Loneliness, social support networks, mood and wellbeing in community-dwelling elderly

Age-related shifts in mental health determinants from a deprived area in the European Union: informing the national healthy aging program of Hungary

Mental disorders are among the leading causes of disability worldwide, disproportionately affecting older people. This study aims to assess the mental health of elderly individuals living in a deprived region of Hungary, and to identify and estimate the weight of different determinants of mental health across different age groups. A cross-sectional study was conducted with randomly selected samples of individuals (n = 860) aged 18 years and older in Northeast Hungary. The World Health Organization Well-Being Index (WHO-5), the single-item Life Satisfaction Scale, and the 12-item General Health Questionnaire (GHQ-12) were used to measure mental health of the participants. Multiple linear regression analysis was performed to measure the association between sociodemographic and health-related variables and mental health. Overall, the mean WHO-5 score was 69.2 ± 18.1 and it showed a significant decrease by age (p < 0.001), with the lowest score observed in aged 75 years and above (p < 0.001). The mean life satisfaction score was 7.5 ± 1.9 and it showed a significant decreasing trend over the life course (p < 0.001). The highest level of psychological distress as assessed by GHQ-12 was observed in the group aged 75 years or older (11.5 ± 6.0, p < 0.001). Multiple linear regression indicated that self-reported financial status, social support, sense of control over their health, activity limitation and pain intensity were the most important determinants of mental health among older adults. Interventions to improve the mental health of older adults should focus on the positive impact of social support, the reduction of financial insecurity and the use of effective pain relief medications.

Financial strain and social support as moderators of the relationship between living alone and depressive symptoms in older people

This study investigated the moderating effect of financial strain or social support on depressive symptoms among older people living alone in Taiwan. Data were collected from the "Taiwan Longitudinal Study on Aging (TLSA)," which included 1513 participants aged 65 and over, among them, 153 (10.1%) were living alone, while 1360 (89.9%) were living with others. Measurement tools included the Depression scale (CES-D), financial stress scale, social support scale, ADL scale, IADL scale, and stress scale, with Cronbach's α coefficients were 0.85, 0.78, 0.67, 0.91, 0.90, and 0.70 respectively. Hierarchical multiple regression was used to examine the moderator effect. The findings revealed that (1) Financial strain was found to moderate the relationship between living alone and depressive symptoms, acting as a promotive moderator among older men living alone. For older women, financial stress does not moderate the relationship between living alone and depressive symptoms. However, financial strain was also identified as a significant factor associated with depressive symptoms among older women living alone. (2) Social support does not moderate effect on the relationship between living alone and depressive symptoms in older men or older women. These results underscore the importance of considering financial stress in mental health policy development by government agencies. It is imperative to address the unique challenges faced by older individuals living alone, particularly in relation to financial strain, in order to promote their mental well-being.

Determinants of social loneliness among older adults in job retirement and the role of emotional expressivity

OBJECTIVES

The study examined the possibility that a mediating role of positive and negative emotional expressivity may contribute to understanding the associations between social loneliness and its previously identified predictors (i.e. health, age, sex, and social living situation).

METHOD

Self-reported assessments were collected from community-dwelling Swedish residents (aged 65 and above) in job retirement. Structural equation modeling with manifest variables was applied to cross-sectional data (N = 601) to analyze two competing models; one main-effect regression model, examining the predictive effect of emotional expressivity (along with health and sociodemographics) on social loneliness, and one mediation model, examining the mediating effect of emotional expressivity (using the bootstrapping technique provided in Mplus).

RESULTS

The results indicated that the mediation model fit the data considerably better than the main-effect regression model (Δχ2 [Δdf = 8] = 72.69, p < 0.00001), and demonstrated a good fit on its own, with CFI = 0.986 and RMSEA = 0.030. This suggests that emotional expressivity contributes to the understanding of the connection between social loneliness and its previously identified predictors.

CONCLUSION

Recognizing the significance of emotional expressivity has the potential to enhance our understanding of loneliness in older adults, both in theory and in practice.

Enjoying the golden years: social participation and life satisfaction among Chinese older adults

Introduction

Older adults commonly face the risk of social isolation, which poses a significant threat to their quality of life. This study explores the association between social participation and life satisfaction among older Chinese adults.

Methods

Data were sourced from the 2018 China Health and Retirement Longitudinal Study. Regression analysis and mediation analysis were employed to examine the relationship between social participation and life satisfaction, with a focus on the roles of loneliness and self-rated health.

Results

The results indicate that social participation is significantly positively associated with older adults' life satisfaction. Furthermore, the positive association is more pronounced with increased diversity in social activities. Mediation analysis reveals that reductions in feelings of loneliness and improvements in health levels mediate the relationship between social participation and life satisfaction. Further analysis showed that social participation had a greater positive association among rural older adults and those lacking family companionship.

Discussion

This study provides evidence for enhancing life satisfaction among older adults and highlights the importance of diversity in social participation.

Sex differences in the social motivation of rats: Insights from social operant conditioning, behavioural economics, and video tracking

BACKGROUND

Social behaviour plays a key role in mental health and wellbeing, and developing greater understanding of mechanisms underlying social interaction-particularly social motivation-holds substantial transdiagnostic impact. Common rodent behavioural assays used to assess social behaviour are limited in their assessment of social motivation, whereas the social operant conditioning model can provide unique and valuable insights into social motivation. Further characterisation of common experimental parameters that may influence social motivation within the social operant model, as well as complementary methodological and analytical approaches, are warranted.

METHODS

This study investigated the effects of biological sex, housing condition, and time-of-day, on social motivation using the social operant model. This involved training rats to lever press (FR1) for 60-s access to a social reward (same-sex conspecific stimulus). Subjects were male and female Wistar rats, housed under individual or paired conditions, and sessions were conducted either in the mid-late light phase (ZT6-10) or early-mid dark phase (ZT13-17). A behavioural economics approach was implemented to measure social demand and the influence of stimulus partner sex (same- vs. opposite-sex stimulus) on social operant responding. Additionally, video tracking analyses were conducted to assess the degree of convergence between social appetitive and consummatory behaviours.

RESULTS

Biological sex, housing conditions, the interaction between sex and housing, and stimulus partner sex potently influenced social motivation, whereas time-of-day did not. Behavioural economics demonstrated that sex, housing, and their interaction influence both the hedonic set-point and elasticity of social demand. Video analysis of social interaction during social operant sessions revealed that social appetitive and consummatory behaviours are not necessarily convergent, and indicate potential social satiety. Lastly, oestrus phase of female experimental and stimulus rats did not impact social motivation within the model.

CONCLUSIONS

Social isolation-dependent sex differences exist in social motivation for rats, as assessed by social operant conditioning. The social operant model represents an optimal preclinical assay that comprehensively evaluates social motivation and offers a platform for future investigations of neurobiological mechanisms underlying sex differences in social motivation. These findings highlight the importance of continued consideration and inclusion of sex as a biological variable in future social operant conditioning studies. Humans are social creatures-our everyday interactions with others and the support this provides play a key role in our wellbeing. For those experiencing mental health conditions, people's motivation to engage with others can wane, which can lead them to withdraw from those who support them. Therefore, to develop better treatment strategies for these conditions, we need to gain a deeper understanding of social motivation. Studying social behaviour in animals can facilitate this investigation of social motivation as it allows for a causal understanding of underlying neurobiology that is not possible in human experiments. An optimal way to study social motivation in animals is using the social operant conditioning model, where rats learn to press a lever that opens a door and allows them to interact with another rat for a short time. This study characterised the social operant model by testing whether sex, housing conditions, time-of-day, and the sex of the stimulus partner influence rats' motivation to seek interaction with another rat. We found that female rats were more socially motivated than males, and that rats living alone were more motivated than those living with another rat; interestingly, this effect of housing affected females more than males. Regardless of sex, rats were more motivated to interact with a rat of the opposite sex. These findings provide insights into sex differences in social motivation in rats and new insights into the social operant model which will help guide future research into social motivation and other mental health conditions.

