived togetherness and its predictors. More attention should be paid to individual differences in order to prevent loneliness and to promote older adults' well-being.

Religiousness and Longitudinal Trajectories in Elders' Functional Status

The purpose of this study was to examine the effects of religiousness on the trajectories of difficulties with activities of daily living (ADLs) and instrumental ADLs (IADLs) in community-dwelling older adults over a three-year period. Seven waves of data from the University of Alabama at Birmingham Study of Aging were analyzed using a hierarchical linear modeling method. The study was based on the 784 participants who completed interviews every six months between December 1999 and February 2004. Frequent religious service attendance was associated with fewer ADL difficulties and IADL difficulties at baseline. Furthermore, religious service attendance predicted slower increases for frequent churchgoers and steeper increases for less frequent churchgoers in IADL difficulties, controlling for variables related to demographics and resources. Religious service attendance was independently associated with ADL and IADL difficulties cross-sectionally. However, significant protective effects of religious service attendance were identified longitudinally only for the IADL trajectory.

Cohabitation Status and Onset of Disability Among Older Danes

Objectives: To investigate the effect of cohabitation status in older men and women on (a) onset of disability at 3- and 4.5-year follow-up and (b) changes in functional ability between 3- and 4.5-year follow-up, and to analyze whether this effect was mediated by social participation. Method: A total of 2,533 nondisabled older men and women enrolled in the Danish Intervention Study on Preventive Home Visits constituted the study population. Data were collected by mailed questionnaires in 1998-1999, 2000, 2001-2002, and 2003. Results: Living alone significantly increased the risk of onset of disability (T3 OR = 1.60[1.06-2.43], T4 OR = 1.74[1.22-2.47]) and the risk of sustained poor functional ability (OR = 2.35[1.44-3.84]) among men, but not among single-living women. Social participation mediated only a small part of the effect of cohabitation status on functional ability. Discussion: Our results underline the importance of cohabitation/marriage for maintaining a high functional ability among older men.

Network type and mortality risk in later life

PURPOSE

The purpose of this study was to examine the association of baseline network type and 7-year mortality risk in later life.

DESIGN AND METHODS

We executed secondary analysis of all-cause mortality in Israel using data from a 1997 national survey of adults aged 60 and older (N=5,055) that was linked to records from the National Death Registry up to 2004. We considered six network types--diverse, friend focused, neighbor focused, family focused, community-clan, and restricted--in the analysis, controlling for population group, sociodemographic background, and health factors. We carried out Cox proportional hazards regressions for the entire sample and separately by age group at baseline: 60-69, 70-79, and 80 and older.

RESULTS

Network types were associated with mortality in the 70-79 and 80 and older age groups. Respondents located in diverse and friend-focused network types, and to a lesser degree those located in community-clan network types, had a lower risk of mortality compared to individuals belonging to restricted networks.

IMPLICATIONS

Gerontological practitioners should address older adults' social networks in their assessments of clients. The parameters used to derive network types in this study can serve toward the development of practical network type inventories. Moreover, practitioners should tailor the interventions they implement to the different network types in which their elderly clients are embedded.

Positive and negative social exchanges and disability in later life: an investigation of trajectories of change

OBJECTIVES

Various aspects of one's social ties are thought to influence the onset, progression, and course of disability in older adulthood. Although the longitudinal course of social ties and physical disability is likely to be marked by fluctuations over time and intraindividual variation, few studies have explored how patterns of change in positive and negative social exchanges relate to patterns of change in disability across time. The current study, therefore, examined the extent to which distinct longitudinal trajectories of positive and negative exchanges were associated with patterns of physical disability.

METHODS

We followed a sample of 482 community-dwelling older adults with little to no disability at baseline for 2 years.

RESULTS

Results identified multiple, distinct trajectory groups for positive and negative exchanges and disability. Latent class growth analyses revealed that individuals with chronically high or low positive exchanges were likely to experience low and increasing levels of disability. With respect to negative exchanges, individuals with moderately increasing negative exchanges showed patterns of increasing disability and disability remission, whereas chronically low or absent negative exchanges were associated with low and increasing levels of disability.

DISCUSSION

Findings highlight the importance of evaluating multiple trajectories of change in older adults' social exchanges and disability.