Why Is Social Isolation Among Older Adults Associated with Depressive Symptoms? The Mediating Role of Out-of-Home Physical Activity

Social Isolation and Depressive Symptoms of Older Chinese Immigrants: The Mediating Effect of Activity Engagement

Objectives: This study aimed to examine the differential impacts of two forms of social isolation on depressive symptoms and investigate the mediating role of activity engagement among older Chinese immigrants. Methods: Data were from four waves of the Population Study of Chinese Elderly in Chicago Study (PINE) (N = 2,075). Social disconnectedness was measured by social network size and range, living arrangement, and marital status. Perceived isolation was measured by loneliness and lack of social support. Activity engagement was assessed by engagement with various social and cognitive activities. Results: The latent growth curve models indicated that social disconnectedness and perceived isolation were associated with a higher initial level of depressive symptoms. However, perceived isolation predicted a faster decline in depressive symptoms. Activity engagement had significant mediating effects on the relationships. Discussion: Efforts should focus on reducing social isolation and providing opportunities for activity engagement to mitigate depression among older Chinese immigrants.

Relationship between objectively measured conversation time and social behavior in community-dwelling older adults

Background

Social isolation is a significant public health concern in aging societies. The association between conversation time and social behavior remains unclear. This study examines whether objective conversation time is associated with social activity frequency in older adults.

Methods

This prospective cohort study enrolled 855 older adults (538 women; mean age, 73.8 years) aged 65 and older, who were followed from 2015 to 2019. All participants wore a wristband sensor to measure conversation time for at least 9 days and an average of 31.3 days per year. Social behaviors were assessed through interviews, and the frequency of engagement in community activities, outings, lessons, or classes and contact frequency were assessed using a self-report questionnaire. The association between conversation time and social behavior was evaluated using multi-linear regression analysis.

Results

Conversation time was significantly associated with the frequency of engagement in community activities and lessons or classes after adjusting for several covariates (β = 0.181, 95% confidence interval: 0.107-0.254, p < 0.001; β = 0.11, 95% confidence interval: 0.04-0.179, p = 0.002).

Conclusion

Objectively measured conversation time using a wearable sensor is associated with social behavior and may be a valuable parameter for social isolation in older adults.

Development and validation of a risk prediction model for older adults with social isolation in China

BACKGROUND

Older adults are vulnerable to social isolation due to declining physical and cognitive function, decreased interpersonal interactions, and reduced outdoor activities after retirement. This study aimed to develop and validate a predictive model to assess the risk of social isolation among older adults in China.

METHODS

Using data from the 2011 China Health and Retirement Longitudinal Study (CHARLS). The study cohort was randomly divided into training and validation groups in a 70:30 ratio. We used least absolute shrinkage and selection operator (LASSO) regression analysis with tenfold cross-validation to identify optimal predictive factors and examined the correlates of social isolation using logistic regression. A nomogram was constructed for the predictive model, and its accuracy was assessed using calibration curves. The predictive performance of the model was assessed using area under the receiver operating characteristic (ROC) curve and decision curve analysis (DCA).

RESULTS

From the 2011 CHARLS database, 4,747 older adults were included in the final analysis, of whom 1,654 (34.8%) experienced social isolation. Multifactorial logistic regression identified educational level, marital status, gender, physical activity, physical self -maintenance ability, and number of children as predictive factors for social isolation. The predictive model achieved an AUC of 0.739 (95%CI = 0.722-0.756) in the training set and 0.708 (95%CI = 0.681-0.735) in the validation set. The Hosmer-Lemeshow test yielded P values of 0.111 and 0.324, respectively (both P > 0.05), indicating significant agreement between the nomogram and observed outcomes. The nomogram showed excellent predictive ability according to ROC and DCA.

CONCLUSIONS

The predictive model developed to assess the risk of social isolation in the Chinese older adults shows promising utility for early screening and intervention by clinical healthcare professionals.

Impact of neighborhood context on self-rated health among very old adults living in Germany: a cross-sectional representative study

BACKGROUND

Increasingly, evidence has shown that different aspects of neighborhood context play a significant role in self-rated health, one of the key health indicators in advanced age. Nevertheless, very old adults are often under represented or excluded from such research. Therefore, the first aim of this study was to examine whether social, socioeconomic, and physical neighborhood context is associated with self-rated health in the very old population of Germany. The second objective was to explore whether the link of socioeconomic and physical neighborhood context with self-rated health is moderated by availability of social resources in neighborhoods.

METHODS

Data from the representative survey, "Old Age in Germany" (D80+) were employed. In total, the study sample of D80+ included 10,578 individuals aged 80 years and over. Additionally, the D80+ data were matched with the freely accessible regional dataset of the Federal Institute for Research on Building, Urban Affairs, and Spatial Development. Two self-rated items (place attachment and social cohesion) were used to assess social neighborhood context. Socioeconomic context of neighborhoods was operationalized by German index of socioeconomic deprivation. To evaluate physical context, perceived measures of building conditions and walkability were included. Using the maximum likelihood estimator with robust standard errors, logistic regression models were estimated to analyze the relationship between neighborhood context (social, socioeconomic, and physical context, as well as their interactions) and self-rated health.

RESULTS

Including 8,066 participants in the analysis, the findings showed that better condition of residential building, higher walkability, being closely attached to outdoor places, and higher social cohesion were associated with higher chance to report good self-rated health of very old adults. In the adjusted models, the German socioeconomic deprivation index was not related to self-rated health. The effect of socioeconomic and physical neighborhood context on self-rated health did not differ according available neighborhood social resources.

CONCLUSIONS

The results indicate that especially more favorable conditions in social and physical neighborhood context are associated with good self-rated health in the very old population of Germany. Further studies should consider multiple aspects of neighborhood context as well as their interplay when examining the neighborhood impact on self-rated health in older populations.

The Relationship Between Social Isolation and Cognitive Frailty Among Community-Dwelling Older Adults: The Mediating Role of Depressive Symptoms

Purpose

Social isolation and depression have an impact on cognitive frailty. However, the underlying mechanisms between these variables have not been well defined. This study aims to investigate the mediating role of depressive symptoms in the association between social isolation and cognitive frailty among older adults in China.

