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Hounkpatin H, Simpson G, Santer M, Farmer A, Dambha-Miller H. Multiple long-term conditions, loneliness and social isolation: A scoping review of recent quantitative studies. Arch Gerontol Geriatr 2024; 120:105347. [PMID: 38309103 DOI: 10.1016/j.archger.2024.105347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Multiple long-term conditions (MLTC), loneliness and social isolation are common in older adults. Recent studies have explored the association of MLTC with loneliness and social isolation. This scoping review aimed to map this current evidence and identify gaps in the literature. METHODS A scoping review was conducted following the PRISMA guidelines for scoping reviews. Ovid Medline, Embase, CINAHL, The Cochrane Library, PsycInfo, and Bielefeld Academic Search Engine were searched for studies published between January 2020-April 2023. Quantitative studies, published in any language, that assessed the association of MLTC with loneliness and/or social isolation were included. RESULTS 1827 records were identified and screened. Of these, 17 met inclusion criteria. Most studies were cross-sectional and based on older adults. Studies were conducted in Europe, the US, Canada, and low- and middle-income countries. Ten studies focused on the association between MLTC and loneliness, six assessed the association between MLTC and social isolation and one examined associations with both loneliness and social isolation. Most studies reported a significant cross-sectional association of MLTC with loneliness, but there was weaker evidence for a longitudinal association between MLTC and loneliness and an association between MLTC and social isolation. Studies were heterogenous in terms of measures and definitions of loneliness/social isolation and MLTC, confounders adjusted for, and analytical models used, making comparisons difficult. CONCLUSIONS Further population-based longitudinal studies using consistent measures and methodological approaches are needed to improve understanding of the association of MLTC with both loneliness and social isolation.
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Affiliation(s)
- Hilda Hounkpatin
- Primary Care Research Centre, School of Primary Care Population Sciences and Medical Education, University of Southampton, UK.
| | - Glenn Simpson
- Primary Care Research Centre, School of Primary Care Population Sciences and Medical Education, University of Southampton, UK
| | - Miriam Santer
- Primary Care Research Centre, School of Primary Care Population Sciences and Medical Education, University of Southampton, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Hajira Dambha-Miller
- Primary Care Research Centre, School of Primary Care Population Sciences and Medical Education, University of Southampton, UK
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Jäger M, Zangger G, Bricca A, Dideriksen M, Smith SM, Midtgaard J, Taylor RS, Skou ST. Mapping interventional components and behavior change techniques used to promote self-management in people with multimorbidity: a scoping review. Health Psychol Rev 2024; 18:165-188. [PMID: 36811829 PMCID: PMC7615688 DOI: 10.1080/17437199.2023.2182813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
Ageing populations and improved survival, have contributed to a rise in the number of people living with multimorbidity, raising issues related to polypharmacy, treatment burden, competing priorities and poor coordination of care. Self-management programs are increasingly included as an essential component of interventions to improve outcomes in this population. However, an overview of how interventions supporting self-management in patients with multimorbidity is missing. This scoping review focused on mapping the literature on patient-centered interventions for people living with multimorbidity. We searched several databases, clinical registries, and grey literature for RCTs published between 1990-2019 describing interventions that supported self-management in people with multimorbidity. We included 72 studies that were found to be very heterogeneous when it comes to the population, delivery modes and modalities, intervention elements and facilitators. The results pointed to an extensive use of cognitive behavioral therapy as a basis for interventions, as well as behavior change theories and disease management frameworks. The most coded behavior change techniques stemmed from the categories Social Support, Feedback and monitoring and Goals and Planning. To allow for implementation of effective interventions in clinical practice, improved reporting of intervention mechanisms in RCTs is warranted.
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Affiliation(s)
- Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Danish Centre for Motivation and Behaviour Science, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Graziella Zangger
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Mette Dideriksen
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Susan M. Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Rod S. Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, Scotland
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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Edney LC, Haji Ali Afzali H, Visvanathan R, Toson B, Karnon J. An exploration of healthcare use in older people waiting for and receiving Australian community-based aged care services. Geriatr Gerontol Int 2023; 23:899-905. [PMID: 37860887 DOI: 10.1111/ggi.14703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/21/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023]
Abstract
AIM Home care packages (HCPs) facilitate older individuals to remain at home, with longer HCP wait times associated with increased mortality risk. We analyze healthcare cost data pre- and post-HCP access to inform hypotheses around the effects of healthcare use and mortality risk. METHODS Regression models were used to assess the impact of delayed HCP access on healthcare costs and to compare costs whilst waiting and in the 6- and 12 month periods post-HCP access for 16 629 older adults. RESULTS Average wait time for a HCP was 89.7 days (SD = 125.6) during the study period. Wait-time length had no impact on any healthcare cost category or time period. However, total per day healthcare costs were higher in the 6 and 12 months post-receipt of a HCP (AU$61.5, AU$63, respectively) compared with those in the time waiting for a HCP (AU$48.1). Inpatient care accounted for a higher proportion of total healthcare costs post-HCP (AU$45.1, AU$46.3, respectively) compared with in the wait time (AU$30.6), whilst spending on medical services and pharmaceuticals reduced slightly in the 6 month (AU$7.1, AU$6.3) and 12 month (AU$7.2, AU$6.3) post-HCP periods compared with in the wait time (AU$7.9, AU$7.1). CONCLUSIONS Increased spending post-HCP on inpatient care or non-health support afforded by HCPs may offer protective effects for mortality and risk of admission to aged care. Further research should explore the association between delayed access to inpatient care for geriatric syndromes and mortality to inform recommendations on extensions to residential care outreach services into the community to improve the timely identification of the need for inpatient care. Geriatr Gerontol Int 2023; 23: 899-905.
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Affiliation(s)
- Laura C Edney
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Hossein Haji Ali Afzali
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- Aged and Extended Care Services, Queen Elizabeth Hospital and Basil Hetzel Institute, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Barbara Toson
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
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Zheng X, Xue B, Xiao S, Li X, Chen Y, Shi L, Liang X, Tian F, Zhang C. Development and validation of a multimorbidity risk prediction nomogram among Chinese middle-aged and older adults: a retrospective cohort study. BMJ Open 2023; 13:e077573. [PMID: 37940154 PMCID: PMC10632863 DOI: 10.1136/bmjopen-2023-077573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVES The aim of this study is to establish a self-simple-to-use nomogram to predict the risk of multimorbidity among middle-aged and older adults. DESIGN A retrospective cohort study. PARTICIPANTS We used data from the Chinese Longitudinal Healthy Longevity Survey, including 7735 samples. MAIN OUTCOME MEASURES Samples' demographic characteristics, modifiable lifestyles and depression were collected. Cox proportional hazard models and nomogram model were used to estimate the risk factors of multimorbidity. RESULTS A total of 3576 (46.2%) participants have multimorbidity. The result showed that age, female (HR 0.80, 95% CI 0.72 to 0.89), chronic disease (HR 2.59, 95% CI 2.38 to 2.82), sleep time (HR 0.78, 95% CI 0.72 to 0.85), regular physical activity (HR 0.88, 95% CI 0.81 to 0.95), drinking (HR 1.27 95% CI 1.16 to 1.39), smoking (HR 1.40, 95% CI 1.26 to 1.53), body mass index (HR 1.04, 95% CI 1.03 to 1.05) and depression (HR 1.02, 95% CI 1.01 to 1.03) were associated with multimorbidity. The C-index of nomogram models for derivation and validation sets were 0.70 (95% CI 0.69 to 0.71, p=0.006) and 0.71 (95% CI 0.70 to 0.73, p=0.008), respectively. CONCLUSIONS We have crafted a user-friendly nomogram model for predicting multimorbidity risk among middle-aged and older adults. This model integrates readily available and routinely assessed risk factors, enabling the early identification of high-risk individuals and offering tailored preventive and intervention strategies.
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Affiliation(s)
- Xiao Zheng
- Department of Health Management, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, China
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Benli Xue
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Shujuan Xiao
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Xinru Li
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Yimin Chen
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Lei Shi
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Xiaoyan Liang
- Department of Health Management, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Feng Tian
- Department of Health Management, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Chichen Zhang
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
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Roskoschinski A, Liang W, Duan Y, Al-Salehi H, Lippke S. Loneliness and depression in older adults with multimorbidity: the role of self-efficacy and social support. Front Psychiatry 2023; 14:1232067. [PMID: 37965359 PMCID: PMC10642299 DOI: 10.3389/fpsyt.2023.1232067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction As relatively little is known about self-efficacy and social support in individuals aged 65 years and older and whether they are facing a decline in life due to multimorbidity and previous COVID-19 infection, this study investigated hypotheses based on Social Cognitive Theory. Methods It was tested whether depressive symptoms in multimorbid patients who were hospitalized for COVID-19 infection, and recover post infection during their hospital stay, do not differ from those of multimorbid patients hospitalized for other conditions. Furthermore, we tested whether depressive symptoms are associated with increased loneliness scores, low self-efficacy beliefs, and poorly perceived social support. Additionally, it was investigated whether self-efficacy is a mediator variable, and social support is a moderator variable between loneliness and depression. N = 135 patients with or without previous COVID-19 infection (mean age 64.76) were recruited. Paper questionnaires were collected at the time of inpatient hospital admission in the year 2021 and in a cross-sectional study design. The study compared n = 45 multimorbid patients who survived COVID-19 infection with those n = 90 who were not infected before. Results No significant difference in depressive symptomology between these two groups revealed [t(133) = 130, p = 0.90, d = 0.024); F(3, 122) = 0.255, p = 0.86]. The study found a positive correlation between loneliness and anxiety and depression in both groups (rdepression = 0.419 and ranxiety = 0.496). Self-efficacy mediated the relation between loneliness and depression. The completely standardized indirect effect was β = 0.111, percentile Bootstrap 95% CI 0.027-0.201. Discussion The research findings suggest the importance of self-efficacy, and loneliness in the development of depressive symptoms, and have several practical implications for improving the mental health of multimorbid patients: Prospectively, treatment should not only focus on physical and cognitive health, but also on promoting self-efficacy and perceived social support, as well as address loneliness with psychoeducational interventions. Replication of the findings and conducting interventional research also employing lifestyle components should follow up, as this study tested associations but no causal relationships.
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Affiliation(s)
- Annika Roskoschinski
- Unit for Geriatrics and Physical Medicine, Helios Klinikum Berlin-Buch, Berlin, Germany
- Constructor University Bremen, Bremen, Germany
| | - Wei Liang
- School of Physical Education, Shenzhen University, Shenzhen, China
| | - Yanping Duan
- Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Hayl Al-Salehi
- Constructor University Bremen, Bremen, Germany
- Bremen International Graduate School of Social Sciences (BIGSSS), Bremen, Germany
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Feng X, Sarma H, Seubsman SA, Sleigh A, Kelly M. The Impact of Multimorbidity on All-Cause Mortality: A Longitudinal Study of 87,151 Thai Adults. Int J Public Health 2023; 68:1606137. [PMID: 37881771 PMCID: PMC10594150 DOI: 10.3389/ijph.2023.1606137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/21/2023] [Indexed: 10/27/2023] Open
Abstract
Objectives: To investigate associations between multimorbidity, socio-demographic and health behaviour factors, and their interactions (multimorbidity and these factors) with all-cause mortality among Thai adults. Methods: Associations between multimorbidity (coexistence of two + chronic diseases) and mortality between 2005 and 2019 were investigated among Thai Cohort Study (TCS) participants (n = 87,151). Kaplan-Meier survival curves estimated and compared survival times. Multivariate Cox proportional hazards models examined associations between risk factors, and interactions between multimorbidity, these factors, and survival. Results: 1,958 cohort members died between 2005 and 2019. The risk of death was 43% higher for multimorbid people. In multivariate Cox proportional hazard models, multimorbidity/number of chronic conditions, age, long sleep duration, smoking and drinking were all independent factors that increased mortality risk. Women, urbanizers, university education, over 20,000-baht personal monthly income and soybean products consumption lowered risk. The interactions between multimorbidity and these variables (except for female, urbanizers and soybeans intake) also had significant (p < 0.05) impact on all-cause mortality. Conclusion: The results emphasise the importance of healthy lifestyle and reduced intake of alcohol and tobacco, in reducing premature mortality, especially when suffering from multimorbidity.
