What really matters in the social network-mortality association? A multivariate examination among older Jewish-Israelis

The Need to Appear Healthy: Concealment of Chronic Illness, Privacy, and Self-Sufficiency Among Chronically Ill Older Nigerians

Background and Objectives

Prior research has highlighted the beneficial impact of social networks and social support on older adults' physical and psychosocial well-being. However, the impact of the relationship between chronic illness and social networks on the psychosocial well-being of older Nigerians remains understudied. This study explored how older Nigerians with chronic illnesses navigate the physical, mental, and emotional changes due to their chronic disease diagnosis within their social contexts.

Research Design and Methods

The current qualitative study used semistructured in-depth interviews with 19 purposively sampled older adults, aged 50 years and over, chronically ill, and receiving clinical care to examine the role of social networks in how chronically ill older Nigerians cope with their diagnosis.

Results

Three main themes reflecting participants' experiences emerged from the findings: (1) closely knit circles, (2) privacy and self-sufficiency, and (3) body image. Results show that chronically ill older Nigerians prefer to keep the knowledge of their conditions strictly within their close family circles. It was considered horrific to inform friends, community members, and religious groups about one's chronic illness. Findings further reveal that the need to appear healthy to one's social network stems from the fear of being discriminated against and attempts to maintain some level of normalcy when interacting with others. Additionally, feelings of inferiority and shame limited their participation in social activities and social network maintenance.

Discussion and Implications

We discuss the implications of the results for the mental well-being and quality of life of chronically ill older Nigerians and make recommendations for policies and resources that can improve the well-being of chronically ill Nigerians.

Identifying pathways to religious service attendance among older adults: A lagged exposure-wide analysis

We used prospective data (spanning 8 years) from a national sample of older U.S. adults aged > 50 years (the Health and Retirement Study, N = 13,771) to evaluate potential factors that lead to subsequent religious service attendance. We applied a lagged exposure-wide epidemiologic design and evaluated 60 candidate predictors of regular subsequent religious service attendance. Candidate predictors were drawn from the following domains: health behaviors, physical health, psychological well-being, psychological distress, social factors, and work. After rigorous adjustment for a rich set of potential confounders, we observed modest evidence that changes in some indices of physical health, psychological well-being, psychological distress, and social functioning predicted regular religious service attendance four years later. Our findings suggest that there may be opportunities to support more regular religious service attendance among older adults who positively self-identify with a religious/spiritual tradition (e.g., aid services for those with functional limitations, psychological interventions to increase hope), which could have downstream benefits for various dimensions of well-being in the later years of life.

Grandparenting, Social Relations, and Mortality in Old Age

Guided by a convoy model of social relations, this study investigates the relationships between grandparenting status, social relations, and mortality among community-dwelling grandparents age 65 and older who are caring for their grandchildren. The data were drawn from the 2008 and 2016 waves of the Health and Retirement Study (N = 564). Latent class analysis was used to identify the social network structure based on six indicators of interpersonal relationships and activities. A series of hierarchical Weibull hazard models estimated the associations between grandparent caregiving, social relations, and mortality risk. Results of survival analyses indicate that co-parenting and custodial grandparents had higher all-cause mortality risk than grandparents who babysat occasionally; however, for custodial grandparents, the association was not significant once social relation variables were added to the model. This study suggests that community-based support may be beneficial to older grandparents and improved relationship quality is integral to the well-being of older adults.

Religious-service attendance and subsequent health and well-being throughout adulthood: evidence from three prospective cohorts

BACKGROUND

Religious-service attendance has been linked with a lower risk of all-cause mortality, suicide and depression. Yet, its associations with other health and well-being outcomes remain less clear.

METHODS

Using longitudinal data from three large prospective cohorts in the USA, this study examined the association between religious-service attendance and a wide range of subsequent physical health, health behaviour, psychological distress and psychological well-being outcomes in separate cohorts of young, middle-aged and older adults. All analyses adjusted for socio-demographic characteristics, prior health status and prior values of the outcome variables whenever data were available. Bonferroni correction was used to correct for multiple testing.

RESULTS

Estimates combining data across cohorts suggest that, compared with those who never attended religious services, individuals who attended services at least once per week had a lower risk of all-cause mortality by 26% [95% confidence interval (CI): 0.65 to 0.84], heavy drinking by 34% (95% CI: 0.59 to 0.73) and current smoking by 29% (95% CI: 0.63 to 0.80). Service attendance was also inversely associated with a number of psychological-distress outcomes (i.e. depression, anxiety, hopelessness, loneliness) and was positively associated with psychosocial well-being outcomes (i.e. positive affect, life satisfaction, social integration, purpose in life), but was generally not associated with subsequent disease, such as hypertension, stroke, and heart disease.

