Spirituality, depression, living alone, and perceived health among Korean older adults in the community

Depressive symptoms among older empty nesters in China: the moderating effects of social contact and contact with one's children

OBJECTIVES

Mental health for older people has become a major social concern. Literature has shown that older people, especially when they become empty nesters-when a parent lives alone or lives with his/her spouse after the youngest child leaves home-may start to develop various mental health problems due to reduced contacts with their children.

Using fixed-effects, multivariate regression with a difference-in-differences approach and propensity score matching, this paper examines the relationship between being an empty nester and mental health among older people in China, and the moderating effects of social contact and contact with one's children in terms of mental health. Our data come from the China Health and Retirement Longitudinal Study of 2011, 2013, 2015 and 2018.

RESULTS

We found that, in the short term, the mental health of older people may not be affected after they became empty nesters. But in the longer term, if they did not have regular contact with their children, their mental health would deteriorate with time. Social contact, especially cognitive activities, was beneficial to the mental health of the older empty nesters. We also found that for older empty nesters with disabilities, frequent social contact and contact with their children were more important.

CONCLUSION

We urge the government to promote community-based social activities for older people, especially for those with functional limitations.

Religiosity/Spirituality and Mental Health in Older Adults: A Systematic Review and Meta-Analysis of Observational Studies

Objectives

The present study investigated the association between religious and spiritual (RS) practices with the prevalence, severity, and incidence of mental health problems in older adults.

Methods

We conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies that investigated older adults aged 60+ years and assessed RS using valid scales and questions from valid scales, and mental health according to validated multidimensional or specific instruments. Studies were retrieved from MEDLINE, LILACS, SCOPUS, CINAHL, and AgeLine databases until July 31, 2021. The risk of bias was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS). A pooled effect size was calculated based on the log odds ratio (OR) and Z-scores. This study is registered on PROSPERO.

Results

One hundred and two studies that investigated 79.918 community-dwellers, hospitalized, and institutionalized older adults were included. Results indicated that high RS was negatively associated with anxiety and depressive symptoms, while a positive association was observed with life satisfaction, meaning in life, social relations, and psychological well-being. Specifically, people with high spirituality, intrinsic religiosity, and religious affiliation had a lower prevalence of depressive symptoms. In relation to longitudinal analysis, most studies supported that high RS levels were associated with a lower incidence of depressive symptoms and fear of death, as well as better mental health status.

Conclusion

Findings of the present study suggest that RS are significantly associated with mental health in older adults. People with high RS levels had a lower prevalence of anxiety and depressive symptoms, as well as reported greater life satisfaction and psychological well-being, better social relations, and more definite meaning in life. Data provided by an increasing number of longitudinal studies have supported most of these findings.

Latent class growth modeling of depression and anxiety in older adults: an 8-year follow-up of a population-based study

BACKGROUND

Depression and anxiety are common mental health conditions in the older adult population. Understanding the trajectories of these will help implement treatments and interventions.

AIMS

This study aims to identify depression and anxiety trajectories in older adults, evaluate the interrelationship of these conditions, and recognize trajectory-predicting characteristics.

METHODS

Group-based dual trajectory modeling (GBDTM) was applied to the data of 3983 individuals, aged 65 years or older who participated in the Korean Health Panel Study between 2008 and 2015. Logistic regression was used to identify the association between characteristics and trajectory groups.

RESULTS

Four trajectory groups from GBDTM were identified within both depression and anxiety outcomes. Depression outcome fell into "low-flat (87.0%)", "low-to-middle (8.8%)", "low-to-high (1.3%)" and "high-stable (2.8%)" trajectory groups. Anxiety outcome fell into "low-flat (92.5%)", "low-to-middle (4.7%)", "high-to-low (2.2%)" and "high-curve (0.6%)" trajectory groups. Interrelationships between depression and anxiety were identified. Members of the high-stable depression group were more likely to have "high-to-low" or "high-curved" anxiety trajectories. Female sex, the presence of more than three chronic diseases, and being engaged in income-generating activity were significant predictors for depression and anxiety.