Mediating role of social disengagement and loneliness in the nexus between functional health and mental well-being in older individuals

Few studies have focused sufficiently on the intricate link between functional health and depression among older people aged 60 and above in India. Therefore, the current study investigates the association between functional health and depression among older Indian adults through the mediating role of social disengagement and loneliness and the moderating role of living arrangements using recent data from the Longitudinal Aging Study in India (LASI: 2017-2018). Composite International Diagnostic Interview-Short Form (CIDI-SF) for depression, the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) for functional health, and the indoor/outdoor activities, visits, and religious events for social disengagement were used. The feelings of loneliness and living arrangements were measured using single-item questions and surveys/interviews of household members. Bivariate analysis, logistic regression, and a Partial Least Squares-Structural Equation Model were adopted. The results show that older persons with functional health had 1.85 times higher odds of depression; similarly, those not engaging in social activities and experiencing loneliness were more likely to feel depressed. Living with someone was negatively linked to depression. A significant moderation by living arrangements in the functional health-depression relationship was also observed. The results also indicate significant mediating roles of social disengagement and loneliness, with 22.0% and 3.08% mediation effects, respectively. Therefore, this study recommends the provision of housing and social interaction among older people.

The association of social networks and depression in community-dwelling older adults: a systematic review

BACKGROUND AND OBJECTIVE

Depression is a globally prevalent mental condition, particularly among older adults. Previous research has identified that social networks have a buffering effect on depression. Existing systematic reviews have either limited their research to specific geographic areas or provided evidence from over a decade ago. The vast body of recent literature particularly from the last decade emphasizes the need for a comprehensive review. This systematic review aims to analyze the association of structural aspects of social networks and depression in older adults.

METHODS

The electronic databases APA PsycINFO, ProQuest, PSYINDEX, PubMed, Scopus, SocINDEX, and Web of Science were searched from date of data base inception until 11 July 2023. Studies were eligible for inclusion if they reported on community-dwelling older adults (defined as a mean age of at least 60 years old), had an acceptable definition for depression, referred to the term social network in the abstract, and were published in English. Quality was appraised using the Newcastle Ottawa Scale for cross-sectional and longitudinal studies. Outcome data were extracted independently from each study and analyzed by direction of the relationship, social network domain and cross-sectional or longitudinal study design.

RESULTS

In total, 127 studies were included. The study categorizes structural network aspects into seven domains and finds that larger and more diverse networks, along with closer social ties, help mitigate depression. The literature on the relationships between depression and network density, homogeneity, and geographical proximity is scarce and inconclusive. DISCUSSION AND IMPLICATIONS: Despite inconsistent findings, this review highlights the importance of quantifying complex social relations of older adults. Limitations of this review include publication and language bias as well as the exclusion of qualitative research. Further research should use longitudinal approaches to further investigate the reciprocal relationship between social networks and depression. Following this review, interventions should promote the integration of older adults in larger and more diverse social settings. Other: This work was supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Grant [454899704]. This systematic review was pre-registered. The review-protocol can be accessed at https://doi.org/10.17605/OSF.IO/6QDPK .

'My parkrun friends.' A qualitative study of social experiences of men at parkrun in Ireland

Social support is a well-established determinant of mental wellbeing. Community initiatives, which combine a purposeful activity with social connection, may be appropriate to promote the mental wellbeing of middle-aged men in Ireland-a group at risk of poor mental wellbeing due to social isolation. parkrun offers free, weekly, 5km run or walk events in 22 countries. This study aims to explore the social experience of parkrun participation for middle-aged men in Ireland and considers how social connections made at parkrun relate to mental wellbeing. Online semi-structured interviews were conducted in 2022/23 with 39 men aged 45-64 years, who run, walk or volunteer at parkrun in Ireland, recruited purposively in rural and urban communities. Men with a range of parkrun experience gave interviews lasting a mean of 32 minutes. Interviews were recorded and transcribed verbatim. Reflexive thematic analysis resulted in three themes and ten subthemes. The men described parkrun as offering a welcoming and supportive environment (Theme 1). Men at parkrun could choose the level of social connections, building strong or weak social ties to provide social support and improve mental wellbeing (Theme 2). Social engagement with parkrun evolved following repeated participation (Theme 3). The results suggest that parkrun is a suitable community initiative for middle-aged men at risk of poor mental wellbeing due to social isolation. Social connections were developed after repeated participation in parkrun and these connections improved subjective mental wellbeing. The findings from this study could be used to design new initiatives for mental health promotion.

Social Support as a Correlate of Depression and Quality of Life Among Nigerian Older Adults: a Cross-Sectional Study

Reduced social support has been associated with presence of depression and reduced quality of life among older adults. The relationships may be better understood by exploring the interactions of individual domains among the constructs. This cross-sectional survey involved a consecutive sample of 206 (116 females and 90 males) older adults living in a Southern Nigeria community. The Multidimensional Scale of Perceived Social Support, Geriatric Depression Scale, and World Health Organization Quality of Life-OLD Questionnaire, were used to measure social support, depression, and quality of life respectively. Data was analyzed using frequency counts, percentages, mean, standard deviation, multiple regression and Spearman rank-order correlation coefficient, at 0.05 alpha level. Prevalence rate of depression among participants was 45.5%. Social support was perceived to be low by 37.4% of participants with the lowest mean social support score coming from friends domain. Participants' quality of life was generally fairly good (> 60%) with the lowest scores coming from the intimacy domain. Significant correlations between social support domains and each of quality of life (p < 0.05) and depression were respectively positive and negative; but weakest for the friend and strongest for significant others domains. All quality of life domains were significantly correlated with social support except the death and dying domain. All the domains of social support (family and significant other) were significant predictors of depression except the friend domain. Significant others around individual older adults particularly those with depression ought to be educated on the importance of their roles. Stakeholders including healthcare providers may create and support programmes for improved social networking for the older adults in order to enhance their general wellbeing and quality of life.

The Impact of Digital Mental Health Services on Loneliness and Mental Health: Results from a Prospective, Observational Study

BACKGROUND

Loneliness has increased since the COVID-19 pandemic and negatively impacts mental health. This study examined relationships between loneliness and mental health among adults using a digital mental health platform.

METHODS

A purposive sample of 919 participants (97% response rate) who were newly enrolled in the platform completed a survey on loneliness, depression, anxiety, well-being, stress, social support, and comorbidities at baseline and 3 months. Platform engagement was tracked during this period. We examined baseline differences between lonely and non-lonely participants; associations between loneliness, mental health symptoms, and comorbidities; and changes in loneliness and mental health through engagement in any form of care.

RESULTS

At baseline, 57.8% of the sample were categorized as lonely. Loneliness was associated with younger age, fewer years of education, and the presence of a comorbidity (p values < .05). Baseline loneliness was associated with greater depression, anxiety, and stress and lower well-being and social support (ps < .001). The percentage of lonely participants decreased at follow-up (57.6% to 52.9%, p = .03). Those who improved in loneliness improved in mental health symptoms, well-being, and social support (ps < .001). Lonely participants who engaged in any form of care reported a greater reduction in loneliness than those who did not engage (p = .04).

CONCLUSIONS

This study confirms previous findings of the high prevalence of loneliness among adults and risk factors for increased loneliness. Findings highlight the potential of digital platforms to reach lonely individuals and alleviate loneliness through remote mental health support.

Lifecourse trajectories and cross-generational trends in social isolation: Findings from five successive British birth cohort studies

Despite growing concerns in the UK about social isolation, there remains a lack of data on the extent and time trends of social isolation from longitudinal, population-based studies. There is also little research that assesses the multiple domains of social isolation across the lifecourse and between generations in a holistic way accounting for different contexts. By applying a multi-context, multi-domain framework of social isolation to 5 successive British birth cohorts, we provide conceptual and empirical understanding of social isolation trajectories across the lifecourse and identify potential generational and sex differences in trends. Where data were available, comparable social isolation indicators were generated to enable lifecourse trajectories and cross-generational trends to be explored. Information on isolation was available across the following relational contexts: household i.e., living alone; partnership, family and friends outside the household; education and employment networks; and community engagement. Trajectories were modelled stratified by sex using a multilevel growth curve framework. Data were analysed from 73,847 individuals (48.5% female), in 5 successive cohorts born in 1946 (N = 5,362), 1958 (N = 16,742), 1970 (N = 16,950), 1989-90 (N = 15,562), and 2000-01 (N = 19,231). Exploring a range of social isolation indicators across several contexts provided a nuanced picture of social isolation across the lifecourse and between generations in the UK, with no consistent pattern of increased or decreased isolation over time. For example, more people are living alone, less women are out of education and employment in midlife, more people are volunteering, but fewer people regularly engage in religious activity. It therefore highlights the need to focus on a range of social isolation indicators across contexts to understand how people compensate for specific types of isolation, and to understand structural differences in social configurations in the UK, which may not only define the timing and sequencing of life transitions but also social isolation.

