Social engagement and physical and cognitive health among American Indian participants in the health and retirement study

Unveiling the dynamics of social engagement and subjective health in older adults: A gendered perspective

OBJECTIVES

As populations age globally, understanding the dynamics that influence the well-being of older individuals become increasingly crucial. The research employs a comprehensive approach to unravel the multifaceted interplay between social engagements and subjective health perceptions of older Indians, with a special focus on gender differences.

SUBJECTS AND METHODS

This study used data from the Longitudinal Aging Study in India (LASI) wave 1, 2017-18 with a total sample of 30,533 older adults aged 60 years and above. Bivariate analysis, chi-square tests and unadjusted and adjusted average marginal effects from logistic regression models were used to assess the relationship between social engagements and subjective health among older adults, stratified by gender.

RESULTS

The prevalence of poor health status decreased with higher frequency of social networks among both men (pp. (percentage point) = 6.1; CI (Confidence Interval): 10.6, 1.6) and women (pp. = 9.2; CI: 14.9, 3.4). The adjusted average marginal effects demonstrate that with an increase in the overall score of social engagement, the likelihood of poor health is almost reduced by half. For men, the prevalence of poor health was 9.8 pp. (95 % CI: 13.7, 5.8), while for women, it was 9.3 pp. (95 % CI: 15.2, 3.1).

CONCLUSION

Gendered perspectives unveil unique patterns, highlighting how societal expectations and roles assigned to each gender may influence the subjective health perceptions of older individuals. This study adds to the expanding knowledge base to enhance the well-being and fulfillment of aging populations, considering the complex interplay of social dynamics and gendered perspectives.

Association between social participation and memory function among Chinese stroke survivors: The mediating role of depressive symptoms

Although the association between social participation and memory function has been documented in other populations, whether it exists among stroke survivors is unclear. Additionally, the mechanisms underlying this association are largely unknown. We attempted to examine the association between social participation and memory function in stroke survivors and the possible mediating role of depressive symptoms. A total of 614 stroke survivors (mean age: 64.73 years) drawn from a nationally representative survey in China were investigated. Based on the descriptive statistics, a Pearson's correlation and bootstrapping-based mediation analysis were executed. The results indicated that an increase in social participation was associated with a decrease in depressive symptoms (r = -0.100, p < 0.05) and an increase in memory function (r = 0.162, p < 0.01). Moreover, memory function was significantly negatively related to depressive symptoms (r = -0.243, p < 0.01). In addition, after controlling for sociodemographic factors, depressive symptoms partially mediated the effects of social participation on memory function. Due to the cross-sectional research design, causal relationships cannot be verified between the study variables. However, interventions aimed at aiding stroke survivors in memory impairment recovery may consider strategies to enhance social participation and mitigate depressive symptoms.

Race, Educational Attainment, and Sustained High Body Mass Index over 24 Years of Follow-up in Middle-Aged and Older Adults

BACKGROUND

Educational attainment has been linked to reduced risk of health problems such as obesity, but research suggests that this effect may be weaker for non-Hispanic Black individuals compared to non-Hispanic White individuals, a pattern known as minorities' diminished returns (MDRs).

OBJECTIVES

This study is aimed at examining the differential association between educational attainment and sustained high body mass index (BMI) among non-Hispanic Black and non-Hispanic White middle-aged and older adults in the USA.

METHODS

Using data from the Health and Retirement Study (HRS) spanning 1992-2016, we analyzed a national sample of 35,110 individuals, including 7766 non-Hispanic Black and 27,344 non-Hispanic White individuals. We used logistic regression models to examine the relationship between educational attainment, race, and sustained high BMI, while controlling for age, sex, and marital status at baseline.

RESULTS

Approximately 30.6% of the sample (n = 10,727) had sustained high BMI, while 69.4% (n = 24,383) had sustained low BMI over the period of follow-up. Higher levels of educational attainment were associated with a lower risk of sustained high BMI. We also found, however, that the protective effects of education against sustained high BMI were weaker for non-Hispanic Blacks compared to non-Hispanic Whites.

CONCLUSION

Our findings suggest that the protective effects of educational attainment against sustained high BMI may be more robust for non-Hispanic Whites than for non-Hispanic Blacks. Further research should explore whether these results are found in other racial and ethnic minorities and whether potential life history experiences may contribute to these disparities.

Prevalence and associated factors of cognitive frailty in community-dwelling older adults: Results from the Korean longitudinal study of aging

BACKGROUND

Cognitive frailty, a condition characterized by physical frailty with cognitive impairment, is emerging as a determinant of adverse health outcomes in older adults. However, its prevalence and correlation with associated factors are unknown in the aging population of Korea.

OBJECTIVES

To estimate the prevalence of cognitive frailty and identify factors associated with it among older Korean adults.

METHODS

A secondary analysis was performed using the Korean Longitudinal Study of Aging seventh survey dataset collected in 2018. Multinomial logistic regression analyses were conducted to examine the association between cognitive frailty and demographic, psychosocial, oral health and physical function factors. Individuals aged ≥65 years and without dementia were included (N = 1024). Participants were classified into four groups based on the presence or absence of physical frailty and mild cognitive impairment. This article is executed in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.