Methods

From Mar 2023 to Aug 2023, a cross-sectional study was conducted with 496 community-dwelling older adults aged ≥60 years in Nanjing, Jiangsu Province, China. Demographic information was collected using the General Information Questionnaire. The Lubben Social Network Scale-6 (LSNS-6), Geriatric Depression Scale 15-item (GDS-15), Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating (CDR), and FRAIL scale were used for the questionnaire survey. Multiple linear regression and binary logistic regression were utilized to explore the associations among social isolation, depressive symptoms, and cognitive frailty, and Bootstrap analysis was used to explore the mediating role of depressive symptoms in social isolation and cognitive frailty.

Results

Linear regression results revealed that social isolation was positively associated with depressive symptoms (β = 0.873, p < 0.001). Logistic regression analysis showed that social isolation (OR = 1.769, 95% CI = 1.018~3.075) and depressive symptoms (OR = 1.227, 95% CI = 1.108~1.357) were significantly associated with cognitive frailty. Mediation analysis demonstrated that depressive symptoms significantly mediated the relationship between social isolation and cognitive frailty, with an indirect effect of 0.027 (95% CI = 0.003~0.051), and the mediating effect accounted for 23.6% of the total effect.

Conclusion

Social isolation is associated with cognitive frailty in community-dwelling older adults, and depressive symptoms partially mediate the effect between social isolation and cognitive frailty. Active promotion of social integration among older individuals is recommended to enhance their mental health, reduce the incidence of cognitive frailty, and foster active aging.

Impacts of active mobility on individual health mediated by physical activities

Active mobility, encompassing walking and cycling for transportation, is a potential solution to health issues arising from inadequate physical activity in modern society. However, the extent of active mobility's impact on individual physical activity levels, and its association with health as mediated by physical activities, is not fully quantified. This study aims to clarify the direct relationship between active mobility usage and individual health, as well as the indirect relationship mediated by physical activity, with a focus on varying levels of physical activity intensity. Utilizing data from the 2017 U.S. National Household Travel Survey (NHTS), we employed Poisson regression to predict active mobility usage based on socio-demographic and household socio-economic characteristics. A Structural Equation Model (SEM) was then used to investigate the direct and indirect effects of active mobility on individual health, mediated by physical activity. We further segmented individuals according to their intensity of physical activity to examine how such effect differs between different levels of physical activity. The study demonstrates that active mobility usage positively correlates with both the amount and intensity of physical activity. The effect of active mobility on individual health includes a direct positive effect (29% for intensity, 67.7% for amount) and an indirect effect mediated by physical activity (71% for intensity, 32.3% for amount). Notably, the mediation effect of active mobility on health is more substantial in the context of vigorous physical activities compared to light or moderate activities. Our findings reveal a significant positive influence of active mobility on individual health, encompassing both direct and indirect effects mediated by physical activities. These results quantitatively underscore the health benefits of active mobility and suggest the importance of promoting active mobility as a strategy to improve public health.

Exploring the Relationship of Leisure Travel with Loneliness, Depression, and Cognitive Function in Older Adults

Loneliness, depression, and cognitive decline are pressing concerns among older adults. This study examines the association between leisure travel participation and these health outcomes in older adults, aiming to provide further evidence of the benefits of leisure travel. Using nationally representative historical data from the 2006 household survey of the Health and Retirement Study, this study conducted a series of regression analyses to investigate the relationship between traveling and the three health outcomes, adjusting for age, sex, race, marital status, education, total wealth, annual income, and difficulty with daily activities. The results reveal that travel patterns in terms of distance are significantly associated with loneliness, depression, and cognitive function. Long-distance travel is positively related to higher cognitive function and a reduction in depressive symptoms, along with lower levels of loneliness, reinforcing the notion that leisure travel can potentially act as a catalyst for improved cognitive and mental health by offering opportunities for enhancing social connections and forming new relationships. The findings on the relationships between participation in leisure travel and mental and cognitive health contribute to the body of evidence supporting the therapeutic value of leisure travel in promoting healthy aging and enhancing the overall well-being in older adults.

Exploring the association between social isolation and utilization of primary health services by older adults: evidence from China

Objective

This study aims to investigate the impact of social isolation on the utilization of primary health services among older adults in China.

Methods

Data from the China Longitudinal Aging Social Survey (CLASS) conducted in 2018 were utilized. A binary logistic regression model was established, and propensity score matching (PSM) was employed for analysis.

Results

The results of the binary logistic regression showed that family isolation within social isolation had a significant negative impact on the utilization of primary health services for older adults. In contrast, there was no significant association between friend isolation, community isolation, and the utilization of primary health services. Furthermore, the PSM results, using three matching methods (nearest neighbor matching, radius matching, and kernel matching), confirmed that family isolation significantly reduced older adults' utilization of primary health services, consistent with the baseline regression findings.

Conclusion

Reducing the occurrence of family isolation among older adults may be a cost-effective intervention measure. Efforts should be directed toward improving family support for older adults, promoting the utilization of primary health services, and strengthening disease prevention.

Appetite and family and friends network among community-dwelling older adults: A cross-sectional study

OBJECTIVES

The aim of this study was to investigate the stronger correlate of appetite-family or friend networks-in community-dwelling older adults, given that undernutrition can impair physical function, increase mortality, and be influenced by social networks.

METHODS

A cross-sectional study was conducted in Kasugai City, Aichi Prefecture, and Nara City, Nara Prefecture, Japan, between August 2019 and March 2023. The analysis included 119 participants (women: 79%, mean age: 76.5 ± 5.6 y). A multiple regression analysis was performed, using the scores from the Japanese version of the Simplified Nutritional Appetite Questionnaire (SNAQ-J) as the dependent variable and family network and friend network as the independent variables. The analysis included social participation, living alone status, sex, age, body mass index, skeletal muscle mass index, grip strength, walking speed, and the Japanese version of the 15 Geriatric Depression Scale score as covariates to examine their relationship with appetite.