Dyadic perspectives on loneliness and social isolation among people with dementia and spousal carers: findings from the IDEAL programme

OBJECTIVES

This study aims to investigate the impact of self and partner experiences of loneliness and social isolation on life satisfaction in people with dementia and their spousal carers.

METHODS

We used data from 1042 dementia caregiving dyads in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) programme cohort. Loneliness was measured using the six-item De Jong Gierveld loneliness scale and social isolation using the six-item Lubben Social Network Scale. Data were analysed using the Actor-Partner Interdependence Model framework.

RESULTS

Self-rated loneliness was associated with poorer life satisfaction for both people with dementia and carers. The initial partner effects observed between the loneliness of the carer and the life satisfaction of the person with dementia and between social isolation reported by the person with dementia and life satisfaction of the carer were reduced to nonsignificance once the quality of the relationship between them was considered.

DISCUSSION

Experiencing greater loneliness and social isolation is linked with reduced life satisfaction for people with dementia and carers. However, having a positive view of the quality of the relationship between them reduced the impact of loneliness and social isolation on life satisfaction. Findings suggest the need to consider the experiences of both the person with dementia and the carer when investigating the impact of loneliness and social isolation. Individual interventions to mitigate loneliness or isolation may enhance life satisfaction for both partners and not simply the intervention recipient.

Association Between Objective Social Isolation and Unmet Medical Needs: A Nationwide Cross-sectional Study in Korea

OBJECTIVES

The aim of this study was to analyze the relationship between objective social isolation (SI) and unmet medical needs (UMN) in adults aged 19 and older.

METHODS

A cross-sectional analysis was conducted of 208 619 adults aged 19 and older, excluding missing data, using the 2019 Korea Community Health Survey. To analyze the association between objective SI and UMN, the chi-square test and logistic regression analysis were performed.

RESULTS

The prevalence of UMN was 1.14 times higher (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.06 to 1.23) among those with SI than among those without SI, and the OR for groups with 5 SI types was 2.77 (95% CI, 1.86 to 4.12) compared to those with no SI types. In addition, a stratified analysis by age group showed that the association between SI and UMN existed even in groups under 64 years old. However, among those aged 65 and older, SI was associated with an OR of 1.53 (95% CI, 1.37 to 1.71) for UMN compared to non-SI. As the number of SI types increased, the prevalence of UMN also increased, indicating a strong association between SI and UMN in older adults.

CONCLUSIONS

This study found that individuals with SI experienced UMN due to fear and anxiety about interpersonal relationships. Therefore, based on the results of this cross-sectional study, it is necessary to investigate the causal relationship between SI and UMN through future longitudinal data.

Association between disability and cognitive function in older Chinese people: a moderated mediation of social relationships and depressive symptoms

Objective

Many previous studies have found that disability leads to cognitive impairment, and in order to better understand the underlying mechanisms between disability and cognitive impairment, the present study aimed to investigate the moderating role of social relationships, including their role as mediators between disability and cognitive impairment in depressive symptoms.

Study design

This is a cross-sectional study.

Methods

A total of 5,699 Chinese older adults from the 2018 China Longitudinal Healthy Longevity Survey (CLHLS) were included in this study, and PROCESS macro was used to perform simple mediator and moderator mediator analyses, which were used to analyze the relationship between depressive symptoms and social relationships between disability and cognitive impairment.

Results

The results of this study showed significant correlations between disability, cognitive impairment, depressive symptoms, and social relationships, and that depressive symptoms mediated the relationship between disability and cognitive functioning [B = -0.232; 95% CI: (-0.304, -0.164)], and that social relationships mediated disability and cognitive functioning through pathway a (Disability-Depressive Symptoms) [B = 0.190; 95% CI: (0.020, 0.036)], path b (depressive symptoms-cognitive impairment) [B = 0.029; 95% CI: (0.015, 0.042)], and path c' (incapacitation-cognitive impairment) [B = 0.492; 95% CI: (0.298, 0.685)] to modulate the effect of incapacitation on cognitive impairment. In addition, social activities and social networks moderated the mediation model directly or indirectly, whereas social support moderated only the direct effect.

Conclusion

This study explains the intrinsic link between incapacitation and cognitive impairment in Chinese older adults, and that social relationships and depressive symptoms can directly or indirectly modulate the effects between them. This provides a basis for healthcare professionals to be able to better develop interventions that can be used to improve the level of cognitive functioning and mental health of older adults.

CATCH-ON Connect: a tablet intervention to address social isolation and loneliness

Technology can aid in alleviating social isolation and loneliness among older adults, however some older adults lack the knowledge and necessary skills to use the technology.

OBJECTIVES

The purpose of this study was to examine the impact of CATCH-ON Connect, a cellular enabled tablet technical assistance program, on social isolation and loneliness among older adults.

METHODS

This is a single-group pre-post program evaluation of the CATCH-ON Connect program.

RESULTS

While there was no statistically significant change in social isolation, older adult participants reported significantly lower levels of loneliness following intervention.

CONCLUSION

This project demonstrates that tablet programs with technical assistance may benefit older adults. Further investigation is warranted to determine the impact of the internet access itself, the technical assistance, or both.

COVID-19 Pandemic-Related Stress and Subjective Well-Being Across Age: The Mediating Role of Social Resources

Stress associated with the COVID-19 pandemic and the measures implemented to prevent its spread dramatically shifted our social networks, interactions, and contexts, all of which influence the assessment of one's subjective well-being (SWB). Drawing on data collected from 1,318 adults between April and May 2020, we used structural equation modeling to analyze the relationship between pandemic-related stress and SWB (life satisfaction, positive affect, negative affect), and examined how these relationships vary across age. Pandemic-related stress was associated with lower life satisfaction and higher negative affect. However, no evidence of age moderation emerged. Subsequent analysis examined different aspects of social resources as potential mediating variables. Loneliness fully mediated the relationship between stress and life satisfaction, while social support demonstrated evidence of partial mediation. Further, loneliness and social support partially mediated the relationship between stress and negative affect. Findings suggest that pandemic-related stress impacts SWB, and social resources help explain these impacts.

Loneliness in older primary care patients and its relationship to physical and mental health-related quality of life

BACKGROUND

Loneliness is a significant public health challenge in the United States, especially among older adults. The epidemiology of loneliness among older adults in primary care is lacking, and specific research is needed on how loneliness impacts older primary patients' physical, mental, and cognitive health. A large sample of older primary care patients were recruited for a trial during the COVID-19 pandemic to measure the relationship between loneliness and physical and mental quality of life (QOL).

METHODS

Baseline data come from the Caregiver Outcomes of Alzheimer's Disease Screening (COADS) study, an ongoing randomized controlled trial evaluating benefits and risks of Alzheimer's disease and related dementias screening among primary care patients ages 65 and older, collected April 2020 to September 2021. Loneliness was measured with the 5-item, Loneliness Fixed Form Ages 18+ from The NIH Toolbox Emotion Battery, physical and mental health-related QOL was measured with the SF-36v2, and depression and anxiety severity were measured with the PHQ-9 and GAD-7, respectively.

RESULTS

Spearman correlation analyses revealed that loneliness was moderately correlated with mental health QOL (r[601] = -0.43, p < 0.001), anxiety severity (r[601] = 0.44, p < 0.001), and depression severity (r[601] = 0.42, p < 0.001), while weakly correlated with physical health QOL (r[601] = -0.15, p < 0.001). After conducting unadjusted and adjusted linear regression models, we found that loneliness was significantly associated with both lower mental (p < 0.001) and physical (p < 0.001) QOL. Furthermore, loneliness remained significantly associated with worse mental QOL after adjusting for age, gender, race, ethnicity, educational level, perceived income status, neighborhood disadvantage, severity of comorbidities, and comorbid depression and anxiety.

CONCLUSION

Primary care providers should discuss loneliness with their older adult patients and provide resources to help patients develop and maintain meaningful social relationships.

How is intergenerational emotional cohesion linked to depression among older internal migrants in China: the mediating roles of loneliness and perceived stress

BACKGROUND

Late-life internal migration is frequently associated with a higher risk of depression in older parents. This research delves into the impact of intergenerational emotional cohesion (IEC) on depression in older internal migrants and the underlying mechanisms within the contemporary Chinese context.