RESULTS

The prevalence of cognitive frailty in the study sample was 11.2%. The results of multinomial logistic regression showed that advanced age, being female, lower education levels, heart disease, arthritis or rheumatoid arthritis, underweight, depression, non-social activity, poor oral health and functional limitation were significantly associated with cognitive frailty.

CONCLUSIONS

Cognitive frailty is prevalent among community-dwelling older adults in Korea. The findings provide primary care providers with insights about effective strategies for identifying at-risk individuals and will guide the development of population-level interventions to prevent or delay the onset of physical frailty and cognitive impairment in older adults.

IMPLICATIONS FOR PRACTICE

The findings provide practical information to healthcare providers for identifying cognitive frailty in older adults. The risk factors of cognitive frailty, such as psychosocial, oral health, and physical function factors, should be thoroughly monitored for older adults. Health personnel working in primary care have a critical role in identifying risk and beneficial factors and promoting preventative strategies that enhance health outcomes.

Longitudinal impact of volunteering on the cognitive functioning of older adults: A secondary analysis from the US Health and Retirement Study

Objectives

To examine the relationship of volunteering with cognitive activity, social activity, and physical activity among older adults and, ultimately, with later cognitive functioning across different time periods.

Methods

We used individual responding to three waves of the US Health and Retirement Study panel data from 2008, 2012, and 2016 (n = 2,862). Self-reported questionnaires were used to assess annual volunteering frequency (non volunteering, volunteering <100 h and ≥100 h), and an adapted version of the Telephone Interview for Cognitive Status (TICS) was used to assess memory, mental processing, knowledge, language, and orientation. A structural equation model was estimated to assess effects on cognitive functioning throughout waves.

Results

Those participants that were part of volunteering activities in 2012 showed an increase between 2008 and 2012 in moderate physical activity (β = 0.19, P < 0.001 for those volunteering less than 100 h and β = 0.21, P < 0.001 for those volunteering at least 100 h), increase in social activity (β = 0.10, P = 0.052 for those volunteering less than 100 h and β = 0.12, P = 0.018 for those volunteering at least 100 h) and increase in higher cognitive activity (β = 0.13, P < 0.001 for those volunteering at least 100 h), compared to participants who did not volunteer. Higher levels of cognitive activity in 2008 and 2012 were associated with higher cognitive functioning on the following waves (β = 0.66 and β = 0.60, P < 0.001, respectively).

Discussion

Volunteering is a modifiable activity that can be increased to bolster cognitive functioning in older adulthood, primarily mediated by increased cognitive activity.

Relationship between Eye Frailty and Physical, Social, and Psychological/Cognitive Weaknesses among Community-Dwelling Older Adults in Japan

This study investigated the relationship between eye frailty and physical, social, and psychological/cognitive weaknesses among older adults in Japan. The participants were 192 community-dwelling older adult women. We measured handgrip strength, walking speed, and skeletal muscle mass; additionally, their physical, social, and psychological/cognitive frailties were surveyed using questionnaires. Eye frailty self-checks were used to assess eye frailty. Exploratory and confirmatory factor analyses were employed to verify the validity of the eye frailty self-checks. Eye frailty prevalence and related factors were investigated by conducting a binomial logistic regression analysis, with eye frailty as the dependent variable. The factor analysis results showed that a model could be constructed with the two factors of visual acuity or contrast and visual field. The model's goodness of fit was acceptable, supporting the validity of the self-checking construct. The Kihon checklist was the only variable with a significant relationship to eye frailty. Regarding the relationship between eye frailty and subordinate items of the Kihon checklist, social withdrawal [odds ratio (OR) 2.437, 95% confidence interval 1.145-5.188], cognitive function (OR 2.047, 95%CI 1.051-3.984), and depressed mood (OR 1.820, 95%CI 1.163-2.848) were significant. Eye frailty can be considered a factor reflecting the existence of social and psychological/cognitive frailties.

Grandchild Care and Well-Being: Gender Differences in Mental Health Effects of Caregiving Grandparents

OBJECTIVES

The literature on the gendered differences of mental health as a result of grandchild care has shown mixed results. Research on grandchild care further suggests that nonresidential grandchild care improves mental health outcomes, while residential grandchild care arrangements decrease mental health outcomes in grandparents. The moderating or buffering role of social engagement remains understudied in the grandchild care-mental health relationship. This study examines mental health effect differences between caregiving grandmothers and grandfathers and the moderating effects of social engagement.

METHODS

Using 2002-2012 data from the Health and Retirement Study, a nationally representative sample of U.S. adults aged 50 and older, I examine the mental health effects of grandchild care and the moderating effect of social engagement in fixed effects models.

RESULTS

Grandfathers experience particularly worsened mental health outcomes when providing grandchild care in a skipped-generation household. Both grandmothers and grandfathers experience mental health improvements from increased social engagement. Social engagement, particularly for grandmothers, serves as a buffer or produces role enhancement for grandmothers in skipped-generation care arrangements.

DISCUSSION

Nonresidential and residential grandchild care affects mental health outcomes differently for grandmothers and grandfathers. However, social engagement consistently serves as a buffer or mental health improvement for all grandparents. Findings further encourage the continued study of social engagement and gender differences in older adults more broadly.

Influence of combined cognitive impairment and social frailty on physical frailty in community-dwelling older adults

PURPOSE

This study aimed to identify the influence of combined cognitive impairment and social frailty on physical frailty.

