Eating Alone as Social Disengagement is Strongly Associated With Depressive Symptoms in Japanese Community-Dwelling Older Adults

Effect of eating alone and depression symptoms on incident disability among community-dwelling older adults

OBJECTIVES

The intent of the present study was to elucidate the association of eating alone and depressive symptoms with the development of disability among community-dwelling older adults, using a longitudinal study.

METHOD

Participants included 4648 Japanese older adults (mean age 73.8 ± 5.4 years; 44.3% men) aged ≥ 65 years at the time of the examination. Eating status was divided into two categories: "Eating with others at least once a day" and "Other." The 15-item Geriatric Depression Scale was used to measure depressive symptoms. Incident disability was certified by long-term care insurance (median duration: 36 months).

RESULTS

During a median follow-up at 36 months, 8.0% of the participants developed an incident disability. Adjusted for covariates, the participants who ate alone were associated with a higher hazard ratio of incident disability compared to those who ate with others (hazard ratio: 1.36, 95% confidence interval: 1.05-1.75). However, adjusted for the covariate depressive symptoms, eating alone was not significantly associated with incident disability. Structural equation models revealed that the indirect model confirmed eating alone habits were associated with disability via depressive symptoms.

CONCLUSIONS

This study confirmed that eating alone was associated with an incident disability after adjusting for the covariates. Furthermore, the present study suggests an indirect relationship between eating alone and incident disability via depressive symptoms, the result of the structural equation model.

Preference for solitude paradox: The psychological influence of social isolation despite preference

BACKGROUND

Although a preference for solitude (PS) may mitigate the negative effects of social isolation (SI) owing to the enjoyment of time alone, its impact on mental health and its underlying factors remain unclear.

METHODS

An Internet survey was conducted with 9000 individuals aged 20-79 years in September 2023 and the analyses were performed across three generations. SI was defined as contact with non-cohabitating family members or relatives and friends/neighbors less than once a week. The PS scale, which was used to assess whether a person preferred spending time alone, stratified respondents into three PS-level groups. Mental health status was evaluated using the K6 (distress symptoms), the WHO-5 (well-being), and the UCLA Loneliness Score (severity of loneliness) as the main outcomes. The mediation analyses assessed whether troublesomeness in socializing, a potential negative aspect of PS, could explain the association between PS and mental health status.

RESULTS

A mixed-design two-way analysis of covariance showed that both SI and PS had significant main effects on all outcomes without interactions across generations, indicating that SI and higher PS were associated with poor mental health status. The association between higher PS and poor mental status was mediated by socializing troublesomeness across generations.

LIMITATIONS

The cross-sectional design prevented making causal inferences from the results. Additionally, sampling bias from Internet surveys may limit the generalizability of the results.

CONCLUSIONS

The results confirmed that there is no protective effect of PS on social isolation-related poor mental health. The hassle of socializing may partly explain why people with a higher PS experience poor mental status, including greater loneliness.

Comparison of Dietary Behaviors and Health-Related Quality of Life of the Elderly Based on Their Household Type in Korea

This study analyzed the raw data from the 2021 National Health and Nutrition Survey conducted annually in Korea to investigate the dietary behavior, nutrient intake, and health-related quality of life of the elderly in the community based on their household type: single-person, couple, or non-couple family household. As a result of the study, based on the household type, significant differences were found in the frequency of breakfast, lunch, and dinner, as well as in the frequency of consuming vegetables and fruits (P<0.05, P<0.01, P<0.001). After analyzing the impact of household type on the depression and happiness levels of the surveyed elderly, it was found that the depression levels of elderly individuals in single-person households were significantly 1.279 times higher, while their feelings of happiness were 0.561 times lower compared to elderly individuals living with their family, including a spouse (P<0.05, P<0.001). In order to enhance the health-related quality of life for elderly individuals living alone with low income and education levels, it is essential to provide systematic management and support activities.

Association of dietary behavior patterns of middle-aged and older adults with their obesity metabolic phenotype: a cross-sectional study

BACKGROUND

Middle-aged and elderly individuals are the most susceptible groups for metabolic diseases, with their dietary behaviors being significant influencing factors. Exploring the association between overall dietary behaviors and obesity metabolic phenotypes is crucial for early prevention and control of chronic diseases, precision treatment and personalized interventions.