METHODS

Obtained from a cross-sectional survey in Nanjing, China, the research involved 654 older internal migrants (66.97% female; mean age = 66.05 years; SD = 4.67). Variables were assessed using the Intergenerational Solidarity Inventory, 3-item R-UCLA Loneliness Scale, Perceived Stress Scale, and 9-item Patient Health Questionnaire (PHQ-9). For mediation exploration, a serial mediation model was utilized, and the Bootstrap method was employed to test the signifcance of these mediation effects.

RESULTS

IEC demonstrates a negative correlation with depression. Through IEC, three significant mediation pathways were identified that directly affect depression: (1) loneliness (β=-0.06; Ratio=17.14%), (2) perceived stress (β=-0.09; Ratio=25.71%), and (3) loneliness and perceived stress (β=-0.03; Ratio=8.57%).

CONCLUSIONS

IEC can impact the depression of older internal migrants by mitigating negative psychological emotions during the migration process. This finding provides valuable theoretical insights for the prevention of mental health problems among this demographic.

Health conditions in spousal caregivers of people with dementia and their relationships with stress, caregiving experiences, and social networks: longitudinal findings from the IDEAL programme

OBJECTIVES

Longitudinal evidence documenting health conditions in spousal caregivers of people with dementia and whether these influence caregivers' outcomes is scarce. This study explores type and number of health conditions over two years in caregivers of people with dementia and subgroups based on age, sex, education, hours of care, informant-rated functional ability, neuropsychiatric symptoms, cognition of the person with dementia, and length of diagnosis in the person with dementia. It also explores whether over time the number of health conditions is associated with caregivers' stress, positive experiences of caregiving, and social networks METHODS: Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised spousal caregivers (n = 977) of people with dementia. Self-reported health conditions using the Charlson Comorbidity Index, stress, positive experiences of caregiving, and social network were assessed over two years. Mixed effect models were used RESULTS: On average participants had 1.5 health conditions at baseline; increasing to 2.1 conditions over two years. More health conditions were reported by caregivers who were older, had no formal education, provided 10 + hours of care per day, and/or cared for a person with more neuropsychiatric symptoms at baseline. More baseline health conditions were associated with greater stress at baseline but not with stress over time. Over two years, when caregivers' health conditions increased, their stress increased whereas their social network diminished DISCUSSION: Findings highlight that most caregivers have their own health problems which require management to avoid increased stress and shrinking of social networks.

The relationship between Internet use and loneliness of middle-aged and older adult people: the moderating effect of residence

Objectives

The proportion of middle-aged and older adult people exposed to the Internet continues to grow. Internet use may have an impact on the mental health of the older adult, especially loneliness. This study analyzed the relationship between Internet use and presence of loneliness.

Methods

A total of 550 person aged 45 years and above were randomly selected from a province in eastern China at the end of 2022. The outcome variable was presence of loneliness, as measured by self-report. Descriptive analysis, chi-square test and binary logistic analysis were used to analyze the data.

Results

58.3% of respondents use the Internet. Internet use could reduce the possible of reported loneliness in middle-aged and older adult people (OR = 0.652, 95%CI: 0.465, 0.940), and residence played a moderating role in the relationship between them. Middle-aged and older adults who used the Internet for 1-3 h (OR = 0.464, 95%CI: 0.275, 0.784) and 3-5 h (OR = 0.484, 95%CI: 0.247, 0.946) were less likely to felt lonely than those who used the Internet for less than 1 h per day. In addition, middle-aged and older adult people using the Internet to contact relatives and friends (OR = 0.488, 95%CI:0.292, 0.818), read the news (OR = 0.485, 95%CI:0.277, 0.848), assets management (OR = 0.297, 95%CI:0.109, 0.818) were less likely to report loneliness, while those who made online payment (OR = 3.101, 95%CI:1.413, 6.807) were more likely to report loneliness.

Conclusion

There is a significant negative correlation between Internet use and presence of loneliness, but different Internet duration and content have different effects on loneliness in middle-aged and older adult people. We should pay attention to the impact of Internet use on loneliness in middle-aged and older adult people.

Mental health and social connection among older lesbian and bisexual women

OBJECTIVE

To assess differences in psychosocial and mental health outcomes between older lesbian and bisexual women compared to heterosexual women.

DESIGN

Cross sectional study.

SETTING

The study was carried out in the California Teachers Study, a prospective cohort study.

PARTICIPANTS

Self-identified heterosexual (n = 35,846), lesbian (n = 710), and bisexual (n = 253) women 50 years of age and older were enrolled.

MEASUREMENTS

Validated questionnaires were used to measure social connection, overall happiness, and depression. Logistic regression modeling was used to estimate odds ratios (OR) and 95% confidence intervals (CI) comparing lesbian and bisexual women separately to heterosexual women in relation to psychosocial and mental health outcomes.

RESULTS

After controlling for age and marital status, older bisexual women were significantly more likely to report lack of companionship (OR = 2.00; 95% CI, 1.30-3.12) and feeling left out (OR = 2.33; 95% CI, 1.36-3.97) compared to older heterosexual women. The odds of reporting feeling isolated from others was significantly higher in lesbian (OR = 1.56; 95% CI, 1.06-2.30) and bisexual women (OR = 2.30; 95% CI, 1.37-3.87) than in heterosexual women. The OR (95% CI) for reporting not being very happy overall was 1.96 (CI, 1.09-3.52) in bisexual women and 1.40 (0.92-2.14) in lesbian women compared to heterosexual women. The likelihood of reporting diagnosed depression was significantly higher in lesbian women (OR = 1.65; 95% CI, 1.38-1.97) and bisexual women (OR = 2.21; 95% CI, 1.67-2.93) compared to heterosexual women.

CONCLUSION

Inclusion of lesbian and bisexual women in aging research is essential to understand their unique mental and other health needs, including those specific to bisexual women.

Problematic Use of the Internet and Well-Being among Youth from a Global Perspective: A Mediated-Moderated Model of Socio-Emotional Factors

Problematic Use of the Internet (PUI) is characterized as the inability to control one's internet use or as an excessive use of the internet that may result in social, psychological, and emotional difficulties (Fernandes et al., 2019). It is regarded nowadays as an increasingly worrisome public heath issue, especially among youth. This study explored the contexts in which youth PUI occurs and its associations with socio-emotional functioning that may lead to a decrease in one's sense of well-being. We conducted this exploration among 783 middle school students from the US (425 students; 54.27%) and Israel (358 students; 45.73%). The overall age of both samples ranged between 12 and 16 (M = 13.94, SD = 1.59). In the Israeli sample, 49.1% of the students were girls and 50.9% were boys, whereas in the US sample, 48.8% were girls and 51.2% were boys. The study examined the role of depressive mood, loneliness, resilience, self-control, and school engagement in mediating the relationship between PUI and well-being, and how country of origin might moderate these relationships. Results indicate PUI was related to lower well-being only for the US sample. Yet, for both samples, higher loneliness was related to lower well-being, and higher school engagement was related to higher well-being. A moderated mediation analysis revealed the socio-emotional variables were all mediators in these associations, but differently for each country sample. The study results are discussed according to key factors required for developing intervention programs for coping with youth PUI behaviors.

Project VITAL at Home: Impact of Technology on Loneliness and Well-Being of Family Caregivers of People with Dementia

OBJECTIVES

Project VITAL At Home aimed to combat social isolation and loneliness in family caregivers of people with dementia through purposeful engagement and connection. This project examined the effects of technology on caregiver loneliness and well-being, as well as their technology experiences, during the COVID-19 pandemic.

METHODS

Family caregivers were provided iN2L tablets and access to Alzheimer's Association supportive programs. Caregivers (n = 124) completed online surveys at pre and post evaluation points (average 7 months apart) to assess loneliness, subjective well-being (affect), supportive program usage, and tablet experiences.

RESULTS

Family caregivers had positive perceptions of the tablets for both themselves and their family members. Tablets had positive effects on caregiver well-being, including giving them an additional caregiver tool, alleviating stress, increasing satisfaction with quiet time, and improving access to supportive programs. Caregiver positive affect decreased, but no changes were observed for negative affect or loneliness.

CONCLUSIONS

Family caregivers found value in the tablets and showed improvements in some aspects of well-being. Randomized trials are needed to more fully assess the benefits of the intervention.