METHODS

This study analyzed secondary data from the 2020 National Survey of Older Koreans, which was collected nationwide from community-dwelling individuals aged ≥ 65 years.

RESULTS

Combined cognitive impairment and social frailty (odds ratio (OR) =4.44, 95% confidence interval (CI)=3.14-6.28), cognitive impairment and social pre-frailty (OR =2.38, 95% CI =1.70-3.34), noncognitive impairment and social frailty (OR =2.16, 95% CI =1.54-3.04), and noncognitive impairment and social pre-frailty (OR =1.40, 95% CI =1.02-1.91) groups were more likely to be physically frail than noncognitive impairment and socially robust groups after adjusting for sociodemographic and health-related factors.

CONCLUSION

Healthcare providers need to be aware that older adults who suffer from both cognitive impairment and social frailty may be vulnerable to physical frailty.

COVID-19-Related Lifestyle Changes among Community-Dwelling Older Adult Day-Care Users: A Qualitative Study

In Japan, the community-based comprehensive care system is an important initiative. The purpose of this study was to understand COVID-19-related lifestyle changes experienced by older adults who lived in communities and used day-care services. Using a qualitative inductive research method, semi-structured interviews were conducted with 13 older adults who used day-care services in Kyoto City, which assessed lifestyle changes before and after the spread of COVID-19 during March-April 2021. The extracted lifestyle change codes were classified into six categories and 16 subcategories. The data revealed that older adults felt socially isolated and experienced multiple changes in their lives, including limited leisure activities, changes in roles, decreased interpersonal interaction with family and acquaintances, poor diet and sleep quality, and reduced attention to personal appearance and grooming. The findings suggest that during COVID-19, older adults had difficulty adapting to the various changes in their lives and showed a decline in physical and mental functioning. Thus, it is important for day-care facilities to create sustainable spaces in response to the various care needs of community-dwelling older adults whose lifestyles have changed as a result of the COVID-19 situation.

Creation and validation of a polysocial score for mortality among community-dwelling older adults in the USA: the health and retirement study

BACKGROUND

the interrelatedness between social determinants of health impedes researchers to identify important social factors for health investment. A new approach is needed to quantify the aggregate effect of social factors and develop person- centred social interventions.

METHODS

participants ([n = 7,383], 54.5% female) were aged 65 years or above who complete an additional psychosocial questionnaire in the health and retirement study in 2006 or 2008. Social determinants of health encompassed five social domains: economic stability, neighbourhood and physical environment, education, community and social context, and healthcare system. We used the forward stepwise logistic regression to derive a polysocial score model for 5-year mortality. Indices of goodness-of-fit, discrimination and reclassification were used to assess model performance. We used logistic regression to identify the association between polysocial score and mortality. Subgroup analyses were conducted to examine sex- and race-specific association.

RESULTS

polysocial score was created using 14 social determinants of health. In the training cohort, the C-statistic was 0.71 for the reference model (only age, sex and race/ethnicity) and increased to 0.75 for the continuous and categorical polysocial score. Compared with the reference model, the integrated discrimination index for adding the continuous or categorical polysocial score was both 0.03 (P values < 0.001). Participants with an intermediate (odds ratio [OR] = 0.69; 95% confidence interval [CI], 0.51-0.82) or high (OR = 0.48; 95% CI, 0.38-0.60) polysocial score had lower odds of death than those in the low category in the fully adjusted model, respectively.

CONCLUSIONS

the polysocial approach may offer possible solutions to monitor social environments and suggestions for older people to improve their social status for specific health outcomes.

Social isolation, social support, and loneliness and their relationship with cognitive health and dementia

BACKGROUND

Poor social health is prevalent in older adults and may be associated with worse cognition, and increased dementia risk. The aim of this study was to determine whether social isolation, social support and loneliness are independently associated with cognitive function and incident dementia over 5 years in older adults, and to investigate potential gender differences.

METHODS

Participants were 11,498 community-dwelling relatively healthy Australians aged 70-94, in the ASPREE Longitudinal Study of Older Persons (ALSOP). Social isolation, social support, loneliness and cognitive function were assessed through self-report. Outcomes examined were cognitive decline (>1.5 SD decline in cognitive performance since baseline) and incident dementia (adjudicated according to DSM-IV criteria).

RESULTS

Most participants self-reported good social health (92%) with very few socially isolated (2%), with low social support (2%) or lonely (5%). Among women, social isolation and low social support were consistently associated with lower cognitive function (e.g., social support and cognition β = -1.17, p < 0.001). No consistent longitudinal associations were observed between baseline social health and cognitive decline (over median 3.1 years) or incident dementia (over median 4.4 years; social isolation: HR = 1.00, p = 0.99; low social support: HR = 1.79, p = 0.11; loneliness: HR = 0.72, p = 0.34 among women and men).

CONCLUSION

Our study provides evidence that social isolation and a low social support are associated with worse cognitive function in women, but not men. Social health did not predict incident cognitive decline or dementia, but we lacked power to stratify dementia analyses by gender.

Reduced social activities and networks, but not social support, are associated with cognitive decline among older chinese adults: A prospective study

BACKGROUND

Social relationships consist of distinct dimensions. The literature on the effect of specific social relationship subdomains on cognitive function is limited. This large-scale, prospective cohort study examined the associations of social relationships with cognitive decline and further explored which subdomains of social relationships were predictive of cognitive decline among elderly Chinese individuals.