METHODS

We conducted a cross-sectional study of 15,160 middle-aged and older adults between June 2019 and August 2021 to collect information on their body mass index (BMI), biochemical indices and disease history. The population was classified into four categories by the criteria of obesity metabolic phenotypes: metabolically healthy non-obesity (MHNO), metabolically unhealthy non-obesity (MUNO), metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). Scores were calculated based on compliance with healthy eating behavior patterns (appropriate or light dietary taste, moderately soft and hard food, slightly hot food temperature, medium or slow eating speed, daily intake of dietary supplements and eating with others), and the population was categorized into subgroups 0-2 (did not meet and met only 1 or 2), 3-4 (met 3 or 4), 5-6 (met 5 or 6). The relationship between dietary behavior patterns and different obesity metabolic phenotypes in middle-aged and elderly people were analyzed by multi-categorical logistic regression model.

RESULTS

Compared with the 5-6 subgroup, the dietary behavior patterns of 0-2 and 3-4 scores were risk factors for MUNO, MHO and MUO (P < 0.05), and the lower the scores of the dietary behavior patterns, the higher the multiplicity of the occurrence of MUNO, MHO and MUO, especially for females and adults between 45-60 years old. Appropriate or light dietary taste, moderately soft and hard food, and slightly hot food temperature were protective factors for MUNO and MUO (P < 0.05); medium or slow eating speed and daily intake of dietary supplements were protective factors for MUNO, MHO and MUO (P < 0.05).

CONCLUSION

Dietary behavior patterns in middle-aged and older adults are associated with different obesity metabolic phenotypes, and healthy dietary behaviors may be beneficial for the prevention and control of MUNO, MHO and MUO.

Trends in the Assessment of Social Frailty in Community-Dwelling Older Adults: A Scoping Review

Assessment of social frailty is crucial; however, definitions and assessment methods lack standardization. This review examined social frailty in community-dwelling older adults, highlighted trends in the definitions and assessment items used to date, and identified issues in assessing social frailty. The PubMed and CINAHL databases were searched for articles related to social frailty published up to 2022, and 95 articles were included in this review. The Bunt classification was used to assess the trends in items considered indicative of social frailty. Existing rating scales for social frailty were used in 82% of studies, and cut-off values were defined in 62% of studies. Factors such as the level of education; social interaction (weekly outings); and feelings of abandonment, emptiness, and lack of social integration (absence of a partner and non-participation in social organizations or activities) were evaluated less frequently. This study revealed that subjective feelings, including the fulfillment of social needs and participation in social activities, are less commonly considered in the assessment of social frailty.

Social disconnection and suicide mortality among Japanese older adults: A seven-year follow-up study

BACKGROUND

Few prospective studies have examined the association between social disconnection and late-life suicide. Therefore, we conducted a large-scale prospective study of older adults in Japan to examine differences in suicide mortality according to specific aspects of social disconnectedness.

METHODS

We conducted a nationwide baseline survey of functionally independent older adults (age ≥65 years) from 12 municipalities in Japan from 2010 to 2011. We followed the participants (n = 46,144) for cause of death through December 2017 using vital statistics. Social disconnection was assessed based on the indicators of eating alone, a lack of instrumental/emotional support, no participation in community activities, and no contact with friends. We adopted Cox regression models with multiple imputation for missing values and calculated the population-attributable fraction (PAF).

RESULTS

A total of 55 suicide deaths were recorded during an average follow-up of 7 years. Older adults with social disconnection had a marginally increased risk of suicide. The hazard ratio for eating alone vs. eating together was 2.81 (95% confidence interval [CI]: 1.47-5.37). The direction of these associations and point estimations did not largely change after controlling for depressive symptoms, an evident risk factor for suicidal behavior. The PAF indicated that eating alone was attributable to around 1800 (29%) of the suicide deaths among older adults annually in Japan.

CONCLUSION

Avoidance of not only depressive symptoms, but also social disconnection including eating alone, is useful in suicide prevention among older adults.