CLINICAL IMPLICATIONS

Pairing tablets with caregiving supports is a promising intervention to improve caregivers' access to vital resources and services and to improve their well-being.

The contribution of objective and perceived crime to neighbourhood socio-inequity in loneliness

Loneliness tends to be more prevalent in socioeconomically disadvantaged neighbourhoods, yet few studies explore the environmental differences contributing to area-based inequity in loneliness. This study examined how perceived and objective crime contributed to differences in loneliness between advantaged and disadvantaged neighbourhoods. The study used cross-sectional data from 3749 individuals aged between 48 and 77 years, residing in 200 neighbourhoods in Brisbane, Australia. We found that participants in disadvantaged neighbourhoods reported higher levels of loneliness and perceived crime, and the most disadvantaged neighbourhoods also had highest prevalence of objective crime. However, while perceived and objective crime were positively correlated with loneliness, only perceived crime accounted for socio-economic inequity in loneliness. Consequently, perceived crime plays an important role in addressing loneliness in disadvantaged communities and requires equitable resourcing for multiple strategies that aim to decrease crime and increase perceived safety.

Longitudinal associations between mental health and social environment in older adults: a multilevel growth modeling

OBJECTIVES

This study aimed to assess longitudinal relationships between social environment indicators (social connectedness, social engagement, social contribution) and mental health indicators (depression and anxiety) among community-dwelling adults age 55 years and older.

METHODS

Data were drawn from 3-waves of the national longitudinal survey of Midlife Development in the United States (MIDUS) (N = 2,020; age range = 55-94 years). We developed multilevel growth models to ascertain the relationships of interest, controlling for sociodemographic and physical health factors.

RESULTS

Over the 20-year period of study, lower levels of emotional social support, social integration and social contribution significantly predicted depression and anxiety, whereas social network and social engagement were not significant predictors of these mental health outcomes in older adults. The models also indicated a moderation effect of the number of chronic conditions on the slopes of depression and anxiety.

DISCUSSION

Considering our findings, interventions to enhance social contribution and social connectedness could be effective to help older adults maintain positive mental health, as well as programs that facilitate older adults' connections with their families, communities and health care providers. These interventions must also account for multiple chronic conditions since functional limitations drive declining integration in the community and participation in social activities.

Psychosocial functioning in individuals with advanced oesophago-gastric cancer: a mixed methods systematic review

BACKGROUND

Oesophago-gastric cancer is an aggressive disease with a high rate of recurrence and mortality across the disease trajectory. Reduced psychosocial functioning has been evidenced amongst those with advanced disease, however little is known about the contributing factors. Determining these factors is an important clinical consideration to inform assessment and intervention. This review aimed to synthesise the available evidence on the psychosocial functioning of individuals with advanced oesophago-gastric cancer and their carers.

METHODS

A JBI mixed-methods systematic review. Four bibliographic databases, MEDLINE, Embase, PsycINFO, and CINAHL, were searched. Quantitative and qualitative studies were screened for inclusion and critically appraised for methodological quality. Both types of data were extracted using JBI tools for mixed-methods systematic reviews. A convergent segregated approach to synthesis and integration was used. The findings of the synthesis have been configured according to JBI methodology.

RESULTS

A total of 12 studies were included in this review, including 6 quantitative studies and 6 qualitative studies. The quantitative results provide preliminary indication of several physical, biological, psychological and macro-level contextual factors associated with psychosocial functioning in this clinical population. The qualitative findings shed light on a range of physical, psychosocial, and existential challenges faced by advanced oesophago-gastric cancer patients. These multiple and often persistent challenges appear to cause considerable distress; however, patients describe the importance of maintaining a sense of normality and control over their illness and its effects. Patients value continuity and structure, however many report shortcomings when accessing care. No findings reporting the experiences from the perspective of carers were found, therefore all findings represent the perspective of the patient.

CONCLUSIONS

Further high-quality research is needed to understand how best to support and manage the palliative care needs of individuals living with advanced oesophago-gastric cancer. Implications for practice are discussed, suggesting that psychosocial interventions, complex symptom management and continuity of care could improve the psychosocial functioning of individuals in this setting.

PRE-REGISTRATION

The systematic review was pre-registered at the International Prospective Register of Systematic Reviews (PROSPERO; CRD42020181273) and the protocol can be viewed on the OSF ( http://osf.io/exuzf ).

Can technology impact loneliness in dementia? A scoping review on the role of assistive technologies in delivering psychosocial interventions in long-term care

PURPOSE

We aimed to identify assistive technologies that are promising for addressing loneliness in people living with dementia in long-term care.

MATERIALS AND METHODS

A scoping review was conducted. EBSCO, PubMed, Cochrane Library, and ProQuest were searched from 2000 to 2020. The included studies were selected by three independent researchers and summarised, compared, and categorized according to technology type. Publications were eligible for inclusion when they reported on psychosocial interventions aiming to reduce loneliness and/or social isolation in people with dementia in long-term care settings.

RESULTS

Twenty-four papers were included (20 original research papers and four reviews). Most studies were conducted in Australia and Europe. The studies aimed to investigate two different types of assistive technology: social robots, and multimedia computer systems. Most studies focussed on behaviour, engagement, and mood as primary outcomes. Only one study directly aimed to alleviate loneliness.

CONCLUSIONS

Even though only one study addressed loneliness directly, it became clear that assistive technologies used to apply psychosocial interventions have the potential to impact loneliness in people with dementia in long-term care. However, it remains unclear why loneliness was not included as an outcome and how loneliness could become a key outcome in evaluating assistive technologies.IMPLICATIONS FOR REHABILITATIONLoneliness among older adults is associated with health risks, such as the development of dementia, depression, and increased mortality.Ambient Assisted Living (AAL) technologies have been studied to address loneliness for older adults; however people with dementia are often excluded from such studies.This diverse group of technologies is shown to have a promising impact on outcomes, such as social engagement, quality of life, and mood, but loneliness was studied less often.More research is needed to discover the potential of assistive technologies for people with dementia living in long-term care.

Determinants of physical activity engagement in older adults

In order to increase engagement in physical activity, it is important to determine which factors contribute to physical activity engagement in older adults. The current study examined the relative predictive ability of several potential determinants, in terms of both the concurrent level as well as longitudinal trajectories. Clinically normal adults aged 61-92 completed the Physical Activity Scale for the Elderly (n = 189 for cross-sectional models; n = 214 for longitudinal models). Potential determinants included age, gender, education, physical health, sensory health, mood, cardiovascular health, cognitive status, and biomarkers of Alzheimer disease (AD). We observed a novel finding that both concurrent physical health (p < 0.001) and change in physical health (p < 0.001) were significant predictors above and beyond other determinants. Concurrent mood predicted levels of physical activity (p = 0.035), particularly in females. These findings suggest that poor physical health and low mood might be important to consider as potential barriers to physical activity engagement in older adults.

Are loneliness and social isolation equal threats to health and well-being? An outcome-wide longitudinal approach

The detrimental effects of loneliness and social isolation on health and well-being outcomes are well documented. In response, governments, corporations, and community-based organizations have begun leveraging tools to create interventions and policies aimed at reducing loneliness and social isolation at scale. However, these efforts are frequently hampered by a key knowledge gap: when attempting to improve specific health and well-being outcomes, decision-makers are often unsure whether to target loneliness, social isolation, or both. Filling this knowledge gap will inform the development and refinement of effective interventions. Using data from the Health and Retirement Study (13,752 participants (59% women and 41% men, mean [SD] age = 67 [10] years)), we examined how changes in loneliness and social isolation over a 4-year follow-up period (from t0:2008/2010 to t1:2012/2014) were associated with 32 indicators of physical-, behavioral-, and psychosocial-health outcomes 4-years later (t2:2016/2018). We used multiple logistic-, linear-, and generalized-linear regression models, and adjusted for sociodemographic, personality traits, pre-baseline levels of both exposures (loneliness and social isolation), and all outcomes (t0:2008/2010). We incorporated data from all participants into the overall estimate, regardless of whether their levels of loneliness and social isolation changed from the pre-baseline to baseline waves. After adjusting for a wide range of covariates, we observed that both loneliness and social isolation were associated with several physical health outcomes and health behaviors. However, social isolation was more predictive of mortality risk and loneliness was a stronger predictor of psychological outcomes. Loneliness and social isolation have independent effects on various health and well-being outcomes and thus constitute distinct targets for interventions aimed at improving population health and well-being.