METHODS

A total of 3314 older Chinese adults aged 65-110 years from the 2011-2012 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. Cognitive decline was defined based on the Chinese version of the Mini-Mental State Examination (MMSE). Social relationships were divided into three subdomains: social activities, social networks, and social support. Linear and binary logistic regression analyses were conducted to assess the effect of social relationships and the social relationship subdomains on cognitive decline after adjusting for age, sex, education, residence, exercise, drinking, smoking, activities of daily living, chronic diseases, depression, and baseline cognitive function.

RESULTS

Seven hundred and sixty-eight participants (23.17%) developed greater cognitive decline during the 3-year follow-up. The social relationships score was negatively associated with cognitive decline. Binary adjusted odds ratios showed that after potential covariates were controlled, social relationships, activities, and networks significantly reduced the risk of cognitive decline. When all social relationships variables were entered simultaneously with all covariates, the effect of social activities and networks on the risk of greater cognitive decline remained significant. However, we did not observe a significant association between social support and the risk of greater cognitive decline.

CONCLUSION

Our findings suggest that social relationships and the subdomains of social activities and networks, but not social support, have a protective effect against greater cognitive decline in older adults. This implies that structural dimensions of social relationships might be more important than functional dimensions in preserving cognitive health among elderly Chinese individuals.

Rejuvenation of standing and gait balance in community-dwelling older individuals: A comparative study between 2006 and 2019

AIM

The present study investigated the rejuvenation of physical function in terms of walking speed and grip strength. Specifically, it examined the rejuvenation of physical functions in community-dwelling older individuals between 2006 and 2019. The study is novel, because it analyzes this by focusing on gait balance.

METHODS

Data were collected from 339 participants (52 men, 287 women) in 2006, and 382 participants (83 men, 299 women) in 2019. They were categorized according to age: early-stage and late-stage groups for men, and early-stage, late-stage and latest-stage groups for women. These groups were analyzed by participants' walking speed, grip strength, Timed Up and Go test, Functional Reach test and One-Leg Standing test. The results were compared based on two factors: time (2006 to 2019) and age group.

RESULTS

The scores for the Timed Up and Go and One-Leg Standing tests were better in 2019 than in 2006 for all age groups in both older men and women. However, improvement in walking speed was observed only in women. Additionally, the decline in physical function with age was slower for walking speed among men, and Functional Reach and One-Leg Standing tests among women.

CONCLUSIONS

The changes over this 13-year period showed that the physical function of community-dwelling older individuals was rejuvenated in terms of improved standing and walking balance. These rejuvenations will aid in preventing falls among community-dwelling older individuals. Geriatr Gerontol Int 2021; 21: 975-980.

The influence of late retirement on health outcomes among older adults in the policy context of delayed retirement initiative: an empirical attempt of clarifying identification bias

Background

The deepening population aging is urging policy makers to launch delayed retirement initiative, when the society is faced with unprecedented challenges of shrinking labor supply, heavier pension burdens and slowing economic growth. However, the health outcomes of late retirees receive scarce attention due to the intrinsic identification difficulties (i.e., (1) self-selection bias – older adults with predetermined ill-health are less likely to delay retirement. (2) there can be situations where the status of late retirement has terminated at the time of interview, although he/she has ever delayed retirement). To fill in this research gap, this study examines the effect of late retirement on the difficulty in physical functioning and problems of cognitive status among older adults.

Method

Using the data from China Health and Retirement Longitudinal Study (CHARLS-2015 harmonized, and CHARLS-2018), this study investigates the influence of late retirement (year 2015) on the difficulty in physical functioning and problems of cognitive status (year 2018) among older adults. A series of robustness checks are also conducted.

Results

Empirical results show that late retirement is associated with better physical functioning and cognitive status. The influence remains robust after considering potential self-selection bias and the sensitivity of including/excluding older adults who have past late retirement experience but have no longer been late retirees at the time of survey.

Conclusion

This study suggests that older adults might benefit from the engagement in late careers in their physical and cognitive functioning.

"Are Filipinos Aging Well?": Determinants of Subjective Well-Being among Senior Citizens of the Community-Based ENGAGE Study

As people age, they are expected to experience adverse life conditions and major life events. These circumstances might have a significant impact on their subjective well-being. This study investigated the factors associated with subjective well-being among community-dwelling Filipino senior citizens. We conducted a cross-sectional study among 1021 senior citizens (68.5% women) aged 60 and above and identified the factors independently associated with their subjective well-being using multiple linear regression analysis. We also used hierarchical regression analysis for model prediction. In the hierarchical regression analysis, psychological resilience was found as the most powerful predictor of subjective well-being. Loneliness, however, was the only psychosocial factor not associated with it. Both men and women with positive self-rated health and had higher psychological resilience and perceived social support showed a higher level of subjective well-being. Women who were separated and received pension and men who were uneducated showed a lower level of subjective well-being. Psychological resilience, positive self-rated health, and perceived social support might be protective factors for low subjective well-being. To improve the subjective well-being of Filipino senior citizens, we should build psychological resilience and social support networks in the community.