CONCLUSIONS

Decisions on religious participation are generally not shaped principally by health. Nevertheless, for individuals who already hold religious beliefs, religious-service attendance may be a meaningful form of social integration that potentially relates to greater longevity, healthier behaviours, better mental health and greater psychosocial well-being.

Family embeddedness and older adult mortality in the United States

Do different operationalizations of family structure offer different understandings of the links between family structure and older adult mortality? Using the American Health and Retirement Study (N = 29,665), we examine mortality risks by three measures of family structure: whether respondents have different family statuses (e.g. married vs. unmarried), volume of family members available (e.g. having one vs. two living immediate family members), and family embeddedness (e.g. having neither spouse nor child vs. having spouse but no child). We focus on three kin types: partner/spouse, children, and siblings. We find that differences in empirical estimates across measures of family structure are not dramatic, but that family embeddedness can show some additional heterogeneity in mortality patterns over family status variables or the volume of ties. This paper tests different ways of operationalizing family structure to study mortality outcomes and advances our understanding of how family functions as a key social determinant of health.

Social network types and cognitive decline among older Korean adults: A longitudinal population-based study

OBJECTIVES

Social network (SN) has been known to impact on cognitive function in late life. However, knowledge regarding the link between SN of various types and cognitive decline (CD) is limited. This study's aim was to investigate which types of SN are associated with reduced risk of CD 2 years later among community-dwelling older adults.

METHODS

Secondary analysis of data from 1960 cognitively intact adults 65 years of age or older who participated in the Korean Longitudinal Study of Aging (KLoSA) was employed. K-means cluster analysis was conducted to derive SN types using seven common SN characteristics (marital status, living with children, number of children, frequency of contact with children, frequency of contact with friends, frequency of participation in religious activities, and frequency of participation in social groups). Multivariable linear regression analysis regarding the effects of SN type on CD between 2012 and 2014 was conducted, controlling for covariates.

RESULTS

K-means cluster analyses identified a model with five types of SN as being most optimal, and they were named diverse/couple, diverse/family, congregant, restricted/married, and widowed. The average CD 2 years later was most pronounced in those in the widowed network. Compared with the widowed, older adults in the diverse/couple network and the congregant network at baseline had a lower risk of CD 2 years after initial assessment.

CONCLUSIONS

Findings show that older Korean adults embedded in widowed network types are at risk for CD and suggest the importance of having a spouse and religious group activities in maintaining cognitive function in later life.

Adherence to a Mediterranean Dietary Pattern Is Associated with Higher Quality of Life in a Cohort of Italian Adults

Background: The observed rise in non-communicable diseases may be attributed to the ongoing changes of urban environment and society, as well as greater awareness of health-related issues and subsequent higher rates of diagnosis, which all contribute to the overall quality of life. The aim of the study was to test the association between adherence to the Mediterranean dietary pattern and self-reported quality of life in a cohort of Italian adults. Methods: The demographic and dietary characteristics of 2044 adults living in southern Italy were analyzed. Food frequency questionnaires (FFQs) and a Mediterranean diet adherence score were used to assess dietary intake. The Manchester Short Appraisal (MANSA) was used to assess self-rated quality of life. Multivariate logistic regression analyses were used to test the associations. Results: A significant linear trend of association was found for the overall quality of life and adherence to Mediterranean diet score. All of the components of the MANSA, with the exception of self-rated mental health, were individually associated with higher adherence to this dietary pattern. Conclusions: Adherence to a healthy dietary pattern is associated with the measures of better overall perceived quality of life.

Social network changes among older Europeans: the role of gender

This study examined changes in the social networks of older Europeans. It utilizes the framework of the socioemotional selectivity theory and the convoy model to explore the social networks' changes over time, as well as the turnover of specific social network members. Furthermore, the study analyzed gender as a predictor of these transformations. The inquiry focused on older adults aged 65+ who participated in the fourth and sixth waves of the Survey of Health, Ageing, and Retirement in Europe (n = 13,938). The findings reveal a general trend of network expansion over time, with addition of new members and a higher proportion of family ties. These trends mask considerable individual variability in change trajectories, however. A series of OLS and Poisson regressions revealed that women were more likely to report network growth via addition of new social network members, and lower family involvement. These findings underscore the dynamic nature of older Europeans' interpersonal milieu. They also underscore the role of gender in social network transformations and show that the dynamics of older Europeans' personal networks differ for men and women.