Examining the social networks of older adults receiving informal or formal care: a systematic review

PURPOSE

To address the care needs of older adults, it is important to identify and understand the forms of care support older adults received. This systematic review aims to examine the social networks of older adults receiving informal or formal care and the factors that influenced their networks.

METHODS

A systematic review was conducted by searching six databases from inception to January 31, 2023. The review included primary studies focusing on older adults receiving long-term care, encompassing both informal and formal care. To assess the risk of bias in the included studies, validated appraisal tools specifically designed for different study types were utilized. Network analysis was employed to identify the grouping of study concepts, which subsequently formed the foundation for describing themes through narrative synthesis.

RESULTS

We identified 121 studies relating to the formal and informal care of older adults' networks. A variety of social ties were examined by included studies. The most commonly examined sources of care support were family members (such as children and spouses) and friends. Several factors were consistently reported to influence the provision of informal care, including the intensity of networks, reciprocity, and geographical proximity. In terms of formal care utilization, older age and poor health status were found to be associated with increased use of healthcare services. Additionally, physical limitations and cognitive impairment were identified as factors contributing to decreased social engagement.

CONCLUSION

This review found that older people were embedded within a diverse network. The findings of this review emphasize the importance of recognizing and incorporating the diversity of social networks in care plans and policies to enhance the effectiveness of interventions and improve the overall well-being of older adults.

The Relationship between Social Support Correlates and Feelings of Loneliness among Male UK Recreational Anglers

The benefits of access to blue spaces (exposure to aquatic environments) have been well reported. One common activity conducted in these spaces is recreational angling. Studies have shown that several correlates are associated with recreational angling, including a lower incidence of anxiety disorders compared to non-anglers. What is currently unknown is how measures of social support relate to feelings of loneliness in this population. The aim of this study, therefore, is to examine experiences of loneliness and social support in male UK anglers. In total, 1752 participants completed an online survey. The results of this study showed that the higher the number of friends or family that anglers hear from and feel close to, the less likely they are to report a lack of companionship, the less likely they are to report feeling left out, and the less likely they are to report feelings of isolation. Furthermore, more than half of the sample reported hardly ever or never having feelings of loneliness, suggesting that recreational angling does not affect feelings of loneliness.

An exploratory psychometric network analysis of loneliness scales in a sample of older adults

To examine the relationships within and between commonly used measures of loneliness to determine the suitability of the measures in older adults. Further, to determine whether certain items in these measures are more psychometrically robust in terms of capturing different types of loneliness across this population. Data were obtained from 350 older adults via completion of an online survey. Four measures of loneliness were completed. These were the University of California Los Angeles Loneliness Scale 4 (Version 3), the de Jong Gierveld Loneliness Scale, the Social and Emotional Loneliness Scale for Adults (Short Version) and a direct measure of loneliness. Analysis via a regularized partial correlation network and via clique percolation revealed that only the SELSA-S encompassed loneliness relating to deficits in social, family and romantic relationships. The remaining measures tapped mostly into social loneliness alone. The direct measure of loneliness had the strongest connection to the UCLA item-4 and the de Jong Gierveld item-1 exhibited the strongest bridge centrality, being a member of the most clusters. The results indicate that should researchers be interested in assessing loneliness resulting from specific relationships, then the SELSA-S would be the most suitable measure. Whereas the other measures are suitable for assessing loneliness more generally. The results further suggest that the de Jong Gierveld item-1 may be a more suitable direct measure of loneliness than that currently employed as it taps into a greater number of relationships.

Social isolation and subsequent health and well-being in older adults: A longitudinal outcome-wide analysis

BACKGROUND

Social isolation has become a serious public health issue. However, most previous studies examine the relationship between social isolation and a single outcome. We aimed to conduct holistic assessments to understand the multidimensional impacts of social isolation on health and well-being.

METHODS

We used the three-wave data (2013, 2016, and 2019) obtained from the Japan Gerontological Evaluation Study. Our exposure, obtained from the 2016 survey, was the Social Isolation Index (SII) comprising five components: no partner, poor interaction with children, poor interaction with relatives, poor interaction with friends, and no social participation). We assessed 36 health and well-being outcomes across six dimensions obtained from the 2019 survey: physical/cognitive health, health behaviours, mental health, subjective well-being, social isolation, and cognitive social capital. Pre-exposure characteristics and prior outcome levels in 2013 were adjusted. We included 47,318 respondents for 4 outcomes (death, dementia, and functional disability) and 34,187 respondents for 32 other outcomes. The Bonferroni correction was used to correct for multiple tests.

RESULTS

The total SII scores were associated with a wide range of health and well-being outcomes across the six dimensions. Specifically, we found a robust association between an SII score of four or greater with mortality (Odds ratio: 1.89; 95% CI: 1.46-2.43). Among the five components of the SII, poor interaction with friends and no social participation showed robust associations with a wide range of health and well-being. We also found some robust evidence regarding effect modification by gender and age in the associations between the components of the SII and health and well-being.

CONCLUSIONS

Social isolation, specifically social interaction with friends and social participation, may affect a wide range of health and well-being among older adults.

The multiple mediating effect of family health and perceived social support on depressive symptoms in older adults: A cross-sectional national survey in China

BACKGROUND

Depression harms older adults' physical health and quality of life, especially for those with disabilities. This study aims to investigate the epidemiological characteristics of depressive symptoms in older adults and influencing factors involving neuroticism in China.

METHODS

A multistage random sampling method was adopted to recruit older adults. We conducted a multiple mediating analysis to explore how overall family health and perceived social support affect the relationship between neuroticism and depressive symptoms in older adults.

RESULTS

A total of 1122 older adults were included in this study, and 529 individuals reported suffering from depressive symptoms (47.1 %). Mediation analysis results indicated that neuroticism had a direct predictive effect on depressive symptoms in older adults. Family health and perceived social support partly mediated the relationship between neuroticism and depressive symptoms in older adults. Moreover, depressive symptoms in older adults with high neuroticism was directly affected by decreasing family health and indirectly and cumulatively aggravated by the mediation of lower perceived social support.

LIMITATIONS

The cross-sectional study design limits the conclusion about causation and directionality.

CONCLUSIONS

Family health and perceived social support can prevent depressive symptoms in older adults with high neuroticism.

The 100 Top-Cited Studies on Loneliness: A Bibliometric Analysis

The present study explores characteristics of the top 100 most-cited articles on loneliness. A systematic search was carried out using the Thomson Reuters Web of Science Core Collection to collect studies on loneliness from inception to June 1, 2022. The initial search resulted in 6,250 search results, which included articles, book chapters, conference proceedings, editorials, and letters. Two authors independently screened the literature and extracted the data. The study supervisor removed any discrepancies. Top 100 papers (articles and reviews) on loneliness published in English were extracted. Data analysis and visualization were performed on Excel, Web of Science (WoS) Data Analyzer, and VOSviewer 1.6.16. The total number of citations of the 100 top-cited articles was 42,044, ranging from 203 to 2,201 per article. All of the studies were published from 1989 to 2021, and the years with the highest number of top-cited articles published were 2003 and 2008. Most publications were from the following journals: Computers in Human Behavior, Developmental Psychology, Psychological Science, Psychology, and Aging (n=4 each). The most cited article was titled "UCLA Loneliness Scale (Version 3): Reliability, validity, and factor structure" by Russell, DW, in the Journal of Personality Assessment. The most productive institute was the University of Chicago. The two most productive authors were Cacioppo, JT, and Hawkley, LC. Of the 100 top-cited publications, 87 were original articles and 13 were reviews. The top three WoS categories were psychology multidisciplinary, gerontology, and psychiatry. In total, 37 author keywords were elicited and further clubbed into eight distinct clusters. The study provides new insight into loneliness research, which may help doctors, researchers, and stakeholders achieve a more comprehensive understanding of trends and influential contributions to the field and highlight under-researched areas, which could be the basis for future investigation.

Factors influencing loneliness among older people using homecare services during the COVID-19 pandemic

BACKGROUND

Elderly homecare service users may reduce their level of social participation and interpersonal interactions due to physiological loss, which may lead to loneliness and depression over the years. However, there is a lack of research on loneliness among older people who use homecare services. The purpose of this study was to examine the factors influencing loneliness among older people using homecare services.