Social Isolation and Cognitive Function in Later Life: A Systematic Review and Meta-Analysis

BACKGROUND

There is some evidence to suggest that social isolation may be associated with poor cognitive function in later life. However, findings are inconsistent and there is wide variation in the measures used to assess social isolation.

OBJECTIVE

We conducted a systematic review and meta-analysis to investigate the association between social isolation and cognitive function in later life.

METHODS

A search for longitudinal studies assessing the relationship between aspects of social isolation (including social activity and social networks) and cognitive function (including global measures of cognition, memory, and executive function) was conducted in PsycInfo, CINAHL, PubMed, and AgeLine. A random effects meta-analysis was conducted to assess the overall association between measures of social isolation and cognitive function. Sub-analyses investigated the association between different aspects of social isolation and each of the measures of cognitive function.

RESULTS

Sixty-five articles were identified by the systematic review and 51 articles were included in the meta-analysis. Low levels of social isolation characterized by high engagement in social activity and large social networks were associated with better late-life cognitive function (r = 0.054, 95% CI: 0.043, 0.065). Sub-analyses suggested that the association between social isolation and measures of global cognitive function, memory, and executive function were similar and there was no difference according to gender or number of years follow-up.

CONCLUSIONS

Aspects of social isolation are associated with cognitive function in later life. There is wide variation in approaches to measuring social activity and social networks across studies which may contribute to inconsistencies in reported findings.

Associations between social and intellectual activities with cognitive trajectories in Chinese middle-aged and older adults: a nationally representative cohort study

BACKGROUND

Associations between the frequency of social and intellectual activities and cognitive trajectories are understudied in Chinese middle-aged and older adults. We aimed to examine this association in a nationally representative longitudinal study.

METHODS

The China Health and Retirement Longitudinal Study (CHARLS) is a nationally representative sample of Chinese middle-aged and older participants. The frequency of social and intellectual activities was measured at baseline. Interview-based cognitive assessments of orientation and attention, episodic memory, and visuospatial skills and the calculation of combined global scores were assessed every 2 years from 2011 to 2016. Cognitive aging trajectories over time were analyzed using group-based trajectory modeling, and the associations of the trajectory memberships with social and intellectual activities were analyzed using multinomial logistic regression. Odds ratios (OR) and 95% confidence intervals (CI) were reported.

RESULTS

Among 8204 participants aged 50-75 years at baseline, trajectory analysis identified three longitudinal patterns of cognitive function based on the global cognitive scores: "persistently low trajectory" (n = 1550, 18.9%), "persistently moderate trajectory" (n = 3194, 38.9%), and "persistently high trajectory" (n = 3460, 42.2%). After adjustment for sociodemographic variables, lifestyles, geriatric symptoms, and health conditions, more frequent intellectual activities (OR 0.54, 95% CI 0.38-0.77) and social activities (OR 0.79, 95% CI 0.65-0.95) were both associated with a lower likelihood of being in the "persistently low trajectory" for global cognitive function.

CONCLUSIONS

These findings suggested that more frequent social and intellectual activities were associated with more favorable cognitive aging trajectories.

The Bidirectional Association Between Physical and Cognitive Function Among Chinese Older Adults: A Mediation Analysis

This study investigated the bidirectional association between physical and cognitive function in later life and examined the mechanisms underlying the interrelationship. We employed cross-lagged panel models to analyze a sample of 4232 unique participants aged 65 years and older from three waves of the Chinese Longitudinal Healthy Longevity Survey. Physical activity and social participation were tested as potential mediators between physical and cognitive function. Our findings revealed a reciprocal relationship between physical and cognitive function and a reciprocal relationship between physical and cognitive decline. Moreover, physical activity was confirmed to mediate the bidirectional association between physical and cognitive function, whereas social participation did not seem to be a mediator. A vicious cycle linking physical and cognitive decline may exist in Chinese older adults. However, leading a physically active lifestyle could be an effective intervention to slow physical and cognitive aging, thereby toning down the vicious cycle.

Depression Symptoms and Cognitive Test Performance in Older American Indians: The Strong Heart Study

BACKGROUND

American Indians have excess risk of depression, which can contribute to cerebrovascular and cognitive disability, with effects on memory, processing speed, executive function, and visuospatial ability. However, studies examining depression and cognition in American Indians are limited; this study aims to report associations of depression with general cognition, verbal fluency and memory, and processing speed.

DESIGN

Cohort study.

SETTING

The Cerebrovascular Disease and its Consequences in American Indians study was an ancillary examination of Strong Heart Study participants from 3 U.S. regions.

PARTICIPANTS

All eligible were included in this analysis (N=818).

MEASUREMENTS

Participants completed evaluations for depressive symptomology, cognition, and physical function-including Center for Epidemiologic Studies Depression (CESD), Modified Mini-Mental State Examination (3MSE), Wechsler Adult Intelligence Scale-Fourth Edition coding (WAIS), Controlled Oral Word Association (COWA), California Verbal and Learning Test, Halstead finger tapping, grip strength, and Short Physical Performance Battery (SPPB) tests. Linear mixed models were adjusted for site, age, sex, education, income, marital status, alcohol, smoking, diabetes, hypertension, obesity, cholesterol, stroke, infarct, and hemorrhage.