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Affiliation(s)
- Xiyu Feng
- National Centre of Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Haribondhu Sarma
- National Centre of Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Sam-Ang Seubsman
- School of Human Ecology, Sukhothai Thammathirat Open University, Pak Kret, Thailand
| | - Adrian Sleigh
- National Centre of Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Matthew Kelly
- National Centre of Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
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Wang F, Gao Y, Han Z, Yu Y, Long Z, Jiang X, Wu Y, Pei B, Cao Y, Ye J, Wang M, Zhao Y. A systematic review and meta-analysis of 90 cohort studies of social isolation, loneliness and mortality. Nat Hum Behav 2023; 7:1307-1319. [PMID: 37337095 DOI: 10.1038/s41562-023-01617-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 04/27/2023] [Indexed: 06/21/2023]
Abstract
The associations between social isolation, loneliness and the risk of mortality from all causes, cardiovascular disease (CVD) and cancer are controversial. We systematically reviewed prospective studies on the association between social isolation, loneliness and mortality outcomes in adults aged 18 years or older, as well as studies on these relationships in individuals with CVD or cancer, and conducted a meta-analysis. The study protocol was registered with PROSPERO (reg. no. CRD42022299959). A total of 90 prospective cohort studies including 2,205,199 individuals were included. Here we show that, in the general population, both social isolation and loneliness were significantly associated with an increased risk of all-cause mortality (pooled effect size for social isolation, 1.32; 95% confidence interval (CI), 1.26 to 1.39; P < 0.001; pooled effect size for loneliness, 1.14; 95% CI, 1.08 to 1.20; P < 0.001) and cancer mortality (pooled effect size for social isolation, 1.24; 95% CI, 1.19 to 1.28; P < 0.001; pooled effect size for loneliness, 1.09; 95% CI, 1.01 to 1.17; P = 0.030). Social isolation also increased the risk of CVD mortality (1.34; 95% CI, 1.25 to 1.44; P < 0.001). There was an increased risk of all-cause mortality in socially isolated individuals with CVD (1.28; 95% CI, 1.10 to 1.48; P = 0.001) or breast cancer (1.51; 95% CI, 1.34 to 1.70; P < 0.001), and individuals with breast cancer had a higher cancer-specific mortality owing to social isolation (1.33; 95% CI, 1.02 to 1.75; P = 0.038). Greater focus on social isolation and loneliness may help improve people's well-being and mortality risk.
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Affiliation(s)
- Fan Wang
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, P. R. China
- NHC Key Laboratory of Etiology and Epidemiology, Harbin Medical University, Harbin, P. R. China
| | - Yu Gao
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, P. R. China
| | - Zhen Han
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, P. R. China
| | - Yue Yu
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, P. R. China
| | - Zhiping Long
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, P. R. China
| | - Xianchen Jiang
- Department of Chronic Disease Prevention and Control, Quzhou Center for Disease Control and Prevention, Quzhou, P. R. China
| | - Yi Wu
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, P. R. China
| | - Bing Pei
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, P. R. China
| | - Yukun Cao
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, P. R. China
| | - Jingyu Ye
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, P. R. China
| | - Maoqing Wang
- National Key Disciplines of Nutrition and Food Hygiene, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, P. R. China.
| | - Yashuang Zhao
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, P. R. China.
- NHC Key Laboratory of Etiology and Epidemiology, Harbin Medical University, Harbin, P. R. China.
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Kaba D, Salwi SM, Daniel NR, Polenick CA. 'I feel like this will never end': mental health during the COVID-19 pandemic among older adults with chronic conditions. Aging Ment Health 2023; 27:1576-1583. [PMID: 37020428 PMCID: PMC10524161 DOI: 10.1080/13607863.2023.2193553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/15/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVES The COVID-19 pandemic may have a negative impact on mental health, especially among older adults with chronic conditions who are more vulnerable to severe illness. In this qualitative study, we evaluated how the pandemic has impacted the ways that adults aged 50 and older with chronic conditions managed their mental health. METHODS A total of 492 adults (M = 64.95 years, SD = 8.91, range = 50-94) who lived in Michigan (82.1%) and 33 other U.S. states completed one anonymous online survey between 14 May 14 and 9 July 2020. Open-ended responses were coded to ascertain relevant concepts and were reduced to develop major themes. RESULTS We determined four main themes. The COVID-19 pandemic impacted how participants took care of their mental health through: (1) pandemic-related barriers to social interaction; (2) pandemic-related routine changes; (3) pandemic-related stress; and (4) pandemic-related changes to mental health service use. CONCLUSION This study indicates that older adults with chronic conditions experienced various challenges to managing their mental health in the early months of the COVID-19 pandemic, but also showed considerable resilience. The findings identify potential targets of personalized interventions to preserve their well-being during this pandemic and in future public health crises.
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Affiliation(s)
- Diarratou Kaba
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
| | - Shreya M. Salwi
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
| | - Nikita R. Daniel
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
| | - Courtney A. Polenick
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
- Aging & Biopsychosocial Innovations Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104
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Eyowas FA, Schneider M, Alemu S, Getahun FA. Multimorbidity and adverse longitudinal outcomes among patients attending chronic outpatient medical care in Bahir Dar, Northwest Ethiopia. Front Med (Lausanne) 2023; 10:1085888. [PMID: 37250625 PMCID: PMC10213652 DOI: 10.3389/fmed.2023.1085888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Background Multimorbidity is becoming more prevalent in low-and middle-income countries (LMICs). However, the evidence base on the burden and its longitudinal outcomes are limited. This study aimed to determine the longitudinal outcomes of patients with multimorbidity among a sample of individuals attending chronic outpatient non communicable diseases (NCDs) care in Bahir Dar, northwest Ethiopia. Methods A facility-based longitudinal study was conducted among 1,123 participants aged 40+ attending care for single NCD (n = 491) or multimorbidity (n = 633). Data were collected both at baseline and after 1 year through standardized interviews and record reviews. Data were analyzed using Stata V.16. Descriptive statistics and longitudinal panel data analyzes were run to describe independent variables and identify factors predicting outcomes. Statistical significance was considered at p-value <0.05. Results The magnitude of multimorbidity has increased from 54.8% at baseline to 56.8% at 1 year. Four percent (n = 44) of patients were diagnosed with one or more NCDs and those having multimorbidity at baseline were more likely than those without multimorbidity to develop new NCDs. In addition, 106 (9.4%) and 22 (2%) individuals, respectively were hospitalized and died during the follow up period. In this study, about one-third of the participants had higher quality of life (QoL), and those having higher high activation status were more likely to be in the higher versus the combined moderate and lower QoL [AOR1 = 2.35, 95%CI: (1.93, 2.87)] and in the combined higher and moderate versus lower level of QoL [AOR2 = 1.53, 95%CI: (1.25, 1.88)]. Conclusion Developing new NCDs is a frequent occurrence and the prevalence of multimorbidity is high. Living with multimorbidity was associated with poor progress, hospitalization and mortality. Patients having a higher activation level were more likely than those with low activation to have better QoL. If health systems are to meet the needs of the people with chronic conditions and multimorbidity, it is essential to understand diseases trajectories and of impact of multimorbidity on QoL, and determinants and individual capacities, and to increase their activation levels for better health improve outcomes through education and activation.
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Affiliation(s)
- Fantu Abebe Eyowas
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Marguerite Schneider
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Shitaye Alemu
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fentie Ambaw Getahun
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Vespa A, Spatuzzi R, Fabbietti P, Di Rosa M, Bonfigli AR, Corsonello A, Gattafoni P, Giulietti MV. Association between Sense of Loneliness and Quality of Life in Older Adults with Multimorbidity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2615. [PMID: 36767986 PMCID: PMC9915419 DOI: 10.3390/ijerph20032615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Multimorbidity has been associated with adverse health outcomes, such as reduced physical function, poor quality-of-life (QoL), poor self-rated health. OBJECTIVE The association between quality of life, social support, sense of loneliness and sex and age in older adult patients affected by two or more chronic diseases (multimorbidity) was evaluated. METHODS Patients n. 162 with multimorbidity and living with family members. TESTS MMSE-Mini-Mental-State-Examination; ADL-Activities of Daily Living; Social Schedule: demographic variables; Loneliness Scale -de Jong Gierveld; Quality-of-Life-FACT-G; WHOQOL-BRIEF Social relationships. STATISTICAL ANALYSIS Multivariate Regression Analysis. RESULTS The patients with three or more diseases have worse dimensions of FACT-G total score (p = 0.029), QoL Physical-well-being (p = 0.003), Social well-being (p = 0.003), Emotional-well-being (p = 0.012), Functional-well-being (p < 0.001), than those with two. Multiple linear regression QoL: FACT_G total score, PWB, SWB, EWB, FWB as dependent variables. In the presence of multimorbidity with an increase in the patient's age FACT-G total score (B = -0.004, p = 0.482), PWB (B = -0.024, p = 0.014), SWB (B = -0.022, p = 0.051), EWB (B = -0.001, p = 0.939), FWB (B = -0.023, p = 0.013) decrease by an average of 0.1, and as the sense of solitude increases FACT-G total score (B = -0.285, p < 0.000), PWB (B = -0.435, p < 0.000), SWB(B = -0.401, p < 0.000), EWB(B = -0.494, p < 0.000), FWB(B = -0.429, p < 0.000) decrease by 0.4. CONCLUSIONS A sense of loneliness and advancing age are associated with bad quality-of life in self-sufficient elderly patients with multimorbidity. IMPLICATIONS FOR PRACTICE Demonstrating that loneliness, as well as in the presence of interpersonal relations, is predictive of worse quality of life in patients with multimorbidity helps identify people most at risk for common symptoms and lays the groundwork for research concerning both diagnosis and treatment.
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Affiliation(s)
- Anna Vespa
- Scientific and Technological Area, Department of Neurology, Italian National Research Center On Aging (IRCCS INRCA), 60124 Ancona, Italy
| | - Roberta Spatuzzi
- Department of Mental Health, ASP Basilicata, 85100 Potenza, Italy
| | - Paolo Fabbietti
- Laboratory of Biostatistics, Italian National Research Center On Aging (IRCCS INRCA), 60124 Ancona, Italy
| | - Mirko Di Rosa
- Laboratory of Biostatistics, Italian National Research Center On Aging (IRCCS INRCA), 60124 Ancona, Italy
| | - Anna Rita Bonfigli
- Scientific Direction, Italian National Research Center On Aging (IRCCS INRCA), 60124 Ancona, Italy
| | - Andrea Corsonello
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, Italian National Research Center On Aging (IRCCS INRCA), 87100 Cosenza, Italy
| | - Pisana Gattafoni
- Clinic of Internal Medicine and Geriatric, Italian National Research Center On Aging (IRCCS INRCA), 60124 Ancona, Italy
| | - Maria Velia Giulietti
- Department of Neurology, Italian National Research Center On Aging (IRCCS INRCA), 60124 Ancona, Italy
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Multimorbidity and loneliness. Longitudinal analysis based on the GSOEP. Arch Gerontol Geriatr 2023; 105:104843. [PMID: 36335675 DOI: 10.1016/j.archger.2022.104843] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/27/2022] [Accepted: 10/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Our aim was to examine the longitudinal association between multimorbidity and loneliness in the general adult population (and in different age groups) in Germany. METHODS Longitudinal data were used from the German Socio-Economic Panel (n= 44,385 observations in the years 2013 and 2017) - a nationally representative sample including adults aged 18 years and above. Respondents are re-surveyed annually. Loneliness was quantified using the established UCLA-3. Multimorbidity was defined as the coexistence of two or more conditions and was indicated by a list containing 13 somatic and mental diseases. Asymmetric linear fixed effects regressions (also stratified by three age groups: 18 to 44 years; 45 to 64 years, 65 years and older) were used to examine the association between the onset and end of multimorbidity as well as loneliness. RESULTS After adjusting for possible confounders, regression analysis revealed that the onset of multimorbidity is associated with an increase in loneliness in the total sample (β = 0.07, p < 0.001) and among individuals aged 65 years and older (β = 0.13, p < 0.001), whereas no significant association was found in the other age groups. The end of multimorbidity was not associated with loneliness neither in the total group nor in the individual age groups. CONCLUSION This study revealed an association between the onset of multimorbidity and higher loneliness particularly among individuals in late life. Thus, preventing or delaying multimorbidity may be beneficial to avoid loneliness among older adults.
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12
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Woodhall-Melnik J, Dunn JR, Dweik I, Monette C, Nombro E, Pappas J, Lamont A, Dutton D, Doucet S, Luke A, Matheson FI, Nisenbaum R, Stergiopoulos V, Stewart C. NB housing study protocol: investigating the relationship between subsidized housing, mental health, physical health and healthcare use in New Brunswick, Canada. BMC Public Health 2022; 22:2448. [PMID: 36577991 PMCID: PMC9795752 DOI: 10.1186/s12889-022-14923-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Income and housing are pervasive social determinants of health. Subsidized housing is a prominent affordability mechanism in Canada; however, waitlists are lengthy. Subsidized rents should provide greater access to residual income, which may theoretically improve health outcomes. However, little is known about the health of tenants who wait for and receive subsidized housing. This is especially problematic for New Brunswick, a Canadian province with low population density, whose inhabitants experience income inequality, social exclusion, and challenges with healthcare access. METHODS: This study will use a longitudinal, prospective matched cohort design. All 4,750 households on New Brunswick's subsidized housing wait list will be approached to participate. The survey measures various demographic, social and health indicators at six-month intervals for up to 18 months as they wait for subsidized housing. Those who receive housing will join an intervention group and receive surveys for an additional 18 months post-move date. With consent, participants will have their data linked to a provincial administrative database of medical records. DISCUSSION: Knowledge of housing and health is sparse in Canada. This study will provide stakeholders with a wealth of health information on a population that is historically under-researched and underserved.