The Inverse U-Shaped Religion-Health Connection Among Israeli Jews

A growing body of evidence indicates an association between religion and health. However, few have studied the connection between the extent of an individual's religiosity and his health. Analysis of the 2004 Israel National Health Survey was performed. Religiosity was self-identified using five continuous categories, distinctive to Israeli Jews. Bivariate and multivariate analyses examined the relationship between the extent of Religious commitment and several health outcomes. The relationship took the shape of an inverse U function: Israeli Jews in the middle religiously have the worst physical and mental health status on both unadjusted and adjusted bases. Israeli Jews exhibit a non-trivial connection between religiosity and health whereby the most Secular and the most Religious individuals seem to be healthier than individuals in between.

Religion and health in Europe: cultures, countries, context

Much of the research on the relationships between religious participation and health comes from the United States. Studies in other geographic regions or cultural contexts is more sparse. Evidence presented by Ahrenfelt et al., and that from other research studies, is reviewed concerning the associations between religion and health within Europe and world-wide. The evidence within Europe suggests protective associations between various forms of religious participation and lower depression, lower mortality, and better self-rated health. Methodological challenges in such research are reviewed, and discussion is given as to whether a person-culture-fit explanation suffices to account for the existing data and to what other mechanisms might be operative.

The Mediterranean healthy eating, ageing, and lifestyle (MEAL) study: rationale and study design

There is accumulating evidence suggesting that Mediterranean lifestyles, including nutrition and sleeping patterns as well as social integration, may play a role in reducing age-related diseases. However, the literature is mostly deficient of evidence provided by Italian Mediterranean islands that more closely adhered to the originally described lifestyles. In this paper, we described the rationale and the study design of the Mediterranean healthy Eating, Ageing, and Lifestyle (MEAL) study, a prospective population-based cohort established in Sicily, southern Italy. The main exposures investigated are classical determinants of health, including demographic, nutritional habits, smoking and physical activity status, as well as eating-related behaviors, sleeping habits, sun exposure, social resources, and perceived stress. Anthropometric measurements will be collected. The main outcomes included depression, quality of life, and, after the follow-up period, also cardiovascular disease and cancer. The MEAL study may provide important data to increase our knowledge regarding the prevalence, incidence, and risk factors of age-related disorders in the Mediterranean region.

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

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

Social network types among older Korean adults: Associations with subjective health

With population aging now a global phenomenon, the health of older adults is becoming an increasingly important issue. Because the Korean population is aging at an unprecedented rate, preparing for public health problems associated with old age is particularly salient in this country. As the physical and mental health of older adults is related to their social relationships, investigating the social networks of older adults and their relationship to health status is important for establishing public health policies. The aims of this study were to identify social network types among older adults in South Korea and to examine the relationship of these social network types with self-rated health and depression. Data from the Korean Social Life, Health, and Aging Project were analyzed. Model-based clustering using finite normal mixture modeling was conducted to identify the social network types based on ten criterion variables of social relationships and activities: marital status, number of children, number of close relatives, number of friends, frequency of attendance at religious services, attendance at organized group meetings, in-degree centrality, out-degree centrality, closeness centrality, and betweenness centrality. Multivariate regression analysis was conducted to examine associations between the identified social network types and self-rated health and depression. The model-based clustering analysis revealed that social networks clustered into five types: diverse, family, congregant, congregant-restricted, and restricted. Diverse or family social network types were significantly associated with more favorable subjective mental health, whereas the restricted network type was significantly associated with poorer ratings of mental and physical health. In addition, our analysis identified unique social network types related to religious activities. In summary, we developed a comprehensive social network typology for older Korean adults.

Social networks and mental health among older Europeans: are there age effects?

This study examined different components of personal social networks-structure, interaction, and quality-and the extent to which each is related to mental health among a 65+ sample (n = 26,784) taken from the fourth wave of the Survey of Health, Ageing, and Retirement in Europe. The first aim of the study was to determine which network components had the strongest associations with the number of depressive symptoms, measured on the EURO-D scale. Secondly, the study considered if and how age impacted the associations between social network and depression, using interaction terms that paired age category (age 65-79; age 80+) with the score on each network component. Hierarchical OLS regressions revealed that social network quality and network structure were both negatively related to the number of depressive symptoms. The association between network size (structure) and depression was even greater among those 80+. Age differences were also found for network interaction. More frequent contact with the network was related to a greater extent of depressive symptoms, but only among respondents aged 80 and older. Closer geographic proximity was related to having fewer depressive symptoms, but only among respondents aged 65-79. The findings imply that the association between meaningful personal relationships and depression in late life is nuanced by both network characteristics and by age.