CONCLUSIONS

Dual trajectory analysis of depression and anxiety in older adults shows that when one condition is present, the probability of the other is increased. Sex, having more than three chronic diseases, and not being involved in income-generating activity might increase risks for both depression and anxiety. Health policy decision-makers may use our findings to develop strategies for preventing both depression and anxiety in older adults.

Psychosocial risk profiles among older adults living alone in South Korea: A latent profile analysis

OBJECTIVES

This study explored the psychosocial risk profiles and various characteristics associated with profile membership among Korean older adults living alone.

METHODS

Our analyses were based on a cross-sectional cohort of 1030 community-dwelling older adults (≥ 65 years) living alone in one Korean city. Latent profile analysis was used to identify psychosocial risk profiles across a wide range of psychosocial dimensions (depressive symptoms, suicidal ideation, cognitive dysfunction, loneliness, and perceived social support). We then explored the characteristics associated with distinct profiles by conducting bivariate and regression analyses.

RESULTS

The three-profile was selected as the best solution: a group with high cognitive dysfunction, high loneliness, and low social support (profile 1), a group with low psychological risks and high social support (profile 2), and a group with high depression and high suicidal ideation (profile 3). Regression analyses showed that a lower frequency of interaction with neighbors or families, a greater frailty score, and lower quality of life were significantly associated with profile 1 or profile 3 than with profile 2 (p < .05). Further, being male and having a poorer nutritional status was more significantly related to profile 3 than profile 2 (p < .05).

CONCLUSIONS

Findings provide evidence for healthcare professionals when developing interventions to prevent and reduce these psychosocial risks for older individuals living alone. In particular, factors associated with profile membership identified in the study may facilitate more tailored interventions.

The Relationship between living alone, sense of belonging, and depressive symptoms among older men: the moderating role of sexual orientation

Objectives: Living alone is a risk factor for depressive symptoms among older men, and is likely to occur due to belongingness needs being unmet. It is proposed the living alone-sense of belonging and living alone-depressive symptoms relations are stronger for gay men than heterosexual men, due to different family circumstances. This research tested a moderated mediation model, specifically whether the relationship between living alone and depressive symptoms is mediated by sense of belonging, and whether the living alone-sense of belonging and living alone-depressive symptoms relationships are moderated by sexual orientation.Method: A community sample of 169 Australian gay men aged 65 to 93 years and 187 Australian heterosexual men aged 65 to 94 years completed the Psychological subscale of the Sense of Belonging Instrument and the Center for Epidemiologic Studies Depression Scale.Results: Results supported the simple mediation model, with living alone being associated directly and indirectly with depressive symptoms via sense of belonging. The conditional indirect effect of living alone on depressive symptoms via sense of belonging was not significant, and therefore the moderated mediation model was not supported.Conclusion: Results imply that older men who live alone are at increased risk of depressive symptoms directly and indirectly via lower levels of sense of belonging.

Spirituality and wellbeing in later life: a multidimensional approach

Objectives: Previous studies pointed at positive associations between spirituality and Subjective Wellbeing (SWB) in later life, but were typically limited to one dimension of spirituality and/or one measure of SWB. Applying Fisher's (2010) multidimensional approach to spirituality and measuring both positive and negative aspects of SWB, this study aims at providing deeper understanding of this association. Method: The study was based on an online survey with 306 individuals aged 50 years and over. The questionnaire included the SHALOM spirituality scale as well as measures of depression, satisfaction with life, and personal background. Results: Personal and communal spirituality were the most dominant domains reported by study participants, followed by environmental spirituality. Transcendental spirituality was the least reported domain. Personal spirituality was the only domain positively associated with SWB (lower depression and higher life satisfaction), whereas communal and transcendental spirituality were associated with more depression. Conclusion: These findings demonstrate that not all spirituality domains are equally dominant in people's lives or positively associate with SWB. They also suggest that encouraging elderly people to develop their personal spirituality and self-growth may contribute to their wellbeing.