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Affiliation(s)
- J. Woodhall-Melnik
- grid.266820.80000 0004 0402 6152Department of Social Sciences, University of New Brunswick, 100 Tucker Park, Saint John, New Brunswick, NB E2L 4L5 Canada
| | - J. R. Dunn
- grid.25073.330000 0004 1936 8227Department of Health, Aging and Society, McMaster University, Hamilton, ON Canada
| | - I. Dweik
- grid.266820.80000 0004 0402 6152Department of Social Sciences, University of New Brunswick, 100 Tucker Park, Saint John, New Brunswick, NB E2L 4L5 Canada
| | - C. Monette
- grid.266820.80000 0004 0402 6152Department of Social Sciences, University of New Brunswick, 100 Tucker Park, Saint John, New Brunswick, NB E2L 4L5 Canada
| | - E. Nombro
- grid.266820.80000 0004 0402 6152Department of Social Sciences, University of New Brunswick, 100 Tucker Park, Saint John, New Brunswick, NB E2L 4L5 Canada
| | - J. Pappas
- grid.266820.80000 0004 0402 6152Department of Social Sciences, University of New Brunswick, 100 Tucker Park, Saint John, New Brunswick, NB E2L 4L5 Canada
| | - A. Lamont
- grid.266820.80000 0004 0402 6152Department of Social Sciences, University of New Brunswick, 100 Tucker Park, Saint John, New Brunswick, NB E2L 4L5 Canada ,grid.266820.80000 0004 0402 6152Department of Psychology, University of New Brunswick, Fredericton, Canada
| | - D. Dutton
- grid.55602.340000 0004 1936 8200Department of Community Health and Epidemiology, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - S. Doucet
- grid.266820.80000 0004 0402 6152Department of Nursing, University of New Brunswick, Saint John, New Brunswick, Canada
| | - A. Luke
- grid.415502.7MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON Canada
| | - F. I. Matheson
- grid.415502.7MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - R. Nisenbaum
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - V. Stergiopoulos
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.468082.00000 0000 9533 0272Canadian Mental Health Association, Toronto, ON Canada
| | - C. Stewart
- grid.266820.80000 0004 0402 6152Department of Mathematics and Statistics, University of New Brunswick, Saint John, New Brunswick, Canada
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13
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Ibáñez-del Valle V, Corchón S, Zaharia G, Cauli O. Social and Emotional Loneliness in Older Community Dwelling-Individuals: The Role of Socio-Demographics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16622. [PMID: 36554512 PMCID: PMC9779629 DOI: 10.3390/ijerph192416622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Social determinants have a major influence on individuals' health, and among them, loneliness has an important impact on the health of the elderly. OBJECTIVES The aims were to determine loneliness and its social and emotional components in a sample of elderly people and to assess its prevalence and associations with sociodemographic variables. METHODS Analytical, cross-sectional, observational research was carried out based on a population over 60 years of age in Valencia (Spain). Loneliness was assessed with the De Jong-Gierveld Loneliness Scale. RESULTS Five-hundred and thirty community-dwelling individuals participated. The mean age of the sample was 72.7 years (84.2% women); 36.2% suffered from moderate loneliness and 6.6% suffered from extreme loneliness. The sociodemographic variables most significantly related to loneliness were being single, separated, or divorced (p < 0.01). Among widowers, loneliness was inversely associated with years of widowhood (p < 0.01). Having sons/daughters was a significant protective factor (p < 0.05), while having grandchildren or siblings did not have a significant influence. The ability to walk and smartphone and video call use were not associated with loneliness. CONCLUSIONS There is a high prevalence of unwanted loneliness in community-dwelling individuals, and some social factors play an important role. Interventions against loneliness among older people are a priority for welfare and public health.
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Affiliation(s)
- Vanessa Ibáñez-del Valle
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
- Department of Nursing, University of Valencia, 46010 Valencia, Spain
| | - Silvia Corchón
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
- Department of Nursing, University of Valencia, 46010 Valencia, Spain
| | - Georgiana Zaharia
- Department of Nursing, University of Valencia, 46010 Valencia, Spain
| | - Omar Cauli
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
- Department of Nursing, University of Valencia, 46010 Valencia, Spain
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14
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Schutter N, Holwerda TJ, Comijs HC, Stek ML, Peen J, Dekker JJM. Loneliness, social network size and mortality in older adults: a meta-analysis. Eur J Ageing 2022; 19:1057-1076. [PMID: 36692789 PMCID: PMC9685120 DOI: 10.1007/s10433-022-00740-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 11/23/2022] Open
Abstract
Loneliness and social network size have been found to be predictors of mortality in older adults. The objective of this study was to investigate whether loneliness and small social network size are associated with an increased mortality risk and to review the evidence for either network size, or loneliness that constitutes the higher mortality risk. A systematic literature search was performed in PubMed, EMBASE and PsychInfo in January/February 2018 and March/April 2021. Studies that mentioned outcome data were included in the meta-analysis and coded using the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies. The meta-analysis showed that both loneliness and small social network size are associated with mortality risk in older adults (Hazard Ratio 1.10 (95% Confidence Interval 1.06-1.14) for loneliness and 0.96 (95% Confidence Interval 0.93-0.99) for larger network size). Sensitivity analyses according to the Newcastle-Ottawa Quality Assessment Scale yielded varying results. Heterogeneity was large. In conclusion, both loneliness and small social network size in older adults are associated with increased mortality, although the effect size is small. Targeting subjective and objective aspects of older adults' social contacts should be on the agenda of preventive as well as personalized medicine. In order to be able to compare the association between loneliness and network size and mortality, more studies are needed that include both these risk factors.
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Affiliation(s)
- Natasja Schutter
- Department of Geriatric Psychiatry, Arkin Mental Health Care, Nieuwe Kerkstraat 156, 1018 VM Amsterdam, The Netherlands
| | - Tjalling J. Holwerda
- Department of Psychiatry, Arkin Mental Health Care, Roetersstraat 210, 1018 WE Amsterdam, The Netherlands
| | - Hannie C. Comijs
- GGZ InGeest/Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Max L. Stek
- GGZ InGeest/Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Jaap Peen
- Department of Clinical Research, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Jack J. M. Dekker
- Department of Clinical Research, Arkin Mental Health Care, Amsterdam, The Netherlands
- Department of Psychology, VU University Amsterdam, Amsterdam, The Netherlands
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15
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Lamar M, James BD, Glover CM, Capuano AW, McSorley VE, Wilson RS, Barnes LL. Social Engagement and All-Cause Mortality: A Focus on Participants of the Minority Aging Research Study. Am J Prev Med 2022; 63:700-707. [PMID: 36272760 PMCID: PMC10019601 DOI: 10.1016/j.amepre.2022.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/10/2022] [Accepted: 05/09/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Social engagement is known to improve health; less is known about whether social activities at the core of African American life decrease mortality risk in this minoritized population. This study investigated whether and which aspects of social engagement predict mortality risk in older African Americans. METHODS Data from 768 African Americans (aged ∼73 years; nondemented at baseline) participating in the Minority Aging Research Study, a longitudinal community-based, cohort study of aging, was collected between 2004 and 2020 and analyzed in 2020. Participants self-reported late-life social activity, social network size, life space, and purpose in life at baseline and completed approximately 6.5 years of annual follow-up (range=15.70). Cox models included time from baseline to death or censoring and an indicator for death versus censored with age, sex, education, cardiovascular disease risk factor burden, depressive symptomatology, and motor gait performance as covariates. RESULTS As of March 2020, 25% of participants died (n=192; age at death ∼83 years). In fully adjusted Cox models, mortality risk decreased by 34% (hazard ratio=0.66; 95% CI=0.48, 0.91; p=0.012) for those with higher compared with that for those with lower social activity generally, with community/volunteer-, group-, and socially-related activities specifically driving these results. CONCLUSIONS Engaging in late-life social activity, especially group- and socially-based activities, was most consistently and robustly associated with reduced mortality risk in African Americans regardless of health. These results lay the foundation for considering community-based approaches to increase and/or maintain social participation in older African Americans as a potential means by which to increase longevity in this population.
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Affiliation(s)
- Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois.
| | - Bryan D James
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois; Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Crystal M Glover
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Ana W Capuano
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois; Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - V Eloesa McSorley
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois; Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois; Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
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16
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Lee TW, Chung J, Song K, Kim E. Incidence and predictors of multimorbidity among older adults in Korea: a 10-year cohort study. BMC Geriatr 2022; 22:565. [PMID: 35799103 PMCID: PMC9264523 DOI: 10.1186/s12877-022-03250-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the rapid growth of the older adult population, multimorbidity has become a global concern for an aging society. Multimorbidity has been associated with poor health outcomes, including low quality of life and a high risk of mortality, resulting in an overload of healthcare systems. However, multimorbidity incidence and its related factors are poorly understood among older adults. This study aimed to determine whether sociodemographic characteristics, lifestyle, and psychosocial factors predict multimorbidity incidence among older adults in Korea. METHODS This longitudinal study used the Korean Longitudinal Study of Aging (KLoSA) dataset from 2008 to 2018. The KLoSA is a panel survey of nationally representative samples aimed at providing data for developing socioeconomic policies for the increasing aging population in Korea. The study sample included 1967 older adults aged 65 years and over who had none or one of the chronic diseases at the baseline in 2008. Multimorbidity incidence was defined as the co-existence of two or more chronic diseases among 12 doctor-diagnosed diseases based on self-reports. Cox's proportional hazards models were used to identify significant predictors of multimorbidity incidence over a 10-year follow-up period. RESULTS Among 1967 respondents (female 54.5%, mean age 72.94), 625 (31.8%) incidents of multimorbidity were reported, contributing to 47.5 incidents per 1000 people after 10 years of follow-up. Low levels of social interaction, obesity, past smoking habits, and current or past drinking habits were identified as significant predictors of multimorbidity incidence among older adults in Korea. CONCLUSIONS This study identified older adults at high risk for multimorbidity incidence. These groups require more attention from health care providers in the course of chronic disease monitoring and management. Specific interventions and health policies to promote social interaction and a healthy lifestyle are essential to delay multimorbidity incidence. This longitudinal approach will contribute to developing preventive strategies to reduce the incidence of multimorbidity among older adults.
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Affiliation(s)
- Tae Wha Lee
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Jane Chung
- School of Nursing, Virginia Commonwealth University, Virginia, USA
| | - Kijun Song
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Eunkyung Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea.
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Greene MC, Bonz A, Cristobal M, Vega C, Andersen LS, Angulo A, Armijos A, Guevara ME, Benavides L, de la Cruz A, Lopez MJ, Moyano A, Murcia A, Noboa MJ, Rodriguez A, Solis J, Vergara D, Scharf J, Dutt P, Wainberg M, Tol WA. Evaluating the feasibility of a group psychosocial intervention for migrant and host community women in Ecuador and Panamá: protocol for a multi-site feasibility cluster trial. Pilot Feasibility Stud 2022; 8:126. [PMID: 35706068 PMCID: PMC9198203 DOI: 10.1186/s40814-022-01085-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 06/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community- and strengths-based psychosocial interventions are central to mental health and psychosocial support guidelines, but rigorous evidence regarding the effectiveness of these interventions is limited. The complexity and variability that is inherent to many community-based psychosocial interventions requires innovative strategies in order to facilitate the comparability and synthesis across research studies without compromising the fit and appropriateness of interventions to specific study populations and context. Entre Nosotras is a community-based psychosocial intervention developed for migrant and host community women that is designed to be flexible enough to enable integration of external intervention components and adaptable to diverse study contexts and populations. This protocol describes a study that aims to evaluate the appropriateness, acceptability, and feasibility of integrating a standardized stress management intervention into Entre Nosotras. METHODS This study will evaluate the appropriateness, acceptability, feasibility, and safety of intervention and research procedures for a cluster randomized comparative effectiveness trial conducted in Ecuador and Panamá with migrant and host community women. In this feasibility trial, we will allocate communities nested within the three study sites to the integrated Entre Nosotras + stress management intervention versus Entre Nosotras alone through stratified randomization. Migrant and host community women residing in these study communities who report low to moderate levels of distress will be allocated to the intervention condition that their community is assigned (n = 220 total). We will collect quantitative measures of psychosocial wellbeing, psychological distress, coping, social support, and functioning from study participants. We will collect quantitative measures of fidelity and facilitator competencies through observation and facilitator self-assessment. Data on appropriateness, acceptability, feasibility, and safety will be gathered from participants and facilitators through quantitative assessments at 0, 5, and 10 weeks post-enrollment and qualitative interviews conducted with all facilitators and a subset of 70 study participants during the post-intervention follow-up period. DISCUSSION Results from this feasibility trial will determine whether a multi-site cluster randomized comparative effectiveness trial of an adaptable community-based psychosocial intervention for migrant and host community women is relevant, acceptable, and feasible. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05130944 . Registered November 23, 2021-retrospectively registered.
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Affiliation(s)
- M Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, USA.
| | | | | | | | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jodi Scharf
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, USA
| | - Priya Dutt
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, USA
| | - Milton Wainberg
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York City, USA
| | - Wietse A Tol
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Hwang S, Nam JY, Ahn JH, Park S. Gender differences in the association between multimorbidity and depression in older Korean adults: an analysis of data from the National Survey of Older Koreans (2011-2017). Epidemiol Health 2022; 44:e2022049. [PMID: 35638226 PMCID: PMC9714839 DOI: 10.4178/epih.e2022049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/24/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Previous studies have shown that people with multimorbidity have a higher risk of depression than those without multimorbidity. However, few studies have examined the association between depression and multimorbidity in men and women separately. Since the rates of depression and multimorbidity are different in men and women, it is necessary to examine whether gender differences affect their association. METHODS This study included 30,138 participants (aged ≥ 65 years) from the National Survey of Older Koreans (2011-2017). Depression was defined using the Korean version of the Geriatric Depression Scale (SGDS-K). Multimorbidity was defined as people who had 2 or more chronic diseases, including arthritis, diabetes, heart disease, hypertension, pulmonary disease, cancer, stroke, or osteoporosis. Multiple logistic regression analysis was performed to determine the association between depression and multimorbidity. RESULTS In total, 22.2% and 30.7% of men and women, respectively, had depression. Those with multimorbidity had a higher risk of depression than those without chronic conditions; specifically, the difference in risk among men was greater than that among women. Age was considered a moderator for women. While the effects of pulmonary disease, stroke, and cancer were especially substantial in the integrated analysis, gender differences were observed related to various chronic conditions comorbid with heart disease. CONCLUSIONS There are gender differences in the association between multimorbidity and depression among older Korean adults. Therefore, gender-specific care should be provided to reduce depression in older adults with multimorbidity.