Relationship of Living and Eating Arrangements to Mental Distress Among Older Korean Immigrants: Gender Difference in the Mediating Role of Loneliness

This study examined how different living/eating arrangements were associated with loneliness and depressive symptoms among older Korean immigrants. We examined gender differences considering: (1) patterns of living/eating arrangements and their relations with loneliness and mental distress and (2) indirect effect of living/eating arrangements on mental distress through feeling lonely. Data were drawn from the Study of Older Korean Americans that surveyed older; Korean immigrants during 2017-2018 (N = 2150). Living/eating arrangements were classified in the combination of four categores. Using the PROCESS macro, we tested gender differences in the mediation effect of loneliness on the relationship between living/eating arrangements and mental distress while controlling for background/health characteristics and social connectedness-related variables. The mediating role of loneliness was manifested differentially between men and women. By administering simple measures of living/eating arrangements, practitioners could potentially identify key targets to improve social and mental well-being, particularly among older immigrants with limited resources.

Does eating with others promote happiness among older adults living alone? A 3-year longitudinal study of the Japan gerontological evaluation study

OBJECTIVE

Living a happy life is an essential issue for old adults. However, how eating with others contributes to happiness and whether this association is different by living arrangements or not is unknown. The current study examined the relationship between the frequency of eating with others and happiness among older adults according to their living arrangements using 3-year longitudinal data.

METHODS

The analyzed sample comprised 18,727 people (10,920 males and 7807 females) with low happiness (0-7 points on score of 0-10 points) from Japan Gerontological Evaluation Study (JAGES) in 2016. Our exposure was the frequency of eating with others: rarely, a few times a year, a few times a month, and a few times a week or more. We performed Modified Poisson Regression to examine the association between the frequency of eating with others and high happiness (8-10 points) in 2019 stratified by living arrangement (living alone/with others).

RESULTS

A total of 4352 (23.2%) people showed high happiness in 2019. After adjusting for age, sex, marital status, education, household income, social participation, illnesses under treatment, and depressive symptoms in 2016, the cumulative incidence ratio (CIR) for high happiness in 2019 among people living alone was more significant, that is, 1.28 (95% confidence intervals: 0.88-1.87), 1.50 (1.05-2.14), and 1.82 (1.26-2.63), than 1.28 (1.11-1.48), 1.30 (1.12-1.50), and 1.33 (1.16-1.52) among people living with others for those who ate with others a few times a year, a few times a month, and a few times a week or more compared to those who rarely ate with others, respectively. The interaction between the frequency of eating with others and living arrangements was statistically significant. The trend test showed that higher frequency of eating with others was significantly associated with high happiness.

CONCLUSIONS

Eating with others was associated with improved happiness among older adults, with such an association being stronger among people living alone.

Effect of Household Type on the Prevalence of Climacteric Syndrome among Middle-Aged Men

Research on climacteric syndrome among middle-aged men remains scant compared to the research among women. Research is also lacking on climacteric syndrome among older adults living alone, particularly men, who are more vulnerable than females living alone. This cross-sectional study investigated whether the prevalence of climacteric syndrome is associated with the type of household middle-aged men live in and identified the determinants of climacteric syndrome based on the household type. Six hundred middle-aged men living in multi-person households and six hundred living alone were surveyed about general characteristics, diet-related factors, and climacteric syndrome. Data were analyzed using Pearson's chi-squared test, Fisher's exact test, and logistic regression. The risk of climacteric syndrome in single-person households was found to be 1.6 times higher than that among multi-person households (p = 0.006). In multi-person households, income and breakfast frequency predicted climacteric syndrome (p < 0.05), while age, breakfast frequency, dinner frequency, and weekly eating out frequency predicted climacteric syndrome in single-person households (p < 0.05). Thus, dietary factors are more closely linked to the prevalence of climacteric syndrome in single-person households than in multi-person households. This highlights the need for climacteric syndrome interventions for middle-aged men, whose health concerns may persist into older adulthood.

Eating together more but feeling worse: Discrepancies between observed and reported well-being of Latino(a/x) students