RESULTS

The mean value of the SNAQ-J score of the participants was 15.4 ± 1.2. Seven participants (6%) had a loss of appetite. Family network was significantly associated with appetite (B = 0.121, β = 0.266, P <0.05; 95% condidence interval [CI], 0.030-0.212). In the single regression analysis, the friend network was significantly associated with the total score of the SNAQ-J (B = 0.115, P <0.001; 95% CI, 0.052-0.177); however, this association was not observed in the multiple regression analysis (B = 0.002, β = 0.006, P = 0.954; 95% CI, -0.074-0.078).

CONCLUSION

Appetite was associated with family networks. Among social networks, focusing on family networks may help prevent the loss of appetite in older adults in Japan.

Social Isolation, Physical Activity, and Subsequent Changes in Cognition Among Middle- and Older-Aged Adults: Results From the Canadian Longitudinal Study on Aging

OBJECTIVE

The objectives of this study were to a) evaluate associations between social isolation and change in cognition over a 3-year period, and b) evaluate whether physical activity mediates the association between social isolation and cognition change.

METHODS

Using baseline and follow-up 1 data from the Canadian Longitudinal Study on Aging, latent change score models, incorporating direct and indirect pathways, were constructed to estimate the indirect effect of social isolation on cognitive change through physical activity. Multigroup models were constructed based on age group (45-65 versus 65+ years) and sex to allow for varying estimates across age and sex. The final analytic sample included 51,338 participants.

RESULTS

Indirect effects of social isolation on cognition through physical activity were evident in men and women 65+ years old for memory change ( = -0.005 [99.9% confidence interval = -0.007 to -0.002], p < .001 in both groups) and in male adults 65+ years old for executive function change ( = -0.01 [99.9% confidence interval = -0.02 to -0.006], p < .001). Statistically significant indirect effects were not observed for adults between 45 and 65 years old.

CONCLUSIONS

Social isolation is associated with diminished physical activity, and in turn, diminished physical activity is associated with decline in memory in older women and men, with larger declines in executive function in older men. Public health initiatives to promote physical activity-perhaps incorporating social interaction-among older adults experiencing social isolation could be one way to mitigate the negative impact of social isolation on cognitive health.

The Effect of Social Isolation, Loneliness, and Physical Activity on Depressive Symptoms of Older Adults during COVID-19: A Moderated Mediation Analysis

Depressive symptoms have been commonly reported in older adults during the coronavirus disease (COVID-19) pandemic. Social isolation as a result of social distancing to prevent COVID-19 was reported to increase the level of depressive symptoms both directly and indirectly through the mediating effect of loneliness. Depressive symptoms in older adults can be regulated through health behaviors such as physical activity. Therefore, this study used a moderated mediation model to explain depressive symptoms. The English Longitudinal Study of Ageing COVID-19 wave 2 data were used. A total of 296 individuals were excluded due to missing values, leaving a final sample of 6499. Depressive symptoms, social isolation, loneliness, and physical activity were used in the moderated mediation analysis with various demographic and general health variables as covariates. Loneliness was found to significantly mediate the relationship between social isolation and depression. While moderate physical activity significantly moderated the effects of social isolation and loneliness on depressive symptoms, mild physical activity alone significantly moderated the effects of loneliness on depressive symptoms. This study revealed the impact of social isolation on depressive symptoms directly and indirectly mediated by loneliness, with a moderating effect of moderate and mild physical activity in the elderly during COVID-19 in a moderated mediation model.

Pandemic-induced increase in adjustment disorders among postpartum women in Germany

BACKGROUND

The current paper analyzed the effect of the pandemic-induced lockdown on maternal mental health during the first 12 postpartum weeks in Germany.

METHODS

In this cohort study, we compared the participants' anamnestic backgrounds and the results of psychological tests, measuring stress levels, depressive symptoms and attachment. The 327 participants were divided into two groups with one representing the "pre-COVID" sample and the other the "lockdown" sample. We performed multiple comparisons, investigating the distribution of diagnoses and the correlating risk profiles between the two cohorts.

RESULTS

Our analysis showed a significant difference between the two cohorts, with a 13.2% increase in the prevalence of adjustment disorders (AD), but not postpartum depression (PPD), in the first 12 weeks postpartum. However, during the pandemic, women with AD had fewer risk factors compared to their pre-pandemic counterparts. In the "lockdown" cohort, a tendency toward higher stress and lower mother-child attachment was observed in AD.

CONCLUSIONS

In sum, we observed some negative impact of the pandemic on maternal mental health. The lockdown might have contributed to an increase in the number of cases involving AD in the postpartum period. The prevalence of PPD (ca. 6-10%), on the other hand, was not affected by the lockdown. Thus, the effect of COVID-19 on maternal mental health might not, after all, have been as severe as assumed at the beginning of the pandemic.

Exploring outdoor activity limitation (OAL) factors among older adults using interpretable machine learning

BACKGROUND

The occurrence of outdoor activity limitation (OAL) among older adults is influenced by multidimensional and confounding factors associated with aging.

AIM

The aim of this study was to apply interpretable machine learning (ML) to develop models for multidimensional aging constraints on OAL and identify the most predictive constraints and dimensions across multidimensional aging data.

METHODS

This study involved 6794 community-dwelling participants older than 65 from the National Health and Aging Trends Study (NHATS). Predictors included related to six dimensions: sociodemographics, health condition, physical capacity, neurological manifestation, daily living habits and abilities, and environmental conditions. Multidimensional interpretable machine learning models were assembled for model construction and analysis.

RESULTS

The multidimensional model demonstrated the best predictive performance (AUC: 0.918) compared to the six sub-dimensional models. Among the six dimensions, physical capacity had the most remarkable prediction (AUC: physical capacity: 0.895, daily habits and abilities: 0.828, physical health: 0.826, neurological performance: 0.789, sociodemographic: 0.773, and environment condition: 0.623). The top-ranked predictors were SPPB score, lifting ability, leg strength, free kneeling, laundry mode, self-rated health, age, attitude toward outdoor recreation, standing time on one foot with eyes open, and fear of falling.