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Affiliation(s)
- SeoYeon Hwang
- Department of Healthcare Management, Eulji University, Sungnam, Korea
| | - Jin Young Nam
- Department of Healthcare Management, Eulji University, Sungnam, Korea,Correspondence: Jin Young Nam Department of Healthcare Management, Eulji University, 553 Sanseongdae-ro, Sujeong-gu, Seongnam 13135, Korea E-mail:
| | - Jeong Hyun Ahn
- Department of Healthcare Management, Eulji University, Sungnam, Korea
| | - Soojin Park
- Department of Healthcare Management, Eulji University, Sungnam, Korea
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19
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Associations of face-to-face and non-face-to-face social isolation with all-cause and cause-specific mortality: 13-year follow-up of the Guangzhou Biobank Cohort study. BMC Med 2022; 20:178. [PMID: 35501792 PMCID: PMC9059436 DOI: 10.1186/s12916-022-02368-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/06/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although social isolation has been associated with a higher mortality risk, little is known about the potential different impacts of face-to-face and non-face-to-face isolation on mortality. We examined the prospective associations of four types of social isolation, including face-to-face isolation with co-inhabitants and non-co-inhabitants, non-face-to-face isolation, and club/organization isolation, with all-cause and cause-specific mortality separately. METHODS This prospective cohort study included 30,430 adults in Guangzhou Biobank Cohort Study (GBCS), who were recruited during 2003-2008 and followed up till Dec 2019. RESULTS During an average of 13.2 years of follow-up, 4933 deaths occurred during 396,466 person-years. Participants who lived alone had higher risks of all-cause (adjusted hazard ratio (AHR) 1.24; 95% confidence interval (CI) 1.04-1.49) and cardiovascular disease (CVD) (1.61; 1.20-2.03) mortality than those who had ≥ 3 co-habitant contact after adjustment for thirteen potential confounders. Compared with those who had ≥ 1 time/month non-co-inhabitant contact, those without such contact had higher risks of all-cause (1.60; 1.20-2.00) and CVD (1.91; 1.20-2.62) mortality. The corresponding AHR (95% CI) in participants without telephone/mail contact were 1.27 (1.14-1.42) for all-cause, 1.30 (1.08-1.56) for CVD, and 1.37 (1.12-1.67) for other-cause mortality. However, no association of club/organization contact with the above mortality and no association of all four types of isolation with cancer mortality were found. CONCLUSIONS In this cohort study, face-to-face and non-face-to-face isolation were both positively associated with all-cause, CVD-, and other-cause (but not cancer) mortality. Our finding suggests a need to promote non-face-to-face contact among middle-aged and older adults.
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Roomaney RA, van Wyk B, Cois A, Pillay-van Wyk V. Multimorbidity Patterns in a National HIV Survey of South African Youth and Adults. Front Public Health 2022; 10:862993. [PMID: 35444991 PMCID: PMC9015099 DOI: 10.3389/fpubh.2022.862993] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Information pertaining to multimorbidity is frequently informed by studies from high income countries and it is unclear how these findings relate to low and middle income countries, where the burden of infectious disease is high. South Africa has a quadruple burden of disease which includes a high HIV prevalence and a growing burden of non-communicable diseases. This study aimed to analyse the prevalence and patterns (disease classes or clusters) of multimorbidity in South Africa. Methods A secondary analysis of individuals over the age of 15 years who participated in the Fifth South African National HIV Prevalence, Incidence, Behavior and Communication Survey, 2017 (SABSSM 2017) was done. Six disease conditions were identified in the analysis (cancer, diabetes, heart disease, hypertension/high blood pressure, tuberculosis, and HIV). Chi-square tests were used to test for the differences in disease prevalence by sex. Common disease patterns were identified using a latent class analysis. Results The sample included 27,896 participants, of which 1,837 had comorbidity or multimorbidity. When taking population-weighting into account, multimorbidity was present in 5.9% (95% CI: 5.4–6.4) of the population The prevalence of multimorbidity tended to be higher among females and increased with age, reaching 21.9% in the oldest age group (70+). The analyses identified seven distinct disease classes in the population. The largest class was “Diabetes and Hypertension” (36.3%), followed by “HIV and Hypertension” (31.0%), and “Heart disease and Hypertension” (14.5%). The four smaller classes were: “HIV, Diabetes, and Heart disease” (6.9%), “TB and HIV” (6.3%), “Hypertension, TB, and Cancer” (2.8%), and “All diseases except HIV” (2.2%). Conclusion As the South African population continues to age, the prevalence of multimorbidity is likely to increase which will further impact the health care system. The prevalence of multimorbidity in the population was relatively low but reached up to 20% in the oldest age groups. The largest disease cluster was the combination of diabetes and hypertension; followed by HIV and hypertension. The gains in improving adherence to antiretrovirals amongst treatment-experienced people living with HIV, should be expanded to include compliance with lifestyle/behavioral modifications to blood pressure and glucose control, as well as adherence to anti-hypertension and anti-diabetic medication. There is an urgent need to improve the early diagnosis and treatment of disease in the South African population.
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Affiliation(s)
- Rifqah Abeeda Roomaney
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.,School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Brian van Wyk
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Annibale Cois
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.,Division of Health Systems and Public Health, Department of Global Health, University of Stellenbosch, Stellenbosch, South Africa
| | - Victoria Pillay-van Wyk
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
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21
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Mallon T, Schäfer I, Fuchs A, Gensichen J, Maier W, Riedel-Heller S, König HH, Mergenthal K, Schön G, Wegscheider K, Weyerer S, Wiese B, van den Bussche H, Scherer M. The moderating effects of social support and depressive symptoms on pain among elderly multimorbid patients-data from the multicentre, prospective, observational cohort study MultiCare. Aging Ment Health 2022; 26:803-809. [PMID: 33949271 DOI: 10.1080/13607863.2021.1916882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Depressive symptoms and chronic pain are common among patients with multimorbidity creating a complex medical condition for both the patient and the general practitioner. Perceived social support may function as a protective measure. UNLABELLED To examine the impact of perceived social support as a potential moderator between depressive symptoms and pain intensity and pain disability in daily activities in multimorbid patients aged 75+. METHOD Data from 3,189 patients of the German longitudinal cohort study MultiCare were obtained at baseline and follow-ups during 5 years. Multilevel linear mixed-effects analyses were conducted for pain intensity (model 1) and pain disability in daily activities (model 2). The interaction term social support by depression score was included to test for moderation. RESULTS The interaction between social support and depressive symptoms was significantly associated with the pain intensity score 0.41 (SE=.17; 95-CI[.08;.74]) but not with the pain disability score 0.35 (SE=.19; 95-CI[-.01;.72]). Additionally, men and individuals with medium or higher educational level showed reduced pain intensity and disability scores. Pain disability scores increased with age and depressive symptoms. Increased pain scores were also found for body mass index and burden of multimorbidity. CONCLUSION Perceived social support amplified the association of depressive symptoms on pain intensity and did not show a protective function. The high scores of perceived social support among the participants may point to the practice of secondary gain due to the patients immense health burden.
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Affiliation(s)
- Tina Mallon
- Department of Primary Medical Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ingmar Schäfer
- Department of Primary Medical Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Fuchs
- Institute of General Practice, University Düsseldorf, Düsseldorf, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Munich, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University Bonn, Bonn, Germany
| | - Steffi Riedel-Heller
- Institute for Social Medicine, Occupational Health and Public Health, University Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany
| | - Gerhard Schön
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Birgitt Wiese
- Institute of General Practice, WG Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Hendrik van den Bussche
- Department of Primary Medical Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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22
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Gan DRY, Wister AV, Best JR. Environmental Influences on Life Satisfaction and Depressive Symptoms Among Older Adults With Multimorbidity: Path Analysis Through Loneliness in the Canadian Longitudinal Study on Aging. THE GERONTOLOGIST 2022; 62:855-864. [PMID: 35034124 PMCID: PMC9290896 DOI: 10.1093/geront/gnac004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES More older adults with multimorbidity are aging in place than ever before. Knowing how the environment affects their mental well-being could enhance the efficacy of age-friendly interventions for multimorbidity resilience. With reference to the Transdisciplinary Neighborhood Health Framework, we construct and examine a priori models of environmental influences on life satisfaction and depressive symptoms. RESEARCH DESIGN AND METHODS Baseline and follow-up data (after 3 years) were drawn from the Canadian Longitudinal Study on Aging to identify a subsample (n = 14,301) of participants aged at least 65 years with at least 2 chronic diseases. Path analysis examined sociobehavioral attributes (i.e., social support, social participation, walking) and loneliness as primary and secondary mediators, controlling for age, sex, education, and outcomes during baseline. RESULTS Good model fit was found (TFI = 1.00; CFI = 1.00; RMSEA < 0.001; SRMR < 0.001). The total effects of housing quality (rtotal = 0.08, -0.07) and neighborhood cohesion (rtotal = 0.03, -0.06) were weak but statistically significant in the expected direction. The mediators explained 21%-31% of the total effects of housing quality and 67%-100% of the total effects of neighborhood cohesion. Loneliness mediated 27%-29% of these environmental influences on mental well-being, whereas walking mediated a mere 0.4%-0.9% of the total effects. Walking did not explain the relationship between housing quality and mental well-being. DISCUSSION AND IMPLICATIONS Data supported a priori pathways from environment to mental well-being through sociobehavioral attributes and loneliness. If these pathways from neighborhood cohesion to life satisfaction reflect causal effects, community-based age-friendly interventions should focus on enhancing neighborhood cohesion to mitigate loneliness among multimorbid older adults for their mental well-being.
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Affiliation(s)
- Daniel R Y Gan
- Address correspondence to: Daniel R. Y. Gan, PhD, Gerontology Research Centre, Simon Fraser University, #2800-515 West Hastings Street, Vancouver, BC V6B 5K3, Canada. E-mail:
| | - Andrew V Wister
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - John R Best
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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Bevilacqua G, Jameson KA, Zhang J, Bloom I, Fuggle NR, Patel HP, Ward KA, Cooper C, Dennison EM. Relationships between non-communicable disease, social isolation and frailty in community dwelling adults in later life: findings from the Hertfordshire Cohort Study. Aging Clin Exp Res 2022; 34:105-112. [PMID: 34845651 PMCID: PMC8628832 DOI: 10.1007/s40520-021-02026-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/07/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Social relationships play a fundamental role in individuals' lives and health, and social isolation is prevalent among older people. Chronic non-communicable diseases (NCDs) and frailty are also common in older adults. AIMS To examine the association between number of NCDs and social isolation in a cohort of community-dwelling older adults in the UK, and to consider whether any potential association is mediated by frailty. METHODS NCDs were self-reported by 176 older community-dwelling UK adults via questionnaire. Social isolation was assessed using the six-item Lubben Social Network Scale. Frailty was assessed by the Fried phenotype of physical frailty. RESULTS The median (IQR) age of participants in this study was 83.1 (81.5-85.5) years for men and 83.8 (81.5-85.9) years for women. The proportion of socially isolated individuals was 19% in men and 20% in women. More women (18%) than men (13%) were identified as frail. The number of NCDs was associated with higher odds of being isolated in women (unadjusted odds ratio per additional NCD: 1.65, 95% CI 1.08, 2.52, p = 0.021), but not in men, and the association remained robust to adjustment, even when accounting for frailty (OR 1.85, 95% CI 1.06, 3.22, p = 0.031). DISCUSSION Number of self-reported NCDs was associated with higher odds of social isolation in women but not in men, and the association remained after considering frailty status. CONCLUSIONS Our observations may be considered by healthcare professionals caring for community-dwelling older adults with multiple NCDs, where enquiring about social isolation as part of a comprehensive assessment may be important.