RESULTS

Symptoms of depression were common, with 20% (N=138) endorsing CES-D scores of 16+. More depressive symptoms were associated with older age, female sex, lower education, lower income, non-married status, not using alcohol, not smoking, hypertension, diabetes, and stroke. In adjusted analyses, processing speed (WAIS: β -0.13, 95%CI -0.25, -0.03), general cognition (3MSE: β -0.10, 95%CI -0.17, -0.03), verbal fluency (COWA: β -0.10, 95%CI -0.19, -0.01), and motor function (SPPB: β -0.05, 95%CI -0.07, -0.03) were significantly associated with more symptoms of depression.

CONCLUSION

These findings maybe informative for health disparities populations, especially those with depressive risk. Clinicians may require particular training in cultural humility. Future studies should validate use of the CES-D scale in this population; longitudinal studies may focus on causal mechanisms and potential secondary prevention, such as social support. J Am Geriatr Soc 68:1739-1747, 2020.

Social capital and health status: longitudinal race and ethnicity differences in older adults from 2006 to 2014

OBJECTIVES

We examined the longitudinal associations of social capital on self-rated health and differences by race/ethnicity in older adults.

METHODS

We used Health and Retirement Study, a nationally representative sample of US adults aged ≥ 50 years evaluated every 2 years (2006-2014) (N = 18,859). We investigated the relationship between social capital indicators (neighborhood social cohesion/physical disorder, positive/negative social support) with self-rated health accounting for age, gender, education and stratified by race/ethnicity. We used structural equation multilevel modeling estimating the associations: within-wave and between-persons.

RESULTS

We observed between-persons-level associations among social capital indicators and self-rated health. Individuals with overall levels of positive social support and neighborhood social cohesion tended to have overall better self-rated health [correlations 0.21 (p < 0.01) and 0.29 (p < 0.01), respectively]. For Hispanics, the correlations with self-rated health were lower for neighborhood social cohesion (0.19) and negative social support (- 0.09), compared to Whites (0.29 and - 0.20). African-Americans showed lower correlations of positive social support (0.14) compared to Whites (0.21) and Hispanics (0.28).

CONCLUSIONS

Interventions targeting social capital are in need, specifically those reinforcing positive social support and neighborhood social cohesion and diminishing neighborhood physical disorder and negative social support of older adults.

Social engagement pattern, health behaviors and subjective well-being of older adults: an international perspective using WHO-SAGE survey data

BACKGROUND

Social engagement forms the basis of social relationships by providing a sense of belonging, social identity, and fulfillment. Previous research demonstrates that social engagement was associated with positive health behaviors among older adults. However, the results have been different across health-related behaviors, and mostly based on data from high-income countries. For example, studies from the US and UK showed that social engagement was protective against smoking, while others found social engagement encouraged more smoking in many Asian cultures. In this study, we aim to examine the association between social engagement and a range of health-related behaviors and subjective well-being among older adults in six low- to middle-income countries.

METHODS

Data from the WHO Study on Global Ageing and Adult Health (SAGE Wave 1) were used. A total of 33,338 individuals aged 50 and older in China, Russia, India, Ghana, South Africa, and Mexico were included. Social engagement, tobacco use, alcohol consumption, fruit and vegetable intake, physical activity, sedentary behavior, sleep duration, depression symptoms, self-rated health status, and quality of life were assessed using established self-reported measures. Multiple logistic regression models were used to examine the relationship between social engagement and nine outcome variables, adjusting for socio-demographic characteristics.

RESULTS

Lower levels of social engagement were positively related to physical inactivity, prolonged sitting time, unhealthy sleep duration, perceived depression, poor self-rated health, and low quality of life. However, the associations between social engagement and tobacco use, excessive drinking, and insufficient fruit and vegetable intake were mixed across countries.

CONCLUSION

This international study found high social engagement as a potential health-promoting factor in some low- to middle-income countries. Although the impacts of social engagement on tobacco and alcohol use and diet were complicated and culture-specific, interventions at both individual and community levels should encourage healthy lifestyles through positive social engagement.

Social Support and the Incidence of Cognitive Impairment Among Older Adults in China: Findings From the Chinese Longitudinal Healthy Longevity Survey Study

OBJECTIVE

Social support shows a protective effect against cognitive impairment in older adults. However, the longitudinal relationship between the distinct sources of social support and the incidence of cognitive impairment remains unclear. This study aims to investigate the association between different sources of social support and the incidence of cognitive impairment among older adults in China.

METHOD

We used longitudinal data (2005-2014) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS, 2005-2014, mean follow-up years 5.32 ± 2.64). In total, 5897 participants (aged 81.7 ± 9.7 years, range 65-112 years, 49.0% male) were enrolled. Cognitive impairment was measured by the Mini-Mental State Examination (MMSE). Social support included support from family and friends (marital status; contacts with family and friends; children's visits; siblings' visits, sick care; money received from and money given to children) and the availability of support from social community (social service and social security). We calculated subdistribution hazard ratios (SHR) of cognitive impairment by establishing Cox regression models, adjusting for residence, gender, age, education, participation in physical exercise, activities of daily living, smoking, drinking, negative psychological well-being, baseline cognitive function, occupation, leisure activities, and diseases.

RESULTS

During a 9-year follow-up, 1047 participants developed cognitive impairment. Participants who were married had a 16.0% lower risk of developing cognitive impairment compared to the widowed older adults after controlling for all covariates, but the protective effect of being married was no longer significant (p = 0.067) when additional adjustment was made for all types of social support. Children's visits were significantly associated with the risk of cognitive impairment after controlling for all types of social support and covariate variables (SHR = 0.808, 95% confidence interval, 0.669-0.975, p = 0.026).