DISCUSSION

Reversible and variable factors, which are higher in the set of high-contribution constraints, should be prioritized as the main contributing group in terms of interventions.

CONCLUSION

The integration of potentially reversible factors, such as neurological performance in addition to physical function into ML models, yields a more accurate assessment of OAL risk, which provides insights for targeted, sequential interventions for older adults with OAL.

Social Media Use and Depression in Older Adults: A Systematic Review

Social media has become an integral part of everyday life and revolutionized how older adults communicate and interact with others. The aim of the current review was to identify and synthesize quantitative studies addressing the potential relationship between social media use and depression in older adults. Medline, CINAHL, and PsycINFO databases were used to identify studies performed up to July 2020. Keywords identified were depression, social media use, and older adults. A nuanced relationship was revealed between social media use and depression in older adults. There were noted differences in the conceptualization of social media use. The reviewed studies lacked exploration of structural characteristics, examination of content, and quality of interactions in older adults' social media use. Health variables, social factors, and age cohort differences could influence the relationship between social media use and depression. Further studies are needed to enhance the understanding and explore the benefits and potential disadvantages of social media use in older adults. [Research in Gerontological Nursing, 16(2), 97-104.].

Sensor-based assessment of social isolation in community-dwelling older adults: a scoping review

Social isolation (SI) is a state of low social interaction with peers associated with various adverse health consequences in older adults living in the community. SI is most often assessed through retrospective self-reports, which can be prone to recall or self-report biases and influenced by stigma. Ambient and wearable sensors have been explored to objectively assess SI based on interactions of a person within the environment and physiological data. However, because this field is in its infancy, there is a lack of clarity regarding the application of sensors and their data in assessing SI and the methods to develop these assessments. To understand the current state of research in sensor-based assessment of SI in older adults living in the community and to make recommendations for the field moving forward, we conducted a scoping review. The aims of the scoping review were to (i) map the types of sensors (and their associated data) that have been used for objective SI assessment, and (ii) identify the methodological approaches used to develop the SI assessment. Using an established scoping review methodology, we identified eight relevant articles. Data from motion sensors and actigraph were commonly applied and compared and correlated with self-report measures in developing objective SI assessments. Variability exists in defining SI, feature extraction and the use of sensors and self-report assessments. Inconsistent definitions and use of various self-report scales for measuring SI create barriers to studying the concept and extracting features to build predictive models. Recommendations include establishing a consistent definition of SI for sensor-based assessment research and development and consider capturing its complexity through innovative domain-specific features.

Social connectedness as a determinant of mental health: A scoping review

Public health and epidemiologic research have established that social connectedness promotes overall health. Yet there have been no recent reviews of findings from research examining social connectedness as a determinant of mental health. The goal of this review was to evaluate recent longitudinal research probing the effects of social connectedness on depression and anxiety symptoms and diagnoses in the general population. A scoping review was performed of PubMed and PsychInfo databases from January 2015 to December 2021 following PRISMA-ScR guidelines using a defined search strategy. The search yielded 66 unique studies. In research with other than pregnant women, 83% (19 of 23) studies reported that social support benefited symptoms of depression with the remaining 17% (5 of 23) reporting minimal or no evidence that lower levels of social support predict depression at follow-up. In research with pregnant women, 83% (24 of 29 studies) found that low social support increased postpartum depressive symptoms. Among 8 of 9 studies that focused on loneliness, feeling lonely at baseline was related to adverse outcomes at follow-up including higher risks of major depressive disorder, depressive symptom severity, generalized anxiety disorder, and lower levels of physical activity. In 5 of 8 reports, smaller social network size predicted depressive symptoms or disorder at follow-up. In summary, most recent relevant longitudinal studies have demonstrated that social connectedness protects adults in the general population from depressive symptoms and disorders. The results, which were largely consistent across settings, exposure measures, and populations, support efforts to improve clinical detection of high-risk patients, including adults with low social support and elevated loneliness.

Social Network and Participation in Elderly Primary Care Patients in Germany and Associations with Depressive Symptoms-A Cross-Sectional Analysis from the AgeWell.de Study

This study aims to describe social network and social participation and to assess associations with depressive symptoms in older persons with increased risk for dementia in Germany. We conducted a cross-sectional observational study in primary care patients (aged 60−77) as part of a multicenter cluster-randomized controlled trial (AgeWell.de). We present descriptive and multivariate analyses for social networks (Lubben Social Network Scale and subscales) and social participation (item list of social activities) and analyze associations of these variables with depressive symptoms (Geriatric Depression Scale). Of 1030 included patients, 17.2% were at risk for social isolation (Lubben Social Network Scale < 12). Looking at the subscales, a reduced non-family network was found almost twice as often as a reduced family network. Patients with depressive symptoms had significantly smaller social networks than patients without depression (p < 0.001). They rather engaged in social activities of low involvement level or no weekly social activity at all (p < 0.001). The study shows associations of depressive symptoms with a decreased social network and less social participation in elderly participants. Sufficient non-family contacts and weekly social activities seem to play an important role in mental health and should be encouraged in elderly primary care patients.

The association of physical activity with loneliness, social isolation, and selected psychological protective factors among older adults

The primary objectives were to investigate the association of physical activity levels with 1) loneliness and social isolation; 2) protective factors: resilience, purpose-in-life, and perception of aging; and 3) the impact of these factors on healthcare expenditure patterns across physical activity levels. The study sample was identified from adults age ≥65 who completed a health survey in 2018 or 2019 (N=6,652). Among survey respondents, the prevalence of low, moderate, and high physical activity levels was 29%, 31%, and 41%, respectively. Moderate and high physical activity were associated with 15%-30% lower likelihoods of loneliness and social isolation; and with 27% to 150% higher protective factors. In addition, physical activity was associated with the mitigation of increased healthcare expenditures associated with loneliness, social isolation, and low levels of protective factors. Thus, physical activity could serve as an intervention to reduce loneliness and social isolation, augment protective factors, and mitigate excess healthcare expenditures.