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Affiliation(s)
- Gregorio Bevilacqua
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
| | - Karen A. Jameson
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
| | - Jean Zhang
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
| | - Ilse Bloom
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicholas R. Fuggle
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
| | - Harnish P. Patel
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Medicine for Older People, University Hospital Southampton, Southampton, UK
| | - Kate A. Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
- National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, OX3 7LE UK
| | - Elaine M. Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
- Victoria University of Wellington, Wellington, New Zealand
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Spiers G, Boulton E, Corner L, Craig D, Parker S, Todd C, Hanratty B. What matters to people with multiple long-term conditions and their carers? Postgrad Med J 2021; 99:postgradmedj-2021-140825. [PMID: 34921067 DOI: 10.1136/postgradmedj-2021-140825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/01/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The number of people living with multiple long-term conditions is increasing worldwide. This presents challenges for health and care systems, which must adapt to meet the needs of this population. This study drew on existing data to understand what matters to people living with multiple long-term conditions and identify priorities for future research. METHODS Two studies were conducted. (1) A secondary thematic analysis of interview, survey and workshop data collected from the 2017 James Lind Alliance Priority Setting Partnership for Older People with Multiple Conditions, and patient and public involvement workshops; (2) a review of ongoing research and published research priorities, relating to older people (80+) living with multiple long-term conditions. FINDINGS Older people with multiple long-term conditions identified a number of key concerns: access to care, support for both the patient and their carer, physical and mental health and well-being and identifying opportunities for early prevention. The review identified no published research priorities or ongoing research focusing specifically on populations aged over 80 years with multiple long-term conditions. CONCLUSION Older people living with multiple long-term conditions experience care that is inadequate for their needs. A holistic approach to care that extends beyond treating single conditions will ensure wide-ranging needs are met. As multimorbidity rises worldwide, this is a critical message for practitioners across health and care settings. We also recommend key areas that should be given greater focus in future research and policy to inform effective and meaningful forms of support for people living with multiple long-term conditions.
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Affiliation(s)
- Gemma Spiers
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Elisabeth Boulton
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Lynne Corner
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Stuart Parker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Todd
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Barbara Hanratty
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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25
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Association between marital relationship and multimorbidity in middle-aged adults: a longitudinal study across the US, UK, Europe, and China. Maturitas 2021; 155:32-39. [PMID: 34876247 DOI: 10.1016/j.maturitas.2021.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Marital relationship plays an important role in health and wellbeing. However, how marriage is associated with multimorbidity (the co-occurrence of two or more chronic conditions) has not been comprehensively investigated. We aimed to assess the association between marriage and multimorbidity in middle-aged adults. METHODS We used nationally representative data on 23641 adults aged 50-60 years who participated in four longitudinal studies in the US, UK, Europe, and China (Health and Retirement Study, English Longitudinal Study on Ageing, Survey of Health, Ageing and Retirement in Europe, and China Health and Retirement Longitudinal Study). Respondents were followed up in 2010-11 (baseline), 2012-13, and 2014-15. We used generalized estimating equations to evaluate the associations between marital status (married/partnered or non-married [separated/devoiced/widowed/never married]), marriage duration and multimorbidity, adjusting for socioeconomic and lifestyle factors. RESULTS Over 4-year follow-up, 24% (n=5699) of respondents experienced separation, divorce, widowhood, or never-married status, and approximately 43% (n=10228) of respondents reported multimorbidity. Those who were not married had a higher odds of multimorbidity (age-, sex- and region-adjusted odds ratio 1.19; 95% confidence interval 1.14 to 1.25). Those who had been married for 21-30 years had a lower odds of experiencing multimorbidity than those married for less than 10 years. The associations remained robust after adjusting for socioeconomic and lifestyle factors. CONCLUSIONS Marital relationship (status and length) was associated with multimorbidity in middle-aged adults, highlighting the role of marital relationship in shaping the trajectory of health and wellbeing across the life course. These findings provide insight for the prevention and management of chronic disease and multimorbidity.
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26
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Schutter N, Holwerda TJ, Comijs HC, Naarding P, Van RHL, Dekker JJM, Stek ML, Rhebergen D. Loneliness, social network size, and mortality in older adults and the role of cortisol. Aging Ment Health 2021; 25:2246-2254. [PMID: 33147982 DOI: 10.1080/13607863.2020.1843001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Loneliness and social isolation have both been found to be associated with increased mortality in previous studies. One potential underlying mechanism is via the hypothalamic-pituitary-adrenal axis. OBJECTIVE This study aimed to examine the association between social network size and cortisol, to analyze the associations between both loneliness and social network size and mortality, and to examine to what extent the association between network size and/or loneliness and mortality is mediated by cortisol. DESIGN The study group consisted of 443 depressed and non-depressed participants of the Netherlands Study of Depression in the Elderly (NESDO). Cross-sectional analysis of the association between social network size and cortisol measures was followed by a survival analysis of the associations between both social network size and loneliness and mortality. RESULTS There were no significant associations between social network size and cortisol measures. Loneliness and small social network size were not associated with mortality. Age and partner status were more important predictors of mortality. CONCLUSION As people grow older the variety of factors that influence mortality risk increases, diminishing the effect of a single factor. Prevention of early morbidity and mortality in older adults should be tailored to specific needs and risks, instead of aiming at one specific factor.
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Affiliation(s)
- Natasja Schutter
- Department of Geriatric Psychiatry, Arkin Mental Health Care, Amsterdam, the Netherlands
| | - Tjalling J Holwerda
- Department of Psychiatry, Arkin Mental Health Care, Amsterdam, the Netherlands
| | - Hannie C Comijs
- GGZ InGeest, Amsterdam, the Netherlands.,Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Paul Naarding
- General Psychiatry Residency Training Program, GGNet, Apeldoorn, the Netherlands.,Department of Geriatric Psychiatry, Apeldoorn, the Netherlands
| | - Rien H L Van
- Department of General Psychiatry Residency Training, Netherlands Psychoanalytical Institute, Arkin Mental Health Care, Amsterdam, the Netherlands
| | - Jack J M Dekker
- Department of Clinical Research, Arkin Mental Health Care, VU University Amsterdam, Amsterdam, the Netherlands.,Department of Psychology, Arkin Mental Health Care, VU University Amsterdam, Amsterdam, the Netherlands
| | - Max L Stek
- GGZ InGeest, Amsterdam, the Netherlands.,Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Didi Rhebergen
- GGZ InGeest, Amsterdam, the Netherlands.,Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
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27
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Bullying and Factors Contributing in Alzheimer’s Disease. PSYCHOLOGICAL STUDIES 2021. [DOI: 10.1007/s12646-021-00629-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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28
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Lu J, Wang Y, Hou L, Zuo Z, Zhang N, Wei A. Multimorbidity patterns in old adults and their associated multi-layered factors: a cross-sectional study. BMC Geriatr 2021; 21:372. [PMID: 34147073 PMCID: PMC8214251 DOI: 10.1186/s12877-021-02292-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 05/20/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Influenced by various factors such as socio-demographic characteristics, behavioral lifestyles and socio-cultural environment, the multimorbidity patterns in old adults remain complex. This study aims to identify their characteristics and associated multi-layered factors based on health ecological model. METHODS In 2019, we surveyed a total of 7480 participants aged 60+ by using a multi-stage random cluster sampling method in Shanxi province, China. Latent class analysis was used to discriminate the multimorbidity patterns in old adults, and hierarchical regression was performed to determine the multi-layered factors associated with their various multimorbidity patterns. RESULTS The prevalence of multimorbidity was 34.70% among the old patients with chronic disease. Over half (60.59%) of the patients with multimorbidity had two co-existing chronic diseases. "Degenerative/digestive diseases", "metabolic diseases" and "cardiovascular diseases" were three specific multimorbidity patterns. Behavioral lifestyles-layered factors had the most explanatory power for the three patterns, whose proportions of explanatory power were 54.00, 43.90 and 48.15% individually. But the contributions of other multi-layered factors were different in different patterns; balanced diet, medication adherence, the size of family and friendship network, and different types of basic medical insurance might have the opposite effect on the three multimorbidity patterns (p < 0.05). CONCLUSIONS In management of old patients with multimorbidity, we should prioritize both the "lifestyle change"-centered systematic management strategy and group-customized intervention programs.
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Affiliation(s)
- Jiao Lu
- School of Management, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi Province, China.
| | - Yuan Wang
- School of Management, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi Province, China
| | - Lihong Hou
- The Second Affiliated Hospital, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi Province, China
| | - Zhenxing Zuo
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Na Zhang
- School of Management, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi Province, China
| | - Anle Wei
- School of Management, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi Province, China
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29
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Kiely B, O'Donnell P, Byers V, Galvin E, Boland F, Smith SM, Connolly D, O'Shea E, Clyne B. Protocol for a mixed methods process evaluation of the LinkMM randomised controlled trial "Use of link workers to provide social prescribing and health and social care coordination for people with complex multimorbidity in socially deprived areas". HRB Open Res 2021; 4:38. [PMID: 37901156 PMCID: PMC10605865 DOI: 10.12688/hrbopenres.13258.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 10/31/2023] Open
Abstract
Background Multimorbidity, defined as two or more chronic conditions is increasing in prevalence and is associated with increased health care use, fragmented care and poorer health outcomes. Link workers are non-health or social care professionals who support people to connect with resources in their community to improve their well-being, a process commonly referred to as social prescribing. The use of link workers in primary care may be an effective intervention in helping those with long-term conditions manage their illness and improve health and well-being, but the evidence base in limited. The LinkMM study is a randomised controlled trial of the effectiveness of link workers based in primary care, providing social prescribing and health and social care coordination for people with multimorbidity. The aim of the LinkMM process evaluation is to investigate the implementation of the link worker intervention, mechanisms of impact and influence of the specific context on these, as per the Medical Research Council framework, using quantitative and qualitative methods. Methods Quantitative data will be gathered from a number of sources including researcher logbooks, participant baseline questionnaires, client management database, and will be analysed using descriptive statistics. Semi structured interviews with participants will investigate their experiences of the intervention. Interviews with link workers, practices and community stakeholders will explore how the intervention was implemented and barriers and facilitators to this. Thematic analysis of interview transcripts will be conducted. Discussion The process evaluation of the LinkMM trial will provide important information allowing a more in-depth understanding of how the intervention worked and lessons for future wider scale implementation.
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Affiliation(s)
- Bridget Kiely
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland, D02Vn51, Ireland
| | - Patrick O'Donnell
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland, Ireland
| | - Vivienne Byers
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland, D02Vn51, Ireland
| | - Emer Galvin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland, D02Vn51, Ireland
| | - Fiona Boland
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland, D02Vn51, Ireland
| | - Susan M. Smith
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland, D02Vn51, Ireland
| | - Deirdre Connolly
- Discipline of Occupational Therapy, Trinity College Dublin, Dublin, Ireland, Ireland
| | - Eamon O'Shea
- School of Business and Economics, National Univeristy of Ireland, Galway, Galway, Ireland
| | - Barbara Clyne
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland, D02Vn51, Ireland
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Dumitrache CG, Rubio L, Cabezas Casado JL, Cordón-Pozo E. Psychometric properties and factor structure of the Medical Outcomes Study Social Support Survey Instrument in a sample of Spanish older adults. Eur J Ageing 2021; 19:143-154. [PMID: 35250423 PMCID: PMC8881559 DOI: 10.1007/s10433-021-00612-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 10/21/2022] Open
Abstract
The aim of this study was to explore the factor structure of the MOS-SSS in a sample of community-dwelling Spanish older adults. The sample comprised 406 community-dwelling older adults aged between 65 to 99 years old (M age = 74.88, SD = 6.75). Confirmatory factor analysis (CFA) was performed, and four possible models were compared: the one-factor, the three-factor, the four-factor and the five-factor model, using an additional analysis with a second-order factor. The internal consistency reliability and convergent validity of the scale were also assessed. For the 19-item MOS-SSS scale, the five-factor model had the best fit to the data. All five subscales of the MOS-SSS showed adequate internal consistency, good convergent and discriminant validity. These findings contribute to the literature on the factor structure of the MOS-SSS in Spanish older adults. The MOS-SSS is a reliable and valid scale that can be used to assess Spanish older adults' social support perception for social services, health and in research contexts.
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Affiliation(s)
- Cristina G. Dumitrache
- grid.4489.10000000121678994Department of Developmental and Educational Psychology, University of Granada, Campus de Cartuja S/N, 18071 Granada, Spain
| | - Laura Rubio
- grid.4489.10000000121678994Department of Developmental and Educational Psychology, University of Granada, Campus de Cartuja S/N, 18071 Granada, Spain
| | - José Luis Cabezas Casado
- grid.4489.10000000121678994Department of Developmental and Educational Psychology, University of Granada, Campus de Cartuja S/N, 18071 Granada, Spain
| | - Eulogio Cordón-Pozo
- grid.4489.10000000121678994Department of Business and Management, University of Granada, Campus de Cartuja S/N, 18071 Granada, Spain
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Demirer I, Bethge M, Spyra K, Karbach U, Pfaff H. Does social support mediate the effect of multimorbidity on mental wellbeing in the German working population? A longitudinal mediation analysis using structural equation modelling. SSM Popul Health 2021; 13:100744. [PMID: 33604446 PMCID: PMC7873675 DOI: 10.1016/j.ssmph.2021.100744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 11/29/2022] Open
Abstract
This study provides insights into the longitudinal relation between multimorbidity, mental wellbeing, and social support. The analysis used the German Sociomedical Panel of Employees, a study of the German working population aged 40 to 54. In the context of multimorbidity, this population has been little studied. Multimorbidity is significantly associated with reduced mental wellbeing and social support, whereas social support increases mental wellbeing. We argue that, especially among the working population, multimorbidity reduces perceived social support and decreases mental wellbeing. We elaborate on the mediation process empirically by comparing two distinct structural equation models: a cross-lagged panel mediation model that models a potential reverse-causality between social support and mental wellbeing; and a synchronous mediation model that allows for more immediate mediation. Both models estimated significant mediation. The relative size of the mediation effect, however, varied widely based on the added mediational paths (8.57% vs. 28%). Fit statistics for both models were good, and the comparison did not favour either model. We conclude that theoretical reasoning must prevail over empirical testing. The cross-lagged model implies a more longitudinal (lagged) mediation process for social support. However, we suggest an immediate, flexible mediation as more plausible. Nevertheless, we suggest that cross-lagged models, when given a data structure and time gaps, reflect the social processes adequately.