Depressive Disorders and Religious Engagement in Very Old People

Objective: To examine associations between religious engagement and depressive disorders in very old people. Method: This cross-sectional study uses data from the Umeå 85+/Gerontological Regional Database (GERDA) study. Every other 85-year-old, every 90-year-old, and everyone more than 95 years from eight municipalities in northern Sweden and Finland were invited: 1,014 persons accepted participation. Data were gathered using questionnaires and assessment scales during structured home visits. Results: The prevalence of depressive disorders was 35.8%. In a logistic regression model, several factors were adjusted for, such as demographic variables including social factors, diseases, and cognitive and physical functional level. A high level of self-reported religious engagement was independently associated with not having depressive disorders (odds ratio [OR] = 0.58, confidence interval [CI] = [0.38, 0.89]). After stratifying by gender, religious engagement was only significant for women (OR = 0.49, CI = [0.29, 0.82]). Discussion: There is an association between a high level of religious engagement and being free from diagnosis of depressive disorders among very old women.

Spirituality but not Religiosity Is Associated with Better Health and Higher Life Satisfaction among Adolescents

Careful conceptualization and differentiation of both spirituality and religiosity is a necessary precondition for understanding the potential role they play in health, whether physical or mental. The aim of this study was to explore the associations of spirituality with self-rated health, health complaints, and life satisfaction of adolescents with the moderating role of religiosity. Data from the Health Behaviour in School-aged Children study conducted in 2014 in Slovakia were used. The final sample consisted of 658 adolescents (mean age = 15.37; 50.6% boys). Data regarding spirituality, religiosity, self-rated health, health complaints, and life satisfaction were obtained. Binary logistic models revealed spirituality to be associated with self-rated health, health complaints, and life satisfaction. A moderating role of religiosity was not confirmed. The presented findings indicate the need to distinguish between the concepts of religiosity and spirituality in connection with subjective health and life satisfaction.

Socio-demographics, spirituality, and quality of life among community-dwelling and institutionalized older adults: A structural equation model

PURPOSE

The increasing life expectancy of the population prompts an array of health conditions that impair an older adults' quality of life (QoL). Although demographics and spirituality have been associated with QoL, limited literature elucidated the exact mechanisms of their interactions, especially in a culturally-diverse country like Philippines. Hence, this study determined the relationship among socio-demographics, spirituality, and QoL of Filipino older adults in a community and institutional setting.

MATERIALS AND METHODS

A predictive-correlational study among 200 randomly-selected community-dwelling and institutionalized older adults was conducted, with a 99% power and a medium effect size. Data were collected using a three-part questionnaire from September to November 2015. The questionnaire was composed of the robotfoto, Spirituality Assessment Scale, and modified Older People's Quality of Life which assessed socio-demographics, spirituality, and QoL.

RESULTS

Analysis showed that institutionalization in a nursing home positively and negatively affected spirituality and QoL, generating an acceptable model (χ(2)/df=2.12, RMSEA=0.08, and CFI=0.95). The negative direct effect of institutionalization on social relationship, leisure, & social activities QoL (β=-0.42, p<0.01) also initiates a cascade of indirect negative effects on both spirituality and QoL dimensions.

CONCLUSIONS

The development of a structural model illustrating the interrelationship of socio-demographics, spirituality, and QoL helps healthcare professionals in predicting facets of spirituality and QoL that can be compromised by living in a nursing home. This understanding provides impetus in evaluating and refining geriatric healthcare programs, policies, and protocols to render individualized, holistic care in a socially-cohesive environment among older adults.

Comparison of spiritual well-being and coping strategies of patients with generalized anxiety disorder and with minor general medical conditions

The purpose of the present study was to compare the spiritual well-being and coping strategies of patients with generalized anxiety disorder (GAD) and those with general medical conditions (GMC). The sample was comprised of 40 participants with GAD fulfilling the diagnostic criteria of DSM IV-TR and 50 participants with GMC. The descriptive statistics, correlation analysis and independent sample t test were used for data analysis. The results revealed the significant negative correlation of spiritual wellness with GAD symptoms and positive correlation between spiritual wellness, active practical and religious-focused coping strategies. The independent sample t test showed that spiritual wellness of participants with GMC was higher than participants with GAD. Moreover, out of 13 dimensions of spiritual wellness inventory, the scores of participants with minor general medical conditions in the dimensions of conception of divinity, present centeredness, hope, forgiveness, conscientiousness and spiritual freedom remained significantly higher than those with GAD. The participants with GMC used more active practical coping strategies and religious-focused coping strategies than participants with GAD. There was no difference between two groups of participants in using active distracting coping strategies, while avoidance-focused coping strategies were used by participants with GAD more than those with GMC.