Measuring Social Engagement among Low-Income, Depressed Homebound Older Adults: Validation of the Social Engagement and Activities Questionnaire

Objectives: To investigate the psychometric properties of the 10-item Social Engagement and Activities Questionnaire (SEAQ) to assess social-group, interpersonal interaction, and solitary activities among low-income, depressed homebound older adults (n = 269).Methods: We used principal component analysis (PCA) to evaluate the underlying dimensions of the 10-item full SEAQ and a 6-item abbreviated item set. We assessed evidence of validity for the SEAQ by examining relationships between the SEAQ and older adults' clinical characteristics: perceived social support, disability, and depressive symptoms.Results: PCA results showed two components: (1) a general social-group activities engagement component; and (2) a low level of socialization (i.e., strong negative coefficients on the recreational activities and self-enrichment/educational activities and a negative coefficient for interpersonal interaction activities). The general social-group activities engagement component in both the full and abbreviated SEAQ were significantly positively correlated with the full and abbreviated SEAQ and perceived social support, providing evidence for convergent validity, and they were significantly negatively correlated with disability and depressive symptoms, providing evidence for discriminant validity.Conclusions: The present study provides evidence of validity for the use of the SEAQ to assess social engagement and activities among low-income, depressed homebound older adults.Clinical Implications: The SEAQ may be used in future studies measuring changes in social engagement and activities in these older adults.

Association of personality traits with polypharmacy among community-dwelling older adults in Japan: a cross-sectional analysis of data from the SONIC study

Background

Polypharmacy is a serious concern among older adults and is frequently related to adverse outcomes, including health problems, reduced quality of life, and increased medical expenses. Although personality traits are associated with health behaviors and diseases, the effect of polypharmacy on personality traits is unclear. Therefore, we examined the association of personality traits with polypharmacy among community-dwelling older adults.

Methods

This cross-sectional study analysed data on 836 community-dwelling older adults aged 69–71 years who participated in the Japanese longitudinal cohort study of Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians. Polypharmacy was defined as the intake of ≥ 5 medications concurrently. Personality traits were assessed using the Japanese version of the NEO-Five-Factor Inventory (NEO-FFI). A five-factor model of personality traits, including “neuroticism,” “extraversion,” “openness,” “agreeableness,” and “conscientiousness,” was measured by the NEO-FFI.

Results

The average number of medications was about 3 in both men and women. Among the participants, polypharmacy was observed in 23.9% of men and 28.0% of women. Multivariable logistic regression analysis showed that neuroticism (adjusted odds ratio [aOR] per 1 point increase = 1.078, 95% confidence interval [CI] = 1.015–1.144) in men and extraversion (aOR = 0.932, 95% CI = 0.884–0.983) in women were associated with polypharmacy.

Conclusions

Higher neuroticism in men and lower extraversion in women were associated with polypharmacy. This study suggests that personality traits may be involved in the process leading to the development of polypharmacy. Information on individual personality traits may help medical professionals in decision-making regarding medication management for lifestyle-related diseases.

Community welfare resources and late-life depression among older adults in Seoul: A multi-level analysis

OBJECTIVES

This study aimed to examine whether community welfare resources in neighborhoods (recreational facilities, healthcare access, and public welfare expenditure) are associated with late-life depression among older adults in Seoul, South Korea.

METHODS

Data for this study were obtained by merging two different data sources: the 2018 Seoul Elderly Survey for individual-level variables and publicly available administrative data for neighborhood-level variables. The sample included 3036 older adults (unweighted n = 3034) living in 25 neighborhoods (Gu) in Seoul. Multilevel regression models examined the effects of neighborhood-level variables on late-life depression while controlling for individual-level variables. We also explored the extent to which individual characteristics moderate the main effects of neighborhood characteristics on late-life depression.

RESULTS

The results indicated that recreational facilities, health care centers, and public welfare expenditure in the neighborhoods were associated with late-life depression among older adults beyond individuals' predisposing conditions. Also, the effects of recreational facilities and public welfare expenditure on depressive symptoms were larger for those with higher education level.

CONCLUSIONS

Older adults living in neighborhoods with more recreational facilities, more health care centers, and high public welfare expenditure were less likely to experience late-life depression. Of note is that the effects of neighborhoods' recreational facilities and public welfare expenditure varied by certain individual characteristics. Hence, local governments should introduce neighborhood-based health promotion policies to prevent depression among older adults. In doing so, local governments should also consider ways to improve access to community welfare resources for underprivileged older adults.

Latent class analysis of loneliness and connectedness in US young adults during COVID-19

Objective

The coronavirus disease 2019 (COVID‐19) pandemic in the United States has exacerbated a number of mental health conditions and problems related to prolonged social isolation. While COVID‐19 has led to greater loneliness and a lack of social connectedness, little is known about who are the most affected and how they are impacted. Therefore, we performed a Latent Class Analysis using items from two scales – the UCLA Loneliness Scale and the Social Connectedness Scale – to characterize different experiences of loneliness and connectedness, examine their relationship with mental health and substance use symptoms, including depression, anxiety, drinking, and drug use.

Methods

Data were drawn from an anonymous one‐time online survey examining the mental health of 1008 young adults (18–35 years old) during COVID‐19. A latent class analysis (LCA) was conducted to observe and identify classes based on responses to loneliness and connectedness scale items, and to examine the existence of subgroups among this young adult population.

Results

We identified a 4‐class model of loneliness and connectedness: (1) Lonely and Disconnected – highest probabilities in items of loneliness and disconnectedness, (2) Moderately Lonely and Disconnected – adaptive levels of some isolation and disconnection during COVID‐19, (3) Ambivalent Feelings – displaying negative responses in particular to negatively‐worded items while simultaneously affirming positively worded items, and (4) Connected and Not Lonely – lowest probabilities in items of loneliness and disconnectedness.