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Affiliation(s)
- Ibrahim Demirer
- Institute of Medical Sociology, Health Services Research, Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Eupener Str. 129, 50933, Köln, Germany
| | - Matthias Bethge
- Department Rehabilitation and Work. Institute for Social Medicine and Epidemiology at University of Lübeck, Ratzeburger Allee 160; Haus V50, 23538, Lübeck, Germany
| | - Karla Spyra
- Head of the Rehabilitation Department Charité – University Medicine Berlin, Charitéplatz 1, Virchowweg 23, 10117, Berlin, Germany
| | - Ute Karbach
- Department Rehabilitation Sociology. Faculty of Rehabilitation Sciences. Technical University Dortmund, Emil-Figge-Str. 50; EF50, 44227, Dortmund, Germany
| | - Holger Pfaff
- Director of Institute of Medical Sociology, Health Services Research, And Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Eupener Str. 129, 50933, Köln, Germany
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Bezerra de Souza DL, Oliveras-Fabregas A, Espelt A, Bosque-Prous M, de Camargo Cancela M, Teixidó-Compañó E, Jerez-Roig J. Multimorbidity and its associated factors among adults aged 50 and over: A cross-sectional study in 17 European countries. PLoS One 2021; 16:e0246623. [PMID: 33571285 PMCID: PMC7877625 DOI: 10.1371/journal.pone.0246623] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/22/2021] [Indexed: 11/18/2022] Open
Abstract
AIMS To estimate the prevalence of multimorbidity among European community-dwelling adults, as well as to analyse the association with gender, age, education, self-rated health, loneliness, quality of life, size of social network, Body Mass Index (BMI) and disability. METHODS A cross-sectional study based on wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) was conducted, and community-dwelling participants aged 50+ (n = 63,844) from 17 European countries were selected. Multimorbidity was defined as presenting two or more health conditions. The independent variables were gender, age group, educational level, self-rated health, loneliness, size of network, quality of life, BMI and disability (1+ limitations of basic activities of daily living). Poisson regression models with robust variance were fit for bivariate and multivariate analysis. RESULTS The prevalence of multimorbidity was 28.2% (confidence interval-CI 95%: 27.5.8-29.0) among men and 34.5% (CI95%: 34.1-35.4) among women. The most common health conditions were cardiometabolic and osteoarticular diseases in both genders, and emotional disorders in younger women. A large variability in the prevalence of multimorbidity in European countries was verified, even between countries of the same region. CONCLUSIONS Multimorbidity was associated with sociodemographic and physical characteristics, self-rated health, quality of life and loneliness.
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Affiliation(s)
- Dyego Leandro Bezerra de Souza
- Department of Collective Health, Graduate Programme in Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Postgraduate Programme in Collective Health, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil
- Faculty of Health Sciences and Welfare, Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Barcelona, Spain
| | - Albert Oliveras-Fabregas
- Faculty of Health Sciences and Welfare, Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Barcelona, Spain
- Faculty of Psychology, Education and Sport Sciences Blanquerna, Physical Activity, Sport and Health Research Group, Universitat Ramon Llull, Barcelona, Spain
| | - Albert Espelt
- Faculty of Health Sciences of Manresa, University of Vic–Central University of Catalonia, Manresa, Spain
- Departament de Psicobiologia i Metodologia en Ciències de la Salut, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Marina Bosque-Prous
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | | | - Ester Teixidó-Compañó
- Faculty of Health Sciences of Manresa, University of Vic–Central University of Catalonia, Manresa, Spain
| | - Javier Jerez-Roig
- Postgraduate Programme in Collective Health, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil
- Faculty of Health Sciences and Welfare, Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Barcelona, Spain
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Ma Y, Liang C, Gu D, Zhao S, Yang X, Wang X. How Social Media Use at Work Affects Improvement of Older People's Willingness to Delay Retirement During Transfer From Demographic Bonus to Health Bonus: Causal Relationship Empirical Study. J Med Internet Res 2021; 23:e18264. [PMID: 33565983 PMCID: PMC7904398 DOI: 10.2196/18264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 10/25/2020] [Accepted: 12/17/2020] [Indexed: 01/30/2023] Open
Abstract
Background With the increased older population in China and the subsequent reduced labor force, the “demographic bonus” is disappearing. The Chinese government proposed a Healthy China strategy in 2017. The transfer of the demographic bonus to a “health bonus” extended the working life of people and reduced the negative impact of the population’s aging on the labor force structure. Objective This research focuses on the effect of older workers’ social media usage at work on their work ability (related to both physical and mental health) and thus their willingness to delay retirement. Methods The questionnaire respondents were older than 55 years, and they obtained the questionnaire from social media, from June to July 2018. A total of 1020 valid questionnaires were collected, and SmartPLS 3.28 (SmartPLS GmbH) was used to analyze the data. Effects were analyzed using 2-tailed t tests. Results (1) Use of social media at work can improve information support (t14=13.318, P<.001), emotional support (t14=13.184, P<.001), and self-efficacy (t14=6.364, P<.001) for older people; (2) information support is the main factor affecting the self-efficacy of older workers (t14=23.304, P<.001), as compared with emotional support (t14=1.799, P=0.07); (3) the impacts of emotional support on work ability (t14=8.876, P<.001) and work stress (t14=9.545, P<.001) are generally higher than those of information support (t14=4.394, P<.001; t14=5.002, P<.001); (4) self-efficacy has an impact on work ability (t14=5.658, P<.001) and work stress (t14=4.717, P<.001); and (5) the impacts of work ability (t14=8.586, P<.001) and work stress (t14=8.579, P<.001) on retirement willingness are greater than those of emotional support (t14=2.112, P=.04) and information support (t14=4.314, P<.001). Conclusions Our study confirms that the use of social media at work has a positive impact on older workers. Based on the findings, we have put forward proposals to extend people’s working lives and help governments implement health bonus policies. In the future, we will compare the different values of willingness to delay retirement among older people in different occupations and different cultures.
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Affiliation(s)
- Yiming Ma
- School of Management, Hefei University of Technology, Hefei, China
| | - Changyong Liang
- School of Management, Hefei University of Technology, Hefei, China
| | - Dongxiao Gu
- School of Management, Hefei University of Technology, Hefei, China.,Key Laboratory of Process Optimization and Intelligent Decision-making of Ministry of Education, Hefei, China
| | - Shuping Zhao
- School of Management, Hefei University of Technology, Hefei, China
| | - Xuejie Yang
- School of Management, Hefei University of Technology, Hefei, China
| | - Xiaoyu Wang
- The First Affiliated Hospital, Anhui University of Traditional Chinese Medicine, Hefei, China
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Kiely B, Clyne B, Boland F, O'Donnell P, Connolly D, O'Shea E, Smith SM. Link workers providing social prescribing and health and social care coordination for people with multimorbidity in socially deprived areas (the LinkMM trial): protocol for a pragmatic randomised controlled trial. BMJ Open 2021; 11:e041809. [PMID: 33526499 PMCID: PMC7852975 DOI: 10.1136/bmjopen-2020-041809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Link workers are non-health or social care professionals based in primary care who support people to develop and achieve a personalised set of health and social goals by engaging with community resources. Link workers have been piloted in areas of deprivation, but there remains insufficient evidence to support their effectiveness. Multimorbidity is increasing in prevalence, but there are limited evidence-based interventions. This paper presents the protocol for a randomised controlled trial (RCT) that will test the effectiveness of link workers based in general practices in deprived areas in improving health outcomes for people with multimorbidity. METHODS AND ANALYSIS The protocol presents the proposed pragmatic RCT, involving 10 general practitioner (GP) practices and 600 patients. Eligible participants will be community dwelling adults with multimorbidity (≥two chronic conditions) identified as being suitable for referral to a practice-based link worker. Following baseline data collection, the patients will be randomised into intervention group that will meet the link worker over a1-month period, or a 'wait list' control that will receive usual GP care. Primary outcomes are health-related quality of life as assessed by EQ-5D-5L and mental health assessed by Hospital Anxiety and Depression Scale. Secondary outcomes are based on the core outcome set for multimorbidity. Data will be collected at baseline and on intervention completion at 1 month using questionnaires self-completed by participants and GP records. Parallel process and economic analyses will be conducted to explore participants' experiences and examine cost-effectiveness of the link worker intervention. ETHICS AND DISSEMINATION Ethical approval has been granted by the Irish College of General Practitioners Ethics Committee. The findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN10287737;Pre-results.
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Affiliation(s)
- Bridget Kiely
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland
| | - Fiona Boland
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland
| | - Patrick O'Donnell
- Primary Healthcare, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Deirdre Connolly
- Discipline of Occupational Therapy, Trinity College, Dublin, Ireland
| | - Eamon O'Shea
- School of Business and Economics, National University of Ireland, Galway, Ireland
| | - Susan M Smith
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons, Dublin, Ireland
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Sheffler JL, Joiner TE, Sachs-Ericsson NJ. The Interpersonal and Psychological Impacts of COVID-19 on Risk for Late-Life Suicide. THE GERONTOLOGIST 2021; 61:23-29. [PMID: 32959869 PMCID: PMC7454594 DOI: 10.1093/geront/gnaa103] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Indexed: 11/13/2022] Open
Abstract
Older adults experience increased risk for suicide compared to the general population, and the circumstances surrounding the Coronavirus Disease 2019 (COVID-19) may potentiate this risk. We discuss how current COVID-19 pandemic-related policies are likely to harm older adults disproportionately. COVID-19 pandemic social distancing policies and ethical guidelines for COVID-19 treatment may exacerbate experiences of social isolation, perceived expendability, and exposure to suffering, which are related to the three main components of the Interpersonal Theory of Suicide (i.e., thwarted belongingness, perceived burdensomeness to society, and capability for suicide). The COVID-19 pandemic poses a drain on services and has drawn ethical debates about policies around treating younger adults first. These experiences may lead older adults to have reduced access to needed medical and psychiatric services and may convey damaging messages of expendability. Further, the potential prolonged stress associated with the COVID-19 pandemic may impact neurological, immunological, and health functioning – exacerbating suicide risk. Potential venues to increase treatment options and decrease social isolation are discussed. We acknowledge optimistic effects as well, such as ‘pulling together’ as a society and the many valuable ways older adults may contribute during this crisis.
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Affiliation(s)
- Julia L Sheffler
- Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee
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Youm Y, Baldina E, Baek J. All-cause mortality and three aspects of social relationships: an eight-year follow-up of older adults from one entire Korean village. Sci Rep 2021; 11:465. [PMID: 33432096 PMCID: PMC7801415 DOI: 10.1038/s41598-020-80684-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/24/2020] [Indexed: 01/29/2023] Open
Abstract
Various aspects of social relationships have been examined as risk factors for mortality. In particular, most research has focused on either loneliness or social disengagement. We aimed to extend the current research by adding a group-level segregation measure utilizing the whole social network of one entire village in South Korea. The analyses were based on the Korean Social Life, Health and Aging Project data collected over eight years across five waves. Of the 679 old adults who participated throughout the entire project (to wave 5), 63 were confirmed as deceased. All three aspects of social relationships examined, loneliness, social disengagement, and group-level segregation, were associated with mortality in the traditional Cox proportional hazard model without considering health-related time-varying covariates. However, a Cox marginal structural model, a counterfactual statistical measure that is designed to control for censoring bias due to sample attrition over the eight years and time-varying confounding variables, revealed that only group-level segregation was associated with mortality. Our results strongly suggest that more attention is needed on group-level segregation for mortality studies, as well as on well-known individual-level risk factors, including social disengagement and loneliness. All methods were carried out in accordance with relevant guidelines and regulations.
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Affiliation(s)
- Yoosik Youm
- grid.15444.300000 0004 0470 5454Department of Sociology, Yonsei University, Seoul, 03722 Republic of Korea
| | - Ekaterina Baldina
- grid.15444.300000 0004 0470 5454Department of Sociology, Yonsei University, Seoul, 03722 Republic of Korea
| | - Jiwon Baek
- grid.31501.360000 0004 0470 5905Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, 03080 Republic of Korea
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Ferry FR, Rosato MG, Curran EJ, O'Reilly D, Leavey G. Multimorbidity among persons aged 25-64 years: a population-based study of social determinants and all-cause mortality. J Public Health (Oxf) 2020; 44:e59-e67. [PMID: 33348365 DOI: 10.1093/pubmed/fdaa209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/13/2020] [Accepted: 10/26/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Despite increasing multimorbidity across the lifespan, little is known about the co-occurrence of conditions and risk factors among younger adults. This population-based study examines multimorbidity, social determinants and associated mortality among younger and middle-age adults. METHOD Analysis was based on the Northern Ireland population aged 25-64 years enumerated in the 2011 Census (n = 878 345), with all-cause mortality follow-up to 2014 (8659 deaths). Logistic regression was used to examine social determinants and Cox proportional hazards models in the analysis of associated mortality. RESULTS Prevalence of multimorbidity was 13.7% in females and 12.7% in males. There was a strong association between multimorbidity that included mental/cognitive illness and deprivation. Among those never married, multimorbid physical conditions were less likely [relative risk ratios (RRR) = 0.92: 95% confidence interval (CI) = 0.88, 0.95 for males; and RRR = 0.90: 0.87, 0.94 for females]. Rurality was associated with lower physical multimorbidity (RRR = 0.92: 0.89, 0.95) but higher mental/cognitive multimorbidity (RRR = 1.35: 1.12, 1.64) among females. All multimorbid categories were associated with elevated risk of mortality. CONCLUSION The health and economic challenges created by multimorbidity should be addressed further 'upstream'. Future multimorbidity research should include younger adults to inform the development of preventative interventions and align health and social care services more closely with patients' needs.