Calidad de vida de adultos mayores en centros de protección social en Cartagena—Colombia

Objetivo: describir la calidad de vida relacionada con la salud de los adultos mayores residentes en centros de protección social en Cartagena (Colombia). Materiales y métodos: estudio descriptivo. La población fueron 187 adultos mayores residentes en centros de protección social en Cartagena. Se aplicó el Test de Valoración Mental (Pfeiffer), una encuesta sociodemográfica y el “Índice multicultural de calidad de vida”. Se mantuvo la confidencialidad de la información, el anonimato de los participantes y se diligenció el consentimiento informado. Resultados: el promedio de edad fue de 75 años (95 %), predominó el estado civil soltero (57,6 %), nivel educativo primaria (45,5 %), recibir medicamentos (80,3 %), realizar actividades físicas (54,5 %) y no realizar actividades productivas (37,9 %). La autopercepción de la calidad de vida relacionada con salud tiende a valores que pueden considerarse como buenos (7,6 %). Conclusiones: las dimensiones que presentaron puntajes más altos fueron la plenitud espiritual y el autocuidado, y con menor puntaje el bienestar físico y el apoyo comunitario. Esta información será útil para proponer políticas de salud y prácticas de cuidado para esta población.

Self-transcendence, spiritual perspective, and sense of purpose in family caregiving relationships: a mediated model of depression symptoms in Korean older adults

OBJECTIVES

This study used structural equation modeling to test the mediated model of late-life depression to understand the mechanisms that account for the direct and indirect effects of spiritual variables and purpose in life on depression within the context of Korean family caregiving relationships.

METHOD

A secondary analysis study design used data from a study that tested a theory of family interdependence of 157 Korean elder-family caregiver dyads in Seoul, Korea.

RESULTS

Both caregivers' and elders' self-transcendence was positively related to their own sense of purpose in life. However, only elders' spiritual perspective was related to purpose in life. Also, elders' purpose in life was positively associated with caregivers' purpose in life. Furthermore, there was a strong negative relationship between elders' purpose in life and their depressive symptoms, but there was not a significant negative relationship between caregivers' purpose in life and elders' depressive symptoms. Last, elders' purpose in life mediated the negative effects of elders' self-transcendence and spiritual perspective and of caregivers' self-transcendence and purpose in life on elders' depression.

CONCLUSION

The findings suggest that purpose in life for both the caregiver and elder played an important role in elders' depression. Self-transcendence also was related to decreased depression in elders. It is suggested that more attention be given to caregiver and elder purpose in life in developing interventions to reduce or avoid elder depression in Korean elders.

The spiritual well-being of elderly people: a study of a French sample

The aim of our research was to identify predictors of the spiritual well-being of elderly people. More specifically, we postulated that subjective well-being and its components would be predictors of spiritual well-being, and more so than age and health status. We invited 133 people aged 60-95 to complete a questionnaire that included the French adaptation (Velasco and Rioux in Revue Canadienne des Sciences du Comportement 41(2):102-128, 2009) of Paloutzian and Ellison's (Loneliness: A sourcebook of current theory, research and therapy, Wiley-Interscience, New York, 1982) Spiritual Well-Being Scale, Ryff and Essex's (Psychol Aging 7:507-517, 1992) Psychological Well-Being Scale (translated by Lapierre and Desrochers 1997), Salamon and Conte's (Meas Eval Guid 15(3):194-200, 1982) Life Satisfaction in the Elderly Scale (validated by Rousseau and Dubé in 1993), and the French version (Blais et al. in Can J Behav Sci 21:210-223, 1989) of Diener et al. (J Pers Assess 49:71-75, 1985) Satisfaction with Life Scale. The results only partially confirm our hypothesis, because only satisfaction with life as a whole and two items in "Life Satisfaction in the Elderly Scale" make it possible to predict the spiritual well-being of elderly people. Moreover, neither health status nor age was found to be a significant predictor of spiritual well-being. This research helps understand better the links between the concept of spiritual well-being and that of subjective well-being of elderly people and could contribute to the development of a tool that could take into account the spiritual well-being of elderly people, whether they be believers, agnostic, or atheist.