Conclusion

Key findings include (1) the delineation of classes by levels of loneliness and connectedness showcasing differential mental health and substance use symptoms, (2) the utility of item‐level evaluation with LCA in determining specific classes of people in need of outreach and intervention, and (3) the promise of social connection to bolster resilience in young adults.

Relationships between physical activity, social isolation, and depression among older adults during COVID-19: A path analysis

Background: There are known significant relationships between greater physical activity and less depression, and greater social isolation and greater depression; therefore, it is important to understand these relationships among older adults during COVID-19.

Methods: The Physical Activity Scale for Elders, Geriatric Depression Scale, and PROMIS Social Isolation were administered. Path analysis was performed to evaluate the relationship between physical activity, social isolation, and depression.

Results: 803 surveys were received. Consistent with our a-priori model, higher social isolation predicted greater depression. (p<0.001).

Conclusion: Older adults may suffer a high emotional price during times of imposed social distancing.

Educational and Social Exergaming: A Perspective on Physical, Social, and Educational Benefits and Pitfalls of Exergaming at Home During the COVID-19 Pandemic and Afterwards

Physical inactivity and coronavirus disease 2019 (COVID-19) signify two pandemics with negative physical, mental, and economic consequences. Younger and older people have not reached the recommended physical activity level for years. Societal restrictions due to COVID-19 additionally reduce opportunities for physical activity, and they increase social isolation. Here, we outline how playing exergames with others (social exergaming) at home could foster physical and mental health and promote communication and discussions on exergaming. Accordingly, we highlight the educational and social benefits of exergaming at home and delineate the concept of Educational and Social Exergaming (EASE). We outline specific benefits and pitfalls of exergaming regarding its physical and nonphysical effects, including educational values of discussing exergaming experiences and related topics. Moreover, we discuss the relevance of practical guidelines for educational and social exergaming at home as well as prospects for future research. Overall, educational and social exergaming could alleviate several detrimental effects of both pandemics on the health and well-being of people of all ages.

Leisure activity moderates the relationship between living alone and mental health among Japanese older adults

AIM

As living alone is associated with poor mental health, seeking a moderating factor in this relationship may help enhance quality of life of older people living alone. Therefore, this study examined the moderating effect of leisure activity on the relationship between living alone and mental health in older people.

METHODS

This study employed a cross-sectional analysis of questionnaire data. Research was conducted in a metropolitan Tokyo ward from September to October 2017. Participants were 314 community-dwelling Japanese individuals (158 women, 156 men) aged 70-84 years (mean ± SD, 77.7 ± 4.4). We analyzed mental health using the Japanese version of the World Health Organization-Five Well-Being Index as the outcome variable, and the 11 items of the Leisure Activity Scale and living arrangements as explanatory variables. Multivariate analyses were used to examine effects of leisure activity on living arrangements and mental health.

RESULTS

The proportion of people living alone was 22.9% (N = 72), and the mental health score was mean ± SD, 14.2 ± 7.2. Multiple regression analysis showed that subjective economic status (β = -0.177), instrumental activities of daily living (β = 0.167), living arrangements (β = -0.142) and leisure activity (β = 0.481) were associated with mental health. The interaction effect between living arrangements and leisure activity on mental health was significant (β = 0.112).

CONCLUSIONS

Our findings show that leisure activity moderates poor mental health in older adults living alone. Accordingly, interventions should encourage older adults living alone to engage in leisure activity to improve their mental health. Geriatr Gerontol Int 2021; 21: 421-425.

Physical activity and depression in older adults: the knowns and unknowns

This study provides a comprehensive and updated review of the literature with respect to the relationship between physical activity and depression in older adults. The evidence from both observational studies and experimental studies are collected to present a discussion on the type and dose of physical activity, as well as the underlying mechanisms of physical activity and depression in older adults. Overall, the results from previous studies support a solid inverse relationship between physical activity and depression in older adults, while the dose-effect relationship between them, as well as different effects among different types of physical activities, remains largely unexplored. Depression in older adults is related to an array of negative health outcomes and is more chronic compared to that in younger adults. Physical activity has been regarded as a promising non-pharmaceutical method in treating and preventing depression in older adults. Further experimental work and research need to be done to develop theoretically grounded and evidence-based interventions to better advance our knowledge of this topic and effectively promote physical activity in older adults.

The Effectiveness of an Active Learning Program in Promoting a Healthy Lifestyle among Older Adults with Low Health Literacy: A Randomized Controlled Trial

BACKGROUND

Older adults often have a greater need for health information and health care services because access to these helps them manage their health and the chronic conditions of aging. Therefore, low health literacy bears a special significance for the population of older adults.

OBJECTIVES

The aim of this study was to examine the effects of an active learning program on health literacy, lifestyle behaviors, physical function, and mental health among community-dwelling older adults with low health literacy.

METHODS

This single-blind, randomized controlled trial involved 60 participants aged ≥65 years with a low health literacy who were randomly assigned to an intervention (n = 30) or control (n = 30) group. Across 24 weeks, the intervention group attended weekly 90-min active learning program sessions, which involved exploratory learning, group work, and the self-planning of behavior changes that promote a healthy lifestyle. The control group attended a 90-min class, which was taught in accordance with the didactic teaching method. For both groups, the programs focused on the role of exercise, diet/nutrition, and cognitive activity for promoting health among older adults. The outcome measures were administered at baseline and week 24. Comprehensive health literacy (i.e., primary outcome) was assessed using the Health Literacy Scale-14. Lifestyle factors (i.e., physical activity, dietary variety, life-space mobility, and social network size), physical function, and depressive symptoms were measured. We used a linear mixed model to estimate the intervention effects in accordance with the intention-to-treat approach.

RESULTS

When compared to the control group, the intervention group demonstrated a significant improvement in communicative health literacy, step count, engagement in moderate-to-vigorous physical activity, dietary variety, life-space mobility, social network size, grip strength, gait speed, and depressive symptoms.