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Affiliation(s)
- F R Ferry
- Bamford Centre for Mental Health and Wellbeing, Room H253, School of Psychology, Ulster University, Coleraine BT52 1SA, Northern Ireland
| | - M G Rosato
- Bamford Centre for Mental Health and Wellbeing, Room H253, School of Psychology, Ulster University, Coleraine BT52 1SA, Northern Ireland
| | - E J Curran
- Bamford Centre for Mental Health and Wellbeing, Room H253, School of Psychology, Ulster University, Coleraine BT52 1SA, Northern Ireland
| | - D O'Reilly
- Centre for Public Health, Block A Royal Victoria Hospital, Queen's University Belfast, Belfast BT12 6BA, Northern Ireland
| | - G Leavey
- Bamford Centre for Mental Health and Wellbeing, Room H253, School of Psychology, Ulster University, Coleraine BT52 1SA, Northern Ireland
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Multimorbidity, Loneliness, and Social Isolation. A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228688. [PMID: 33238506 PMCID: PMC7700324 DOI: 10.3390/ijerph17228688] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/11/2020] [Accepted: 11/20/2020] [Indexed: 12/11/2022]
Abstract
No systematic review has appeared so far synthesizing the evidence regarding multimorbidity and loneliness, social isolation, or social frailty. Consequently, our aim was to fill this gap. Three electronic databases (PubMed, PsycINFO, and CINAHL) were searched in our study. Observational studies examining the link between multimorbidity and loneliness, social isolation, and social frailty were included, whereas disease-specific samples were excluded. Data extraction included methods, characteristics of the sample, and the main results. A quality assessment was conducted. Two reviewers performed the study selection, data extraction, and quality assessment. In sum, eight studies were included in the final synthesis. Some cross-sectional and longitudinal studies point to an association between multimorbidity and increased levels of loneliness. However, the associations between multimorbidity and social isolation as well as social frailty remain largely underexplored. The quality of the studies included was rather high. In conclusion, most of the included studies showed a link between multimorbidity and increased loneliness. However, there is a lack of studies examining the association between multimorbidity and social isolation as well as social frailty. Future studies are required to shed light on these important associations. This is particularly important in times of the COVID-19 pandemic.
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Abebe F, Schneider M, Asrat B, Ambaw F. Multimorbidity of chronic non-communicable diseases in low- and middle-income countries: A scoping review. JOURNAL OF COMORBIDITY 2020; 10:2235042X20961919. [PMID: 33117722 PMCID: PMC7573723 DOI: 10.1177/2235042x20961919] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022]
Abstract
Background: Multimorbidity is rising in low- and middle-income countries (LMICs). However, the evidence on its epidemiology from LMICs settings is limited and the available literature has not been synthesized as yet. Objectives: To review the available evidence on the epidemiology of multimorbidity in LMICs. Methods: PubMed, Scopus, PsycINFO and Grey literature databases were searched. We followed the PRISMA-ScR reporting guideline. Results: Of 33, 110 articles retrieved, 76 studies were eligible for the epidemiology of multimorbidity. Of these 76 studies, 66 (86.8%) were individual country studies. Fifty-two (78.8%) of which were confined to only six middle-income countries: Brazil, China, South Africa, India, Mexico and Iran. The majority (n = 68, 89.5%) of the studies were crosssectional in nature. The sample size varied from 103 to 242, 952. The largest proportion (n = 33, 43.4%) of the studies enrolled adults. Marked variations existed in defining and measuring multimorbidity. The prevalence of multimorbidity in LMICs ranged from 3.2% to 90.5%. Conclusion and Recommendations: Studies on the epidemiology of multimorbidity in LMICs are limited and the available ones are concentrated in few countries. Despite variations in measurement and definition, studies consistently reported high prevalence of multimorbidity. Further research is urgently required to better understand the epidemiology of multimorbidity and define the best possible interventions to improve outcomes of patients with multimorbidity in LMICs.
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Affiliation(s)
- Fantu Abebe
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.,Jhpiego Corporation, Ethiopia Country Office, Bahir Dar, Ethiopia
| | - Marguerite Schneider
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Biksegn Asrat
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Fentie Ambaw
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Jiao D, Watanabe K, Sawada Y, Tanaka E, Watanabe T, Tomisaki E, Ito S, Okumura R, Kawasaki Y, Anme T. Multimorbidity and functional limitation: the role of social relationships. Arch Gerontol Geriatr 2020; 92:104249. [PMID: 32980575 DOI: 10.1016/j.archger.2020.104249] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To examine the relationship between multimorbidity and functional limitation, and how social relationships alter that association. METHODS This cross-sectional study used data collected by self-reported questionnaires from adults aged 65 years and older living in a rural area in Japan in 2017. This analysis included complete data from 570 residents. Multimorbidity status was defined as having two chronic diseases exist simultaneously in one individual, and the function status was measured by their long-term care needs. Social relationships were assessed by the Index of Social Interaction and divided into high and low levels. Multiple logistic regression analysis was used to examine the association between social relationships and functional limitation and to assess the role of social relationships in this association. RESULTS The logistic regression model indicated that the risk of functional limitation was higher in multimorbidity participants than free-of-multimorbidity participants (OR = 2.55, 95% CI = 1.56-4.16). Compared with participants with no multimorbidity and a high level of social relationships, low level of social relationships increased the risk of functional limitation among participants both with and without multimorbidity, with the OR = 7.71, 95% CI = 3.03-19.69 and OR = 3.28, 95% CI = 1.30-8.27, respectively. However, no significant result was found in participants with multimorbidity and a high level of social relationships (P = 0.365). CONCLUSIONS Multimorbidity was associated with functional limitations. However, this association could be increased by a low level of social relationships and decreased by a high level of social relationships.
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Affiliation(s)
- Dandan Jiao
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, 305-8577, Japan
| | - Kumi Watanabe
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, 305-8577, Japan
| | - Yuko Sawada
- Medical Sciences, Morinomiya University of Medical Sciences, Osaka, 559-8611, Japan
| | - Emiko Tanaka
- Community Nursing, Musashino University, Tokyo, 202-8585, Japan
| | - Taeko Watanabe
- College of Nursing and Nutrition, Shukutoku University, Chiba, 260-8703, Japan
| | - Etsuko Tomisaki
- Faculty of Nursing and Medical Care, Keio University, Tokyo, 160-0016, Japan
| | - Sumio Ito
- Department of Public Welfare, Tobishima, Aichi, 490-1434, Japan
| | - Rika Okumura
- Department of Public Welfare, Tobishima, Aichi, 490-1434, Japan
| | - Yuriko Kawasaki
- Department of Public Welfare, Tobishima, Aichi, 490-1434, Japan
| | - Tokie Anme
- Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan.
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Hanlon P, McCallum M, Jani BD, McQueenie R, Lee D, Mair FS. Association between childhood maltreatment and the prevalence and complexity of multimorbidity: A cross-sectional analysis of 157,357 UK Biobank participants. JOURNAL OF COMORBIDITY 2020; 10:2235042X10944344. [PMID: 32844098 PMCID: PMC7416137 DOI: 10.1177/2235042x10944344] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/08/2020] [Accepted: 06/22/2020] [Indexed: 11/16/2022]
Abstract
Background: Child maltreatment is associated with long-term conditions (LTCs) in
adulthood. Its relationship to multimorbidity (≥2 LTCs) is less clear. We
explore the relationship between child maltreatment, multimorbidity and
factors complicating management. Methods: Cross-sectional analysis of 157,357 UK Biobank participants. Experience of
four maltreatment types (physical/sexual/emotional/neglect) was identified.
We explored the relationship between type, number and frequency of
maltreatment and LTC count (0, 1, 2, 3, ≥4) using multinomial logistic
regression. Binary logistic regression assessed the relationship between
maltreatment and self-rated health, loneliness, social isolation, frailty
and widespread pain in those with multimorbidity, adjusting for
sociodemographics and lifestyle factors. Results: 52,675 participants (33%) experienced ≥1 type of maltreatment; 983 (0.6%)
experienced all four. Type, frequency and number of types of maltreatment
were associated with higher LTC count. People experiencing four types of
maltreatment were 5 times as likely to have a LTC count of ≥4 as those
experiencing none (odds ratio (OR): 5.16; 99% confidence interval (CI):
3.77-7.07). Greater number of types of maltreatment was associated with
higher prevalence of combined physical/mental health LTCs (OR: 2.99; 99% CI:
2.54–3.51 for four types of maltreatment). Compared to people who reported
no maltreatment, people experiencing all four types of maltreatment were
more likely to have poor self-rated health (OR: 3.56; 99% CI: 2.58–4.90),
loneliness (OR: 3.16; 99% CI: 2.17–4.60), social isolation (OR: 1.45; 99%
CI: 1.03–2.05), widespread pain (OR: 3.19; 99% CI: 1.87–5.44) and frailty
(OR: 3.21; 99% CI: 2.04–5.05). Conclusion: Peoplewith a history of maltreatment have higher LTC counts and potentially
more complicated management needs reinforcing calls for early
intervention.
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Affiliation(s)
- Peter Hanlon
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Marianne McCallum
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Bhautesh Dinesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Ross McQueenie
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Duncan Lee
- School of Mathematics and Statistics, The mathematics and Statistics Building, University of Glasgow, University Place, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK
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Pasyar N, Rambod M, Behrouzi Z. The Predictor Role of Perceived Social Support and Spiritual Intelligence in Hope Among Thalassemia Patients. Malays J Med Sci 2020; 27:75-83. [PMID: 32684808 PMCID: PMC7337945 DOI: 10.21315/mjms2020.27.3.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 05/12/2020] [Indexed: 11/12/2022] Open
Abstract
Background Thalassemia is a prevalent chronic blood disorder, which is accompanied with a wide range of challenges. This study aimed to determine the predictor role of perceived social support and spiritual intelligence in hope among thalassemia patients. Methods This cross-sectional study was conducted on 300 thalassemia patients. The data were collected using Miller hope scale, spiritual intelligence scale, and personal resource questionnaire. The data were analysed using Pearson’s correlation coefficient and multiple regression analysis. Results The results indicated that the mean score of hope was 173.38 (standard deviation [SD] = 24.6). Besides, 86.7% of the patients showed high levels of hope. The mean score of spiritual intelligence was 134.66 (SD = 18.07). In addition, 91.7% of the patients showed moderate levels of spiritual intelligence. The mean score of social support was 127.87 (SD = 20.19) and the patients showed high social support levels. The results revealed a significant association between hope and perceived social support (r = 0.65, P < 0.001) as well as between hope and spiritual intelligence (r = 0.63, P < 0.001). Moreover, perceived social support (b = 0.43, P < 0.001) and spiritual intelligence (b = 0.37, P < 0.001) were the predictors of hope among thalassemia patients. Conclusion Considering the study results, in addition to common treatments for thalassemia, policymakers’ are recommended to pay attention to spiritual intelligence and more importantly social support to enhance thalassemia patients’ hope.
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Affiliation(s)
- Nilofar Pasyar
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoume Rambod
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Behrouzi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Porzsolt F, Matosevic R, Kaplan RM. Recommendations for cancer screening would be different if we measured endpoints that are valid, reliable, specific, and important to patients. Cancer Causes Control 2020; 31:705-711. [PMID: 32415530 DOI: 10.1007/s10552-020-01309-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite enthusiasm for cancer screening, systematic reviews consistently fail to show that screening reduces all-cause mortality. This narrative review explores conceptual issues, and inconsistencies between evidence and opinion about screening. REVIEW We examined the interpretation of screening studies in relation to three intellectual traditions: (1) The relationship between prevention and cure; (2) Confirmation bias and the challenge of incorporating new data: less care may produce better outcomes than more care; (3) The answers to three structured questions about efficacy, effectiveness, and value of treatments proposed by Sir Archie Cochrane and Sir Austin Bradford Hill. SYNTHESIS When considering extensions of life expectancy or all-cause mortality, systematic reviews typically show cancer screening to have only small effects and often non-significant effects on all-cause mortality. Early diagnosis does not assure application of an intervention that alters the pathway toward demise. The interpretation of screening results is also affected by several known biases. Investigators and advocates are encumbered by an over focus on studies designed to determine if a treatment can work under ideal circumstances. To advance the field, we need a greater emphasis on evaluations that ask 'Does the treatment work under real-world conditions?', and 'Is the treatment worth it?' in terms of outcomes that are meaningful to patients.
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Affiliation(s)
| | - Rafael Matosevic
- Department Radiology, Ludgerus Kliniken Münster, 48153, Münster, Germany
| | - Robert M Kaplan
- Clinical Excellence Research Center, Stanford University, Stanford, CA, 94305-6015, USA.