CONCLUSION

Children's visits were consistently associated with a lower incidence of cognitive impairment in Chinese older adults.

Combined effect of self-reported hearing problems and level of social activities on the risk of disability in Japanese older adults: A population-based longitudinal study

BACKGROUND

We used longitudinal cohort data to investigate whether hearing problems and low levels of social activity lead to a higher incidence of disability among community-dwelling older adults.

METHODS

Participants were 4576 older adults (47.8% male, mean age 75.9 years) who met the study inclusion criteria. Longitudinal data on the incidence of disability were monitored monthly. Disability was defined as Japanese long-term care insurance certification for personal support or care for 2 years following the baseline assessment. Hearing problems were measured using the Hearing Handicap Inventory for the Elderly and for Adults - Screening version. Participants completed a questionnaire that included five questions on daily social activities.

RESULTS

In the adjusted model that included potential covariates, participants with co-occurring hearing problems and low participation rates in social activities were at higher risk of developing a disability than participants without hearing problems and low levels of social activity (hazard ratio [HR] = 2.13, 95% confidence interval [CI]: 1.31-3.45). The second highest risk of developing a disability was found for those with low levels of social activity alone (HR = 1.98, 95% CI: 1.26-3.11), and the third highest for those with hearing problems alone (HR = 1.38, 95% CI: 1.07-1.77).

CONCLUSIONS

Hearing problems and a lack of social activity were independent risk factors for developing a disability. Co-occurring hearing problems and low levels of participation in social activities represented the largest risk factor for disability.

Social Frailty Is Associated with Physical Functioning, Cognition, and Depression, and Predicts Mortality

OBJECTIVES

Social frailty is related to adverse health-related outcomes. However, the measurement thereof is controversial and research into the relationship between social frailty and physical functioning remains limited. This study aimed to determine social frailty status via developing a simple self-reported screening tool, termed the HALFT scale, and to examine the association between social frailty and physical functioning, cognition, depression, and mortality among community-dwelling older adults.

DESIGN

Prospective cohort study.

SETTING

Community.

PARTICIPANTS

1697 community-dwelling adults aged ≥60 years from Beijing Longitudinal Study of Aging were included.

MEASUREMENTS

The HALFT scale was developed based on 5 items: unhelpful to others, limited social participation, loneliness, financial difficulty, and not having anyone to talk to. Socioeconomic and demographic data were collected, and physical functioning, frailty index, cognition, and depression were assessed.

RESULTS

The prevalence of social frailty was 7.7% (weighted, 4.5%). Participants with physical frailty, low levels of physical activity, and poor physical functioning had a higher prevalence of social frailty. Social frailty was associated with dementia, subjective memory decline, depression, cognitive impairment, and having experienced a recent significant life event. After adjusting for age and sex, the 8-year mortality hazard ratios were 2.5-4.3 and 1.6-2.3, respectively, for those with social frailty or pre-social frailty. Each component of the HALFT scale predicted 8-year mortality.

CONCLUSIONS

Social frailty is associated with physical functioning, cognition, and depression, and predicts mortality. The HALFT scale could be a useful screening tool for determining social frailty in older adults. Interventions aimed at preventing or delaying social frailty are warranted.

The impact of social activities, social networks, social support and social relationships on the cognitive functioning of healthy older adults: a systematic review

BACKGROUND

Social relationships, which are contingent on access to social networks, promote engagement in social activities and provide access to social support. These social factors have been shown to positively impact health outcomes. In the current systematic review, we offer a comprehensive overview of the impact of social activities, social networks and social support on the cognitive functioning of healthy older adults (50+) and examine the differential effects of aspects of social relationships on various cognitive domains.

METHODS

We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, and collated data from randomised controlled trials (RCTs), genetic and observational studies. Independent variables of interest included subjective measures of social activities, social networks, and social support, and composite measures of social relationships (CMSR). The primary outcome of interest was cognitive function divided into domains of episodic memory, semantic memory, overall memory ability, working memory, verbal fluency, reasoning, attention, processing speed, visuospatial abilities, overall executive functioning and global cognition.

RESULTS

Thirty-nine studies were included in the review; three RCTs, 34 observational studies, and two genetic studies. Evidence suggests a relationship between (1) social activity and global cognition and overall executive functioning, working memory, visuospatial abilities and processing speed but not episodic memory, verbal fluency, reasoning or attention; (2) social networks and global cognition but not episodic memory, attention or processing speed; (3) social support and global cognition and episodic memory but not attention or processing speed; and (4) CMSR and episodic memory and verbal fluency but not global cognition.

CONCLUSIONS

The results support prior conclusions that there is an association between social relationships and cognitive function but the exact nature of this association remains unclear. Implications of the findings are discussed and suggestions for future research provided.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2012: CRD42012003248 .

Association of Social Frailty With Both Cognitive and Physical Deficits Among Older People

OBJECTIVES

Our objective was to investigate the association between social frailty and cognitive and physical function among older adults.

DESIGN

This was a cross-sectional study.

SETTING

We examined community-dwelling adults in Japan.

PARTICIPANTS

Participants comprised 4425 older Japanese people from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes.