CONCLUSIONS

The active learning program can promote a healthy lifestyle and prevent functional decline among older adults who lack the confidence to engage in health communication.

Sarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss

The COVID-19 pandemic is an extraordinary global emergency that has led to the implementation of unprecedented measures in order to stem the spread of the infection. Internationally, governments are enforcing measures such as travel bans, quarantine, isolation, and social distancing leading to an extended period of time at home. This has resulted in reductions in physical activity and changes in dietary intakes that have the potential to accelerate sarcopenia, a deterioration of muscle mass and function (more likely in older populations), as well as increases in body fat. These changes in body composition are associated with a number of chronic, lifestyle diseases including cardiovascular disease (CVD), diabetes, osteoporosis, frailty, cognitive decline, and depression. Furthermore, CVD, diabetes, and elevated body fat are associated with greater risk of COVID-19 infection and more severe symptomology, underscoring the importance of avoiding the development of such morbidities. Here we review mechanisms of sarcopenia and their relation to the current data on the effects of COVID-19 confinement on physical activity, dietary habits, sleep, and stress as well as extended bed rest due to COVID-19 hospitalization. The potential of these factors to lead to an increased likelihood of muscle loss and chronic disease will be discussed. By offering a number of home-based strategies including resistance exercise, higher protein intakes and supplementation, we can potentially guide public health authorities to avoid a lifestyle disease and rehabilitation crisis post-COVID-19. Such strategies may also serve as useful preventative measures for reducing the likelihood of sarcopenia in general and in the event of future periods of isolation.

The Impact of Measures Recommended by the Government to Limit the Spread of Coronavirus (COVID-19) on Physical Activity Levels, Quality of Life, and Mental Health of Brazilians

To reduce transmission of the coronavirus, the Brazilian government adopted containment measures to control the virus’ spread, including limitations to the practice of physical activity. It was aimed to analyze the effects of COVID-19 quarantine on physical activity levels, energy expenditure, quality of life, and level of stress in a sample of the Brazilian population. The sample included 426 participants (7 to 80 years). The International Physical Activity Questionnaire, Short form survey-36 (SF-36), and Stress Perception Scale, were used to assess the level of physical activity, quality of life and stress, respectively. The anthropometric data was used to the assessment of body mass index and basal metabolic rate. Body weight increased significantly in all sample (p < 0.05). During the pandemic, 84% of the sample indicated a low level of physical activity. Furthermore, weekly energy expenditure decreased significantly in all age groups during the pandemic (children p < 0.0001; adolescents: p < 0.0001; adults p < 0.001, and elderly p < 0.0001). All aspects of quality of life, significantly reduced in both sexes in all age groups (p < 0.05). With the exception of children, stress levels increased significantly during the pandemic (adolescents: male: p = 0.003, female: p < 0.05; adults: male: p = 0.003, female: p = 0.01, and elderly: male: p = 0.02, female: p = 0.03). Findings from the present study suggests that COVID-19 social isolation has negatively affected Brazilian’ physical activity and quality of life.

Increase in prevalence of current mental disorders in the context of COVID-19: analysis of repeated nationwide cross-sectional surveys

AIMS

The United Nations warned of COVID-19-related mental health crisis; however, it is unknown whether there is an increase in the prevalence of mental disorders as existing studies lack a reliable baseline analysis or they did not use a diagnostic measure. We aimed to analyse trends in the prevalence of mental disorders prior to and during the COVID-19 pandemic.

METHODS

We analysed data from repeated cross-sectional surveys on a representative sample of non-institutionalised Czech adults (18+ years) from both November 2017 (n = 3306; 54% females) and May 2020 (n = 3021; 52% females). We used Mini International Neuropsychiatric Interview (MINI) as the main screening instrument. We calculated descriptive statistics and compared the prevalence of current mood and anxiety disorders, suicide risk and alcohol-related disorders at baseline and right after the first peak of COVID-19 when related lockdown was still in place in CZ. In addition, using logistic regression, we assessed the association between COVID-19-related worries and the presence of mental disorders.

RESULTS

The prevalence of those experiencing symptoms of at least one current mental disorder rose from a baseline of 20.02 (95% CI = 18.64; 21.39) in 2017 to 29.63 (95% CI = 27.9; 31.37) in 2020 during the COVID-19 pandemic. The prevalence of both major depressive disorder (3.96, 95% CI = 3.28; 4.62 v. 11.77, 95% CI = 10.56; 12.99); and suicide risk (3.88, 95% CI = 3.21; 4.52 v. 11.88, 95% CI = 10.64; 13.07) tripled and current anxiety disorders almost doubled (7.79, 95% CI = 6.87; 8.7 v. 12.84, 95% CI = 11.6; 14.05). The prevalence of alcohol use disorders in 2020 was approximately the same as in 2017 (10.84, 95% CI = 9.78; 11.89 v. 9.88, 95% CI = 8.74; 10.98); however, there was a significant increase in weekly binge drinking behaviours (4.07% v. 6.39%). Strong worries about both, health or economic consequences of COVID-19, were associated with an increased odds of having a mental disorder (1.63, 95% CI = 1.4; 1.89 and 1.42, 95% CI = 1.23; 1.63 respectively).

CONCLUSIONS

This study provides evidence matching concerns that COVID-19-related mental health problems pose a major threat to populations, particularly considering the barriers in service provision posed during lockdown. This finding emphasises an urgent need to scale up mental health promotion and prevention globally.

The impact of the COVID-19 pandemic on patients awaiting spinal cord stimulation surgery in the United Kingdom: a multi-centre patient survey

Introduction

Spinal cord stimulation (SCS) is a recommended treatment for chronic refractory neuropathic pain. During the COVID-19 pandemic, elective procedures have been postponed indefinitely both to provide capacity to deal with the emergency caseload and to avoid exposure of elective patients to COVID-19. This survey aimed to explore the effect of the pandemic on chronic pain in this group and the views of patients towards undergoing SCS treatment when routine services should resume.