Religious leaders' opinions and guidance towards oral health maintenance and promotion: a qualitative study

Religions emphasize the supreme value of life. However, potential or concrete conflicts of perception between dictates of faith and science often present an inescapable dilemma. The aim of this qualitative research was to examine the views of spiritual and religious leaders towards general and oral health issues. A total of 11 eminent Jewish spiritual and religious community leaders were purposively chosen. They were interviewed using a semi-structured questionnaire. The verbatim transcriptions of the interviews were analysed in the spirit of grounded theory, using qualitative data analysis software. Open, axial, and thematic coding served to build categories and themes. Analysis of participants' perspectives reflected that they, based upon Jewish theology, attributed high importance to primary prevention at both personal and community levels. Religious and orthodox people were depicted as being motivated towards maintaining oral health behaviours due to a sense of obligation to follow religious edicts, strong social support, and elevated perceived spiritual levels. We offer a theoretical model that can explain the potential high motivation among these communities towards implementing positive general and oral health behaviours. Religiosity may be regarded as an example of a psycho-social health determinant, encompassing spiritual belief ("psycho") and social support ("social") components.

Religious differences in self-rated health among US Jews: findings from five urban population surveys

Research findings on religion and health among Jews are in relatively short supply. While recent studies report on the health of Israelis and the mental health of Jews in the USA, little information exists on the physical health of US Jews, especially from population surveys. In this study, data are analyzed from five urban surveys of Jews conducted since 2000: two surveys from New York (N = 4,533; N = 5,993) and one apiece from Chicago (N = 1,993), Philadelphia (N = 1,217), and Boston (N = 1,766). A strategy of two-way ANCOVA with interaction was used to test for differences in self-rated health across five categories of Jewish religious affiliation (secular, Reform, Reconstructionist, Conservative, Orthodox) and four categories of synagogue attendance (from never to at least weekly). Findings, adjusted for age and effects of other covariates, reveal that affiliated and synagogue-attending Jews report moderately better health than secular and non-attending Jews.

[Aging well in the 20th century: a psychosocial perspective]

Aging well refers to retaining or restoring well-being in the face of various age-related changes in later life. This process is influenced by the quality of social relationships and active adaptation to loss and change. According to recent studies from the Longitudinal Aging Study Amsterdam, more older adults are maintaining relationships with friends, colleagues and other non-kin longer. Greater diversity in their social networks contributes to happiness and morale, and provides protection against anxiety, depression and loneliness. There is also a slight increase in mastery and in cognitive functioning among new cohorts of older adults. These developments promote adaptation to declines in health and loss of the partner. These improvements are found less frequently among those with lower education, lower incomes, and/or small networks. Several interventions have proven to be effective for these disadvantaged groups: a visiting service for widows and widowers and two self-management interventions for chronically ill or physically vulnerable older adults.

Is social stress in the first half of life detrimental to later physical and mental health in both men and women?

This study examined gender differences in the associations between affection- and status-related stressors encountered in the first half of life and physical and mental health problems later on. Based on the theory of Social Production Functions (SPF) two hypotheses have been formulated, which were tested in a representative sample of 446 men and 514 women (aged 40–79). Main outcome measures were number of chronic somatic diseases and level of psychological distress. As expected, regression analyses showed no gender differences in the associations between affection-related stressors and physical and mental health problems later on. In contrast, but as also expected, status-related stressors encountered in the first half of life were associated with later physical and mental health for men only. It is concluded that the gender differences in the associations between earlier social stressors and later health problems may be more complex than the common assumption that men are only affected by status stress and women only by affection stress. This study contributes to the knowledge on gender differences concerning the link between social stress and health, and it indicates that social experiences encountered earlier in life are of importance for being healthy and happy in later life.

Social networks and well-being: a comparison of older people in Mediterranean and non-Mediterranean countries

OBJECTIVES

This study examined whether the social networks of older persons in Mediterranean and non-Mediterranean countries were appreciably different and whether they functioned in similar ways in relation to well-being outcomes.

METHODS

The sample included family household respondents aged 60 years and older from the first wave of the Survey of Health, Ageing and Retirement in Europe in 5 Mediterranean (n = 3,583) and 7 non-Mediterranean (n = 5,471) countries. Region was regressed separately by gender on variables from 4 network domains: structure and interaction, exchange, engagement and relationship quality, and controlling for background and health characteristics. In addition, 2 well-being outcomes-depressive symptoms and perceived income inadequacy-were regressed on the study variables, including regional social network interaction terms.

RESULTS

The results revealed differences across the 2 regional settings in each of the realms of social network, above and beyond the differences that exist in background characteristics and health status. The findings also showed that the social network variables had different effects on the well-being outcomes in the respective settings.

DISCUSSION

The findings underscore that the social network phenomenon is contextually bound. The social networks of older people should be seen within their unique regional milieu and in relation to the values and social norms that prevail in different sets of societies.