MEASUREMENTS

Social frailty was defined by using responses to 5 questions (going out less frequently, rarely visiting friends, feeling unhelpful to friends or family, living alone, and not talking with someone every day). Participants showing none of these components were considered nonfrail; those showing 1 component were considered prefrail; and those showing 2 or more components were considered frail. To screen for cognitive deficits, we assessed memory, attention, executive function, and processing speed. Having 2 or more tests with age-adjusted scores of at least 1.5 standard deviations below the reference threshold was sufficient to be characterized as cognitively deficient. To screen for physical function deficits, we assessed walking speed (<1.0 m/s cut-off) and grip strength (<26 kg for men; <18 kg for women cut-off). Scoring below the cut-off point on 1 or more tests was sufficient to be characterized as physically deficient.

RESULTS

The prevalence of social frailty was the following: nonfrailty, 64.1% (N = 2835); social prefrailty, 24.8% (N = 1097); social frailty, 11.1% (N = 493; P for trend < .001). All cognitive function tests (word list memory, Trail Making Test parts A and B, and the symbol digit-substitution task) significantly varied between social frailty groups; physical function (gait speed and grip strength) also varied between social frailty groups (all Ps for trend <.001). Referred to social nonfrailty, social frailty was independently associated with each cognitive deficit (odds ratio = 1.61, 95% confidence interval 1.13-2.30) and deficits in physical function (odds ratio = 1.99, 95% confidence interval 1.57-2.52) after adjusting for covariates.

CONCLUSIONS

This study revealed that social frailty is associated with both cognitive and physical function among Japanese older adults. And social frailty status was also negatively associated with physical function. Further studies are needed to elucidate if a casual association exists between social frailty and cognitive and physical function.

All Nations Breath of Life: A Randomized Trial of Smoking Cessation for American Indians

INTRODUCTION

American Indians have the highest cigarette smoking prevalence of any racial/ethnic group in the U.S. There is currently no effective empirically based smoking-cessation program for American Indians. The purpose of this study was to determine if a culturally tailored smoking-cessation program, All Nations Breath of Life (ANBL), is more effective than a non-tailored cessation program among American Indian smokers.

DESIGN

A multisite RCT was conducted from September 2009 to July 2014; analysis was conducted in 2015.

SETTING/PARTICIPANTS

Participants were rural or reservation-based American Indian smokers aged ≥18 years.

INTERVENTION

Smokers were group randomized to either the culturally tailored ANBL or non-tailored current best practices (CBP) for a total enrolled sample size of 463 (ANBL, n=243; CBP, n=220).

MAIN OUTCOME MEASURES

The primary outcome of interest was salivary cotinine-verified 7-day point prevalence smoking abstinence at 6 months. Results for both responder-only and intent-to-treat analyses for self-reported and cotinine-verified abstinence are presented.

RESULTS

Intention-to-treat, imputing all non-responses as smokers, the self-reported point prevalence abstinence rates at 12 weeks were 27.9% in the ANBL arm and 17.4% in the CBP arm (p=0.028). There was a statistically significant difference in self-reported 6-month intent-to-treat point prevalence abstinence rates between ANBL (20.1%) and CBP (12.0%) arms (p=0.029). None of the cotinine-verified results were statistically significant.

CONCLUSIONS

The culturally tailored smoking-cessation program ANBL may or may not be an effective program in promoting cessation at 12 weeks and 6 months. Participants in the culturally tailored ANBL program were approximately twice as likely to quit smoking at 6 months compared with the CBP program, using self-reported abstinence.

Attitudes Toward Mental Health Services Among American Indians by Two Age Groups

This study examined determinants of attitudes toward mental health services with a sample of American Indian younger-old-adults (aged 50-64, n = 158) and American Indian older-old adults (aged 65 and older, n = 69). Adapting Andersen's behavioral model of healthcare utilization, predisposing factors, mental health needs, and enabling factors were considered as potential predictors. Female and those with higher levels of social support tend to report more positive attitudes toward mental health services. Culture-influenced personal belief was associated with negative attitudes toward mental health services among American Indian younger-old -adults. Age and higher chronic medical conditions were significantly related to negative attitudes toward mental health services. Health insurance was positively associated with positive attitudes toward mental health services in the American Indian older-old adults. Findings indicate that practitioners should engage how culture, social support, and chronic conditions influence the response to mental health needs when working with older American Indians.

Stressors, Coping Resources, and Depressive Symptoms among Rural American Indian Older Adults

The purpose of this study was to examine the associations of physical health stressors and coping resources with depressive symptoms among American Indian older adults age 50 years or older. The study used a convenience sample of 227 rural American Indian older adults. A hierarchical multiple regression tested three sets of predictors on depressive symptoms: (a) sociodemographics, (b) physical health stressors (functional disability and chronic medical conditions), and (c) coping resources (social support and spirituality). Most participants reported little difficulty in performing daily activities (e.g., eating, dressing, traveling, and managing money), while presenting over two types of chronic medical conditions. Depressive symptoms were predicted by higher scores on perceived social support and lower scores on functional disability; women and those having no health insurance also had higher levels of depressive symptoms. Findings suggest that social work practitioners should engage family and community support, advocate for access to adequate health care, and attend to women's unique circumstances and needs when working with American Indian older adults.