Effect of domain-specific life satisfaction on depressive symptoms in late adulthood and old age: results of a cross-sectional descriptive survey

PURPOSE

The aim of this study was to determine the effect of domain-specific life satisfaction on the risk of depressive symptoms in late adulthood and old age.

METHODS

A cross-sectional descriptive survey was conducted using stratified data from the Korean Longitudinal Study of Aging (KLoSA). The respondents completed the Korean version CES-D and domain-specific life satisfaction.

RESULTS

In both groups, satisfaction with health and economic status were significant predictors of depressive symptoms. In the old age group, depressive symptoms were also predicted by satisfaction with the relationships with one's spouse and with one's children.

CONCLUSION

Life satisfaction was a crucial predictive factor for depressive symptoms in late adulthood and old age.

Associations and impact factors between living arrangements and functional disability among older Chinese adults

Objectives

To examine the association of living arrangements with functional disability among older persons and explore the mediation of impact factors on the relationship.

Design

Cross-sectional analysis using data from Healthy Aging study in Zhejiang Province.

Participants

Analyzed sample was drawn from a representative rural population of older persons in Wuyi County, Zhejiang Province, including 1542 participants aged 60 and over in the second wave of the study.

Measurements

Living arrangements, background, functional disability, self-rated health, number of diseases, along with contemporaneous circumstances including income, social support (physical assistance and emotional support). Instrument was Activities of Daily Living (ADL) scale, including Basic Activities Daily Living (BADL) and Instrumental Activities of Daily Living (IADL).

Results

Living arrangements were significantly associated with BADL, IADL and ADL disability. Married persons living with or without children were more advantaged on all three dimensions of functional disability. Unmarried older adults living with children only had the worst functional status, even after controlling for background, social support, income and health status variables (compared with the unmarried living alone, ß for BADL: −1.262, ß for IADL: −2.112, ß for ADL: −3.388; compared with the married living with children only, ß for BADL: −1.166, ß for IADL: −2.723, ß for ADL: −3.902). In addition, older adults without difficulty in receiving emotional support, in excellent health and with advanced age had significantly better BADL, IADL and ADL function. However, a statistically significant association between physical assistance and functional disability was not found.

Conclusion

Functional disabilities vary by living arrangements with different patterns and other factors. Our results highlight the association of unmarried elders living with children only and functioning decline comparing with other types. Our study implies policy makers should pay closer attention to unmarried elders living with children in community. Community service especially emotional support such as psychological counseling is important social support and should be improved.

Quality of life in older outpatients living alone in the community in Italy

There is limited knowledge on the relationship between the living conditions of community-dwelling older people and their quality of life (QOL) considered in all its specific domains. The purpose of this study was to determine (1) which dimensions of QOL were independently associated with living alone and (2) the independent correlates of these dimensions of QOL amongst older outpatients. We conducted a cross-sectional survey of 239 community-dwelling outpatients aged 65+ (mean age 81.5 years) consecutively referred to a geriatric medicine clinic in Italy between June and November 2009 (response rate 93%). Subjects underwent a comprehensive geriatric assessment including QOL, which was evaluated by using the Older People's QOL questionnaire. In multivariate logistic regression analyses, living alone was associated with the lowest score-based tertile of two specific dimensions of QOL out of seven, namely 'social relationships and participation' [odds ratio (OR) 2.73, 95% confidence interval (CI) 1.08-6.91] and 'home and neighbourhood' (OR 4.96, 95% CI 1.75-14.07), independently of the main demographic, social, functional and clinical characteristics of the subjects. Amongst the 107 subjects living alone, independent correlates of these dimensions of QOL were depression, having no caregiver and having never been married. Depression, having no caregiver and having never been married could provide a valuable means of identifying older people living alone who are at greater risk of a poor QOL and who would most benefit from effective social and medical interventions.