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Turuba R, Pirkle C, Bélanger E, Ylli A, Gomez Montes F, Vafaei A. Assessing the relationship between multimorbidity and depression in older men and women: the International Mobility in Aging Study (IMIAS). Aging Ment Health 2020; 24:747-757. [PMID: 30724575 DOI: 10.1080/13607863.2019.1571018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objectives: Our study aims to assess whether multimorbidity is an independent risk factor for the development of depression in older adults living in Canada, Brazil, Colombia, and Albania and examines differences in incidence of depression regarding social and psychosocial characteristics.Methods: The longitudinal International Mobility Aging Study (IMIAS) collected information from adults between 65-74 years old. Depression was defined by a 16 or higher score assessed by the Centre for Epidemiological Studies Depression (CES-D) Scale. Multimorbidity was defined as having two or more chronic conditions, which were self-reported by participants using a list of eight physical chronic conditions. Poisson regression was performed to estimate the relative risk of depression in older adults with multimorbidity compared to those living with 0-1 chronic conditions, adjusting for sex, age, education, number of doctor visits, degree of assistance needed, social support, and smoking status. The analysis was stratified by study region (Canada; Latin America; Albania).Results: Crude and adjusted models showed no statistically significant associations between multimorbidity and the incidence of depression in any of the study regions, confirmed by sensitivity analyses. However, the incidence of depression varied across study region, confirmed by the intra-class correlation coefficient which indicated that 13% of variations in depression incidence were due to geographic differences.Conclusion: Multimorbidity does not appear to increase the risk of developing depression in older adults between 65-74. Higher rates of depression in Latin America and Albania (compared to Canada) may be attributed to lifecourse exposures to social and economic adversity in these regions.
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Affiliation(s)
- Roxanne Turuba
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Catherine Pirkle
- Office of Public Health Studies, University of Hawaii, Honolulu, HI, USA
| | - Emmanuelle Bélanger
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Alban Ylli
- Institute of Public Health, Tirana, Albania
| | - Fernando Gomez Montes
- Research Group on Geriatrics and Gerontology, Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia
| | - Afshin Vafaei
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
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45
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Gender Differences between Multimorbidity and All-Cause Mortality among Older Adults. Curr Gerontol Geriatr Res 2020; 2020:7816785. [PMID: 32148480 PMCID: PMC7049854 DOI: 10.1155/2020/7816785] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 12/17/2022] Open
Abstract
Objectives This study seeks to determine the prevalence of chronic diseases and analyze the association between multimorbidity and all-cause mortality by sex. Methods This is a 16-year longitudinal study of follow-up. We used sample data of the SABE (Health, Well-Being and Aging) study cohort and mortality data obtained through the Mortality Information Improvement Program of the City of São Paulo (PRO-AIM) from the 2000–2016 period. Survival analysis was performed using Cox proportional hazard models. Results Hypertension (HT) was the most prevalent disease in older adults (52.93%), followed by musculoskeletal disorders (MSDs) (27.09%), cardiovascular diseases (CD) (17.79%), diabetes mellitus (DM) (16.95%), mental disorders (MD) (15.43%), and respiratory diseases (RD) (9.72%). The highest mortality rate in women was observed in the combination of HT/MSDs/DM/MD (HR = 6.15, 95% CI = 2.32, 16.32), while in men was in the combination of HT/CD/MSDs/DM (HR = 5.72, 95% CI = 1.72, 19.06). Conclusion Similar to previous studies carried out in developed countries, we found that all-cause mortality increased as diseases are added to an individual. Women and men presented different mortality patterns according to multimorbidity. Therefore, we suggest that additional longitudinal studies should be performed in order to analyze mortality by sex.
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Abstract
Se ha encontrado evidencia de que la soledad incrementa la probabilidad de presentar problemas de ansiedad y depresión en personas mayores, razón por la cual se hace importante el estudio de las consecuencias negativas de este fenómeno sobre la salud mental y física de estas personas. El objetivo de este trabajo fue analizar la influencia de la soledad en la vejez y en la forma de convivencia de los adultos mayores, así como determinar si existen diferencias en función del grupo cultural analizado (España y México). Para esto, se utilizó un diseño cuantitativo con alcances comparativos, en el que participaron 691 adultos mayores (hombres = 40.2 %, mujeres = 59.8 %) de 60 o más años (M = 71.49, DE = 7.41), residentes de España (42.7 %) o México (57.3 %), seleccionados por medio de un muestreo por conveniencia. Para el análisis, por medio de la aplicación de un apartado sobre datos sociodemográficos y la escala ESTE de soledad ¾que mide los déficits existentes en el soporte del sujeto a nivel familiar, conyugal y social, así como los sentimientos resultantes de tales déficits¾, se procesaron pruebas de hipótesis con el coeficiente c2, el coeficiente de contingencia y la prueba t para muestras independi- entes ¾con un nivel de p ≤ .050¾. Los resultados demostraron que las diferencias culturales según el país de pertenencia tienen peso sobre la prevalencia de situaciones de soledad en el adulto mayor; que en ambas submuestras las características demográficas hacen diferencia en la caracterización de la soledad; y que hay evidencia de una relación entre los factores so- ciodemográficos de las personas mayores y la aparición de la soledad. El estudio subraya la importancia del entorno cultural y de las características demográficas sobre la soledad, elementos que se deben tener en cuenta como factores de riesgo para el desarrollo de soledad en las personas mayores.
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Fraser GE, Cosgrove CM, Mashchak AD, Orlich MJ, Altekruse SF. Lower rates of cancer and all-cause mortality in an Adventist cohort compared with a US Census population. Cancer 2019; 126:1102-1111. [PMID: 31762009 DOI: 10.1002/cncr.32571] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/15/2019] [Accepted: 09/18/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Previous research suggests that Adventists, who often follow vegetarian diets, live longer and have lower risks for many cancers than others, but there are no national data and little published comparative data for black subjects. METHODS This study compared all-cause mortality and cancer incidence between the nationally inclusive Adventist Health Study 2 (AHS-2) and nonsmokers in US Census populations: the National Longitudinal Mortality Study (NLMS) and its Surveillance, Epidemiology, and End Results substudy. Analyses used proportional hazards regression adjusting for age, sex, race, cigarette smoking history, and education. RESULTS All-cause mortality and all-cancer incidence in the black AHS-2 population were significantly lower than those for the black NLMS populations (hazard ratio [HR] for mortality, 0.64; 95% confidence interval [CI], 0.59-0.69; HR for incidence, 0.78; 95% CI, 0.68-0.88). When races were combined, estimated all-cause mortality was also significantly lower in the AHS-2 population at the age of 65 years (HR, 0.67; 95% CI, 0.64-0.69) and at the age of 85 years (HR, 0.78; 95% CI, 0.75-0.81), as was cancer mortality; this was also true for the rate of all incident cancers combined (HR, 0.70; 95% CI, 0.67-0.74) and the rates of breast, colorectal, and lung cancers. Survival curves confirmed the mortality results and showed that among males, AHS-2 blacks survived longer than white US subjects. CONCLUSIONS Substantially lower rates of all-cause mortality and cancer incidence among Adventists have implications for the effects of lifestyle and perhaps particularly diet on the etiology of these health problems. Trends similar to those seen in the combined population are also found in comparisons of black AHS-2 and NLMS subjects.
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Affiliation(s)
- Gary E Fraser
- Center for Nutrition, Healthy Lifestyle and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, California
| | | | - Andrew D Mashchak
- Center for Nutrition, Healthy Lifestyle and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, California
| | - Michael J Orlich
- Center for Nutrition, Healthy Lifestyle and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, California
| | - Sean F Altekruse
- Prevention and Population Sciences Program, Division of Cardiovascular Sciences, National Heart Lung and Blood Institute, Bethesda, Maryland
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Kellezi B, Wakefield JRH, Stevenson C, McNamara N, Mair E, Bowe M, Wilson I, Halder MM. The social cure of social prescribing: a mixed-methods study on the benefits of social connectedness on quality and effectiveness of care provision. BMJ Open 2019; 9:e033137. [PMID: 31727668 PMCID: PMC6887058 DOI: 10.1136/bmjopen-2019-033137] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/20/2019] [Accepted: 10/18/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study aimed to assess the degree to which the 'social cure' model of psychosocial health captures the understandings and experiences of healthcare staff and patients in a social prescribing (SP) pathway and the degree to which these psychosocial processes predict the effect of the pathway on healthcare usage. DESIGN Mixed-methods: Study 1: semistructured interviews; study 2: longitudinal survey. SETTING An English SP pathway delivered between 2017 and 2019. PARTICIPANTS Study 1: general practitioners (GPs) (n=7), healthcare providers (n=9) and service users (n=19). Study 2: 630 patients engaging with SP pathway at a 4-month follow-up after initial referral assessment. INTERVENTION Chronically ill patients experiencing loneliness referred onto SP pathway and meeting with a health coach and/or link worker, with possible further referral to existing or newly created relevant third-sector groups. MAIN OUTCOME MEASURE Study 1: health providers and users' qualitative perspectives on the experience of the pathway and social determinants of health. Study 2: patients' primary care usage. RESULTS Healthcare providers recognised the importance of social factors in determining patient well-being, and reason for presentation at primary care. They viewed SP as a potentially effective solution to such problems. Patients valued the different social relationships they created through the SP pathway, including those with link workers, groups and community. Group memberships quantitatively predicted primary care usage, and this was mediated by increases in community belonging and reduced loneliness. CONCLUSIONS Methodological triangulation offers robust conclusions that 'social cure' processes explain the efficacy of SP, which can reduce primary care usage through increasing social connectedness (group membership and community belonging) and reducing loneliness. Recommendations for integrating social cure processes into SP initiatives are discussed.
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Affiliation(s)
| | | | | | | | | | - Mhairi Bowe
- Psychology, Nottingham Trent University, Nottingham, UK
| | - Iain Wilson
- Psychology, Nottingham Trent University, Nottingham, UK
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Szabo S, Lakzadeh P, Cline S, Palma Dos Reis R, Petrella R. The clinical and economic burden among caregivers of patients with Alzheimer's disease in Canada. Int J Geriatr Psychiatry 2019; 34:1677-1688. [PMID: 31353572 DOI: 10.1002/gps.5182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/08/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To estimate the clinical and direct medical economic burden among Alzheimer disease (AD) caregivers using real-world, longitudinal patient-level data in Canada. METHODS/DESIGN This retrospective observational study assessed the clinical and direct medical economic burden among individuals who cohabitate with AD patients ("AD caregiver cohort") compared with older adults who were cohabiting with another adult without dementia ("comparison cohort") using real-world data from the Southwestern Ontario database, a representative Canadian electronic health record (EHR) longitudinal EHR. RESULTS The AD caregiver cohort (n = 2749; mild AD: n = 2254, moderate AD: n = 302, and severe AD, n = 193) had a similar or higher level of clinical and economic burden than the comparison cohort (n = 12 152). The overall AD cohort and caregivers of patients with mild AD had a similar clinical burden to the comparison cohort. Those caregiving for more severely affected AD patients had an increased risk of comorbidities and required more medication, physician attention, and hospital encounters compared with caregivers of less severe AD patients and the comparison cohort. Mean annual costs were higher among the AD caregiver cohort than the comparison cohort, and those caregiving for moderate and severe AD patients incurred the highest costs. Overall mortality was higher in the AD caregiver cohort compared with the comparison cohort. CONCLUSIONS Caregivers of patients with mild AD had a similar clinical and direct economic burden to older adults who were not dementia caregivers, whereas the burden among caregivers of moderate and severe AD patients was much greater.
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Affiliation(s)
| | | | | | | | - Robert Petrella
- Department of Family Practice, University of Western Ontario, London, ON, Canada
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50
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Eyowas FA, Schneider M, Yirdaw BA, Getahun FA. Multimorbidity of chronic non-communicable diseases and its models of care in low- and middle-income countries: a scoping review protocol. BMJ Open 2019; 9:e033320. [PMID: 31619434 PMCID: PMC6797258 DOI: 10.1136/bmjopen-2019-033320] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Multimorbidity is the coexistence of two or more chronic non-communicable diseases (NCDs) in a given individual. Multimorbidity is increasing in low- and middle-income countries (LMICs) and challenging health systems. Individuals with multimorbidity are facing the risk of premature mortality, lower quality of life and greater use of healthcare services. However, despite the huge challenge multimorbidity brings in LMICs, gaps remain in mapping and synthesising the available knowledge on the issue. The focus of this scoping review will be to synthesise the extent, range and nature of studies on the epidemiology and models of multimorbidity care in LMICs. METHODS PubMed (MEDLINE) will be the main database to be searched. For articles that are not indexed in the PubMed, Scopus, PsycINFO and Cochrane databases will be searched. Grey literature databases will also be explored. There will be no restrictions on study setting or year of publication. Articles will be searched using key terms, including comorbidity, co-morbidity, multimorbidity, multiple chronic conditions and model of care. Relevant articles will be screened by two independent reviewers and data will be charted accordingly. The result of this scoping review will be presented using the Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist and reporting guideline. ETHICS AND DISSEMINATION This scoping review does not require ethical approval. Findings will be published in peer-reviewed journal and presented at scientific conferences.
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Affiliation(s)
- Fantu Abebe Eyowas
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Biksegn Asrat Yirdaw
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Fentie Ambaw Getahun
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Public Health, School of Medicine, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
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