Methods

This was a prospective, multi-centre telephone patient survey that analysed data from 330 patients with chronic pain who were on an SCS waiting list. Questions focussed on severity of pain, effect on mental health, medication consumption and reliance on support networks during the COVID-19 pandemic. Views towards undergoing SCS therapy were also ascertained. Counts and percentages were generated, and chi-square tests of independence explored the impact of COVID-19 risk (very high, high, low) on survey responses.

Results

Pain, mental health and patient's ability to self-manage pain deteriorated in around 47%, 50% and 38% of patients, respectively. Some patients reported increases in pain medication consumption (37%) and reliance on support network (41%). Patients showed a willingness to attend for COVID-19 testing (92%), self-isolate prior to SCS (94%) and undergo the procedure as soon as possible (76%).

Conclusion

Our findings suggest that even during the COVID-19 pandemic, there remains a strong clinical need for patients with chronic pain identified as likely SCS responders to be treated quickly. The current prioritisation of new SCS at category 4 (delayed more than 3 months) is challenged judging by this national survey. These patients are awaiting SCS surgery to relieve severe intractable neuropathic pain. A priority at category 3 (delayed up to 3 months) or in some selected cases, at category 2 are the appropriate priority categories.

Vulnerability in health and social capital: a qualitative analysis by levels of marginalization in Mexico

Background

Social capital is employed as an asset when there is a lack of an efficient health-care system. However, this relationship is not homogeneous and can differ according to the characteristics of individuals and their context. In this paper, we aim to analyze the role of social capital in the solution of healthcare problems among individuals with different levels of marginalization and unequal access to health services.

Methods

This qualitative study examines the role of social capital in the demand for healthcare among Mexican individuals with different levels of marginalization. The research draws data from semi-structured interviews (N = 247) that were collected in four Mexican states with different social welfare benefits: Mexico City, Tamaulipas, the State of Mexico, and Oaxaca. The interviewees were selected using the snowball method and other eligibility criteria such as education, age, and gender.

Results

Findings suggest that social capital is a relevant factor in solving healthcare problems, depending on the level of marginalization. The role of social capital can be explained by the precariousness of medical service delivery, the poor health infrastructure, and the difficult access to health care in Mexico. Networks are the main resource to deal with health related issues, food, medicine, and out-of-the-pocket medical expenses in contexts of high levels of marginalization. In the middle level of marginalization, networks also help in raising funds for more-specialized medical services and higher quality hospitals. In the least-marginalized levels, social capital is used as companionship for sick individuals, while support networks act as emotional relief. At this level, most individuals have private health insurance, and many of them have major medical healthcare coverage.

Conclusions

Participants reported low levels of trust in the health care system because of the poor infrastructure and quality of medical service delivery. Although the main criticism is focused on public healthcare institutions, there is a lack of trust in private medical services as well. These facts are related to the access and quality of medical service delivery and turn social capital into a significant asset. Despite that social bonds or links are valuable resources that individuals can use to solve healthcare related issues, the use of social capital is not homogenous. Indeed, it can be influenced by several factors that were represented in this study through the municipal marginalization index.

Depressive symptoms and associated factors in residents living in long-term care facilities from the metropolitan area of Belo Horizonte

OBJECTIVE: To identify the presence of depressive symptoms and its association with self-rated health among older adults living in Long-term Care Facilities. METHODS: This is a cross-sectional study in which institutionalized older adults were screened by using the Mental State Mini Exam. Standard questionnaires were used to collect the following data: 1) sociodemographic variables, 2) depressive symptoms, and 3) self-rated health. The descriptive statistical analysis by measures of central tendency and dispersion was performed to characterize the sample. The multinomial logistic regression analysis was performed to associate the variables. In all tests, the alpha value of 0.05 was considered. RESULTS: A total of 127 older adults living in 47 long-term care facilities were evaluated. Among those who presented depressive symptoms, 32.3% were classified as having mild symptoms and 13.4% had severe symptoms. Regarding self-rated health, 46.5% considered it poor/very poor. In the analysis of the association between mild and severe depressive symptoms and self-rated health, statistical significance (p = 0.004 and p = 0.001, respectively) was found. CONCLUSIONS: The results of this study suggest that more attention should be directed to institutionalized older adults who have symptoms of depression and to their impacts on the negative self-rated health.

Neighborhood, social isolation and mental health outcome among older people in Ghana

OBJECTIVE

Loneliness and living alone have been strongly related to mental health but limited empirical evidence of these relationships exists among older people in Ghana. We examine the pathways of independent and interactive impacts of loneliness and living alone on psychological distress (PD) risk among older people in Ghana and to investigate whether the associations are moderated by neighborhood characteristics.

METHODS

Data were analyzed for 1200 community-dwelling adults aged ≥50 years from a 2016/2017 Aging, Health, Psychological Wellbeing and Health-seeking Behavior Study. Mental health and loneliness were respectively assessed using the Kessler Psychological Distress Scale (KPDS-10) and the Three-Item Loneliness Scale of the University of California, Los Angeles. OLS models estimated the associations and interactions.

RESULTS

Participants were mostly women (63.3% [95%CI: 60.5-66.0%]) with a mean age of 66.2 ± 11.9. Mean scores for PD and loneliness were 15.9 ± 4.7 and 5.3 ± 3.9 respectively whilst the prevalence of living alone was 38.2% (95%CI: 35.4-41.0%). After full adjustment, the OLS regressions showed that loneliness (β = 1.474, SE = 0.151, p < 0.001), living alone (β = 0.381, SE = 0.162, p < 0.05) and the interaction between them (β = 0.917, SE = 0.308, p < 0.05) significantly increased the PD risk. However, engagement in regular physical activity, family contacts and social participation decreased PD outcomes among the socially isolated.

LIMITATION

The cross-sectional nature of the data may prohibit any causal and directional inferences.

CONCLUSIONS

Social connectedness and neighborhood engagements strongly buffer against the risk of later life mental disorders in the context of loneliness, and living alone. Moderate-to-rigorous physical activity and social cohesion should be effectively and strategically included in interventions targeted to improve older age mental health.