METHODS

This is a longitudinal study conducted in communities in Central Taiwan, and data were collected using a structured questionnaire. The questionnaire was first administered as a pre-test to obtain baseline information about the participants, and the same questionnaire was administered as a post-test after 6 months to follow-up. The pre- and post-test questionnaires included five sections, that is, participant demographics, Brief Symptom Rating Scale, Interpersonal Interaction Scale (IIS), Frenchay Activities Index, and UCLA Loneliness Scale (UCLA).

RESULTS

A total of 178 participants were recruited in this study. Results indicated that gender, whether participants eat alone or with others at dinner, social media use, perceived economic status, and IIS score were significantly correlated with the loneliness score on the UCLA. Furthermore, there was a significant increase in the loneliness score among male participants in the low loneliness group from baseline to 6 months follow-up.

CONCLUSIONS

Gender, presence of others at dinner, social media use, perceived economic status, and interpersonal interaction skills are significant factors that influence loneliness among older people using homecare services. Men tend to experience higher levels of loneliness over time.

Staying connected in old age: associations between bonding social capital, loneliness and well-being and the value of digital media

OBJECTIVES

We examined associations between age, bonding social capital (BSC), loneliness and psychological, social and emotional well-being in old age. As in theory digital media can support both preservation of and access to someone's social capital, we also explored associations between the use of WhatsApp, social network sites (SNS) and Internet applications and respectively BSC and loneliness.

METHOD

In this cross-sectional study a sample of 349 older adults (range = 70y-93y; Mean(SD)=74.8y(4.9y); 59.6% male) filled out a questionnaire including the bonding social capital subscale of the personal social capital scale for elderly (PSCSE), validated scales measuring social, emotional, and psychological well-being and loneliness, the SNS intensity scale and items measuring frequencies of Whatsapp use and use of various Internet functions. Also relevant demographic and other covariates were included.

RESULTS

Regression analyses including relevant covariates confirmed our hypotheses, finding negative associations between BSC and both age and loneliness, and positive associations between BSC and psychological, social and emotional well-being. WhatsApp and Internet use were both found positively associated with BSC, whilst a negative association between WhatsApp use and loneliness was found. SNS use was not associated with BSC nor with loneliness.

CONCLUSION

Our findings indicate BSC as an important factor in positive aging and illustrate a widening gap between the need for socio-emotional resources versus their availability. With regard to digital media, we conclude that its value in old age should be sought in providing access to one's bonding social capital rather than adding to it by expanding the number of social relations.

Loneliness in Elderly Inpatients

PURPOSE

Loneliness among the elderly is a widespread phenomenon and is connected to various negative health outcomes. Nevertheless, loneliness among elderly inpatients, especially those with a psychiatric diagnosis, has hardly been examined. Our study assessed loneliness in elderly inpatients, identified predictors, and compared levels of loneliness between inpatients on psychiatric and somatic wards.

METHODS

N = 100 elderly inpatients of a somatic and psychiatric ward were included. Levels of loneliness were assessed, as were potential predictors such as depression, psychological resilience, severity of mental illness, well-being, daily functioning, and psychiatric diagnosis. Analyses of group differences and hierarchical multiple regression analysis were conducted.

RESULTS

37% of all inpatients reported elevated levels of loneliness. Significant predictor variables were self-reported depressive symptoms, well-being, severity of mental illness, being single and living with a caregiver. Hierarchical multiple regression analysis revealed that the full model explained 58% of variance in loneliness. Psychiatric inpatients' loneliness was significantly higher than loneliness in somatic inpatients. When analyzing group differences between inpatients with different main psychiatric diagnoses, highest levels were found in patients with an affective disorder, followed by those treated for organic mental disorder. Since the study took place during the COVID-19 pandemic, potential influence of different measurement points (lockdown vs. no lockdown) were analyzed: Differences in loneliness depending on the phase of the pandemic were non-significant.

CONCLUSION

Elderly inpatients experience high levels of loneliness, especially those with a mental disorder. Interventions to reduce loneliness in this population should address predictors of loneliness, preferably through multiprofessional interventions.

Impact of Loneliness on Functioning in Lung Cancer Patients

Lung cancer is the leading cause of cancer death and carries a greater degree of stigma. Lung cancer stigma contributes to social isolation and increases loneliness, which has an impact on quality of life, increases depressive symptoms and hence affects all aspects of functioning. Functioning is assessed in five dimensions (physical, psychological, cognitive, social and life roles). The aim of the study was to assess the impact of loneliness on the functioning, nutritional status and quality of life of patients with lung cancer.

METHODS

The survey study was conducted among 310 lung cancer patients. The patients were asked to complete the Mini-MAC, HADS-M, MNA, EORTC QoL, AIS and VAS questionnaires.

RESULTS

In total, 136 patients were lonely and 174 were married or in a relationship. Lonely patients had significant difficulty accepting their illness and demonstrated higher levels of depression. The factors most strongly associated with loneliness were being unemployed, age 61 or over and a less score in the constructive coping strategies.

CONCLUSIONS

Loneliness is a significant factor affecting the functioning of patients with lung cancer. It increases the risk of anxiety and depression, reduces levels of illness acceptance, reduces levels of constructive coping and increases the risk of malnutrition.

The mediating role of self-continuity on the link between childhood adversity and loneliness in later life

Many factors may influence adaptation to critical life events such as divorce and bereavement in the second half of life, including having faced childhood adversity. However, pathways to reduced adaptation success are poorly understood. Self-continuity, an identity mechanism that incorporates life changes into a coherent life story, may contribute to better adaptation to adult critical life events, such as feeling less socially and emotionally lonely. We investigated the mediating role of self-continuity channeling the effects of childhood adversity on later life adaptation outcomes among individuals who had experienced divorce or bereavement. Data were derived from the longitudinal LIVES Intimate Partner Loss Study conducted in Switzerland from 2012 to 2016. The sample consisted of individuals who had experienced divorce (n = 416, Mage = 57.35) or bereavement (n = 339, Mage = 71.36) in later life, and a continuously married control group (n = 925, Mage = 67.04). Multilevel moderated mediations were used. Self-continuity mediated the effect of childhood adversity on emotional loneliness for all marital groups, but to a greater extent among divorcees. Self-continuity also mediated the effect of childhood adversity on social loneliness; however, this effect did not differ by marital group. In conclusion, childhood adversity was associated to greater loneliness in later life through self-continuity. Divorcees were the most impacted group regarding emotional loneliness, as they experienced lower levels of self-continuity. Interventions that aim to reinforce self-continuity may help overcome social and emotional loneliness, especially for individuals who have experienced the loss of their partner through divorce.

Well-Being, Physical Activity, and Social Support in Octogenarians with Heart Failure during COVID-19 Confinement: A Mixed-Methods Study

BACKGROUND

This study aimed to compare well-being and physical activity (PA) before and during COVID-19 confinement in older adults with heart failure (HF), to compare well-being and PA during COVID-19 confinement in octogenarians and non-octogenarians, and to explore well-being, social support, attention to symptoms, and assistance needs during confinement in this population.

METHODS

A mixed-methods design was performed. Well-being (Cantril Ladder of Life) and PA (International Physical Activity Questionnaire) were assessed. Semi-structured interviews were performed to assess the rest of the variables.

RESULTS

120 participants were evaluated (74.16 ± 12.90 years; octogenarians = 44.16%, non-octogenarians = 55.83%). Both groups showed lower well-being and performed less PA during confinement than before (p < 0.001). Octogenarians reported lower well-being (p = 0.02), higher sedentary time (p = 0.03), and lower levels of moderate PA (p = 0.04) during confinement. Most individuals in the sample considered their well-being to have decreased during confinement, 30% reported decreased social support, 50% increased their attention to symptoms, and 60% were not satisfied with the assistance received. Octogenarians were more severely impacted during confinement than non-octogenarians in terms of well-being, attention to symptoms, and assistance needs.

CONCLUSIONS

Well-being and PA decreased during confinement, although octogenarians were more affected than non-octogenarians. Remote monitoring strategies are needed in elders with HF to control health outcomes in critical periods, especially in octogenarians.

