Community-dwelling older adults who are low-income and disabled weathering financial challenges

Prevalence and Factors Associated with Depression Among Older Adults During the COVID-19 Pandemic: A Cross-Sectional Study in Urban Areas in Thailand

Purpose

This study examined the prevalence of and factors associated with depression symptoms among Thai older adults during the COVID-19 pandemic.

Patients and Methods

A cross-sectional survey was conducted among older adults in urban areas in Bangkok, Thailand, between July and October 2021. The 15-item Thai Geriatric Depression Scale (TGDS-15) was used to determine the prevalence of depression symptoms, and multiple logistic regression was conducted to identify the associated factors.

Results

A total 156 older adults survey responses were received. The largest group of participants (80.8%) was aged below 70, women (50.6%), married (67.9%), retired (41%), having sufficient income (67.9%), living with their families (89.1%). More than half (71.8%) had an underlying disease, with hypertension being the most common (39.1%). In addition, 17.3% of the participants had received compulsory COVID-19 vaccination. Only 0.6% had a history of COVID-19 infection. The prevalence of depression among Thai older adults was 20.5%. Univariate analysis demonstrated occupation and income sufficiency was associated with depression symptoms. The results of the multivariate analysis found that the "non-worker" group was 3.54 times more likely to experience depression symptoms than the reference group (OR = 3.54, 95% CI = 1.25-10.02, p = 0.018) when controlling for the confounding factors.

Conclusion

This study highlights the importance of addressing depression symptoms among Thai older adults, in which occupation and income sufficiency were the main variable factors for depression. Our study further suggested that the importance of interventions such as increasing job availability and establishing financial aid policies may ameliorate depression symptoms among older adults, especially in high-risk groups during the pandemic situation such as the COVID-19.

Propensity score weighted associations between financial strain and subsequent inflammatory biomarkers of aging among a representative sample of U.S. older adults

BACKGROUND

Despite known socioeconomic disparities in aging-related outcomes, the underlying physiologic mechanisms are understudied. This study applied propensity score weighting to estimate the effect of financial strain on inflammation-related aging biomarkers among a national sample of older adults.

METHODS

Financial strain severe enough to lack money for housing, utilities, medical/prescription bills or food was measured among 4,593 community-dwelling National Health and Aging Trends Study participants aged ≥ 65 years in 2016. Inverse probability propensity score weights were generated based on 2015 background characteristics, including age, gender, race/ethnicity, income to poverty ratio, education, occupation, home ownership, retirement, Sect. 8 housing, Medicaid, food/energy assistance, childhood health, marital status, and U.S. region. Sampling weights additionally accounted for study design and non-response.

RESULTS

In propensity score-weighted analyses adjusting for age, gender, race/ethnicity, 2017 income to poverty ratio and education, those with 2016 financial strain had 15% higher IL-6 (p = 0.026) and 20% higher CRP levels (p = 0.002) in 2017 than those who were not strained, but did not differ with regard to hemoglobin A1c or CMV. In weighted comparisons, those with financial strain did not differ from those without with regard any 2015 background characteristics.

CONCLUSIONS

These results strengthen the etiologic evidence suggesting that financial strain increases inflammatory biomarkers among older adults. Importantly, inflammation is likely a key physiologic pathway contributing to socioeconomic disparities. Therefore, research is needed to address financial strain.

Socioeconomic status impacts cognitive and socioemotional processes in healthy ageing

Socioeconomic status (SES) negatively impacts cognitive and executive functioning in older adults, yet its effects on socioemotional abilities have not been studied in this population. Also, evidence on neurocognitive processes associated with ageing primarily comes from Western, educated, industrialized, rich, and democratic (WEIRD) populations, hindering the generalization of findings to persons from upper-middle- and low-middle-income countries, such as those of Latin America. Here, we compared the performance of low- and high-SES older adults from Argentina in cognitive state, executive functions, social cognition (emotion recognition and theory of mind), and counter-empathic social emotions (envy and Schadenfreude; displeasure at others' fortune and pleasure at others' misfortune, respectively). Subsequently, we developed a path analysis to test the relationship among those variables in a theoretically plausible model and tested the main paths via multiple regression analyses. Relative to the high-SES group, low-SES older adults showed poorer performance on all assessed domains. Convergent evidence from covariance analysis, path analysis, and linear regressions suggested that low-SES impact on socioemotional processes was not primary but mediated by cognitive and executive impairment. These findings offer the first characterization of SES impacts on cognitive and socioemotional processes in a non-WEIRD population and have relevant equity-related implications for brain health.

OUP accepted manuscript

BACKGROUND AND OBJECTIVES

Despite evidence linking financial challenges to poor health among older adults, effective interventions are lacking. This study examined the experience of living with financial challenges, useful strategies to handle them, and social norms that may constrain options and decision-making.

RESEARCH DESIGN AND METHODS

This two-staged qualitative study recruited low-income older adults from the United States Baltimore City area. First, semistructured individual interviews examined older adults' experiences and strategies used to handle financial challenges. Then, vignette-based focus groups examined relevant social norms. Transcripts were coded, and hierarchical themes were described using thematic analysis.

RESULTS

Two themes were generated. First, the social norms relevant to financial challenges share a common underlying assumption of personal responsibility. Second, social norms about personal responsibility are inconsistent with the experiences of older adults facing financial challenges, who typically lack control over their situation and face structural barriers to preventing and handling financial challenges. Differences between statements related to norms and personal responsibility were found across six subthemes, including how finances should be handled to prevent financial challenges, the causes of financial challenges, asking for help from community resources, navigating community resources, getting help from family, and cutting back to handle financial challenges.

DISCUSSION AND IMPLICATIONS

The disconnect between social norms and the reality of financial challenges among older adults may explain why so many older adults cut back to the point of foregoing necessities. There is an urgent need to strengthen the social safety net and remove normative barriers to services.