Older Adults and Social Isolation and Loneliness During the COVID-19 Pandemic: An Integrated Review of Patterns, Effects, and Interventions

A scoping review was conducted to identify patterns, effects, and interventions to address social isolation and loneliness among community-dwelling older adult populations during the COVID-19 pandemic. We also integrated (1) data from the Canadian Longitudinal Study on Aging (CLSA) and (2) a scan of Canadian grey literature on pandemic interventions. CLSA data showed estimated relative increases in loneliness ranging between 33 and 67 per cent depending on age/gender group. International studies also reported increases in levels of loneliness, as well as strong associations between loneliness and depression during the pandemic. Literature has primarily emphasized the use of technology-based interventions to reduce social isolation and loneliness. Application of socio-ecological and resilience frameworks suggests that researchers should focus on exploring the wider array of potential pandemic age-friendly interventions (e.g., outdoor activities, intergenerational programs, and other outreach approaches) and strength-based approaches (e.g., building community and system-level capacity) that may be useful for reducing social isolation and loneliness.

Loneliness and Social Support among the Middle-Aged and Elderly People with Visual Impairment

Loneliness is associated with depression, sleep disturbance, and an increased risk of cardiovascular disease, and it is a global public health problem. Since physical and mental health have a great impact on loneliness, middle-aged and elderly people who are blind or visually impaired may be more affected by loneliness. Previous research has confirmed that effective social support can enhance physical and mental health and alleviate the negative effects of life stress. Therefore, in this study, we applied a cross-sectional design where data were collected using questionnaires completed in person, by phone, or online for a total of 456 middle-aged and elderly people with visual impairment. We found that the enrolled participants who were unemployed, lacked a stable source of income, lived alone, or were unable to move independently were prone to experiencing high levels of loneliness and low social support, which highlights the necessity of interventions such as counseling to alleviate the sense of loneliness in such groups. During the COVID-19 pandemic, social support measures to reduce the sense of loneliness should be highly encouraged to ensure that middle-aged and elderly people with visual impairment can continue to live independently, and social support seems to be an important factor.

Is helping you helping me? The assessment of helping others using event sampling methodology in a clinical and a non‐clinical sample

Individuals diagnosed with major depressive disorder (MDD) and social phobia (SP) have difficulties in social interactions. It is unknown, however, whether such difficulties prevent them from helping others, thereby depriving them of the natural benefits of helping, such as receiving gratitude. Using event sampling methodology (ESM), individuals (MDD, n = 118; SP, n = 47; and control group, n = 119) responded to questions about the frequency of helping, in total at 5333 time points, and their well-being. Contrary to our hypothesis, individuals in the MDD, SP and control group did not differ in their helping frequency. Results did show an association between helping and well-being, such that helping is related to well-being and well-being to helping. Understanding the complex relation of helping others and well-being and how this might be used during therapy and prevention programmes are discussed.

The Association Between Loneliness and Psychiatric Symptomatology in Older Psychiatric Outpatients

PURPOSE

Loneliness in adults increases with age. Although loneliness has been found to be associated with psychiatric disorders and dementia, no information is available on prevalence of loneliness in older psychiatric patients. The aims of this study were to examine prevalence of loneliness in older psychiatric outpatients, including gender differences and associations with psychiatric disorders and social isolation.

METHODS

Cross-sectional study in an outpatient clinic for geriatric psychiatry between September 2013 and February 2018. Interviews were done in 181 patients.

RESULTS

80% of participants were lonely. Loneliness was associated with having contacts in less social network domains, in women but not in men. There were no associations with DSM-IV-TR-classifications. However, loneliness was associated with higher scores on questionnaires for depression and cognitive function. Intensity of treatment did not differ significantly between lonely and non-lonely participants.

CONCLUSION

Loneliness is highly prevalent in older psychiatric outpatients, with men and women equally affected. Loneliness should be assessed in all older psychiatric patients, especially when they show high scores on symptom checklists or have a restricted social network.

The helping older people engage (HOPE) study: Protocol & COVID modifications for a randomized trial

Objectives

Evidence-based strategies to reduce loneliness in later life are needed because loneliness impacts all domains of health, functioning, and quality of life. Volunteering is a promising strategy, as a large literature of observational studies documents associations between volunteering and better health and well-being. However, relatively few studies have used randomized controlled trials (RCTs) to examine benefits of volunteering, and none have examined loneliness. The primary objective of the Helping Older People Engage (HOPE) study is to examine the social-emotional benefits of a social volunteering program for lonely older adults. This manuscript describes the rationale and design of the trial.

Methods

We are randomly assigning adults aged 60 or older (up to 300) who report loneliness to 12 months of either AmeriCorps Seniors volunteering program or an active control (self-guided life review). Co-primary outcomes are assessed via self-report-loneliness (UCLA Loneliness Scale) and quality of life (WHOQOL-Bref). Enrollment was completed in May 2022 and follow-up assessments will continue through May 2023, with completion of primary outcomes soon thereafter.

Conclusions

Since older adults who report loneliness are less likely to actively seek out volunteering opportunities, if results support efficacy of volunteering for reducing loneliness, dissemination and scaling up efforts may involve connecting primary care patients who are lonely with AmeriCorps Seniors through aging services agencies.This RCT is registered at clinicaltrials.gov (NCT03343483).

Isolating together during COVID-19: Results from the Telehealth Intervention Program for older adults

Background

A pressing challenge during the COVID-19 pandemic and beyond is to provide accessible and scalable mental health support to isolated older adults in the community. The Telehealth Intervention Program for Older Adults (TIP-OA) is a large-scale, volunteer-based, friendly telephone support program designed to address this unmet need.

Methods

A prospective cohort study of 112 TIP-OA participants aged ≥60 years old was conducted in Quebec, Canada (October 2020–June 2021). The intervention consisted of weekly friendly phone calls from trained volunteers. The primary outcome measures included changes in scores of stress, depression, anxiety, and fear surrounding COVID-19, assessed at baseline, 4 and 8-weeks. Additional subgroup analyses were performed with participants with higher baseline scores.

Results

The subgroup of participants with higher baseline depression scores (PHQ9 ≥10) had significant improvements in depression scores over the 8-week period measured [mean change score = −2.27 (±4.76), 95%CI (−3.719, −0.827), p = 0.003]. Similarly, participants with higher baseline anxiety scores (GAD7 ≥10) had an improvement over the same period, which, approached significance (p = 0.06). Moreover, despite peaks in the pandemic and related stressors, our study found no significant (p ≥ 0.09) increase in stress, depression, anxiety or fear of COVID-19 scores.

Discussion

This scalable, volunteer-based, friendly telephone intervention program was associated with decreased scores of depression and anxiety in older adults who reported higher scores at baseline (PHQ 9 ≥10 and GAD7 ≥10).

Continuous Neurophysiologic Data Accurately Predict Mood and Energy in the Elderly

The elderly have an elevated risk of clinical depression because of isolation from family and friends and a reticence to report their emotional states. The present study explored whether data from a commercial neuroscience platform could predict low mood and low energy in members of a retirement community. Neurophysiologic data were collected continuously for three weeks at 1Hz and averaged into hourly and daily measures, while mood and energy were captured with self-reports. Two neurophysiologic measures averaged over a day predicted low mood and low energy with 68% and 75% accuracy. Principal components analysis showed that neurologic variables were statistically associated with mood and energy two days in advance. Applying machine learning to hourly data classified low mood and low energy with 99% and 98% accuracy. Two-day lagged hourly neurophysiologic data predicted low mood and low energy with 98% and 96% accuracy. This study demonstrates that continuous measurement of neurophysiologic variables may be an effective way to reduce the incidence of mood disorders in vulnerable people by identifying when interventions are needed.

Exploring the Association between Welfare State and Mental Wellbeing in Europe: Does Age Matter?

Previous research reports show mixed results regarding the age gradient in population mental wellbeing, which may be linked to the role that welfare states play. In this study, we investigate whether an age gradient exists in relation to the association between welfare state and mental wellbeing within the adult population in Europe. We combine individual level data from Round 6 of the European Social Survey and country level data on welfare state and use multilevel regression analyses to explore population mental wellbeing. Subjective and psychological wellbeing dimensions were analyzed, and different approaches to measuring welfare state were explored, including a regime typology and composite welfare state measures constructed on the basis of a set of eight individual indicators. We found the age gradient for mental wellbeing to differ between welfare states, with the positive impact of the welfare state increasing with age. A universal and generous welfare state seems to be particularly important for older adults, who are also more likely to be in higher need of transfers and services provided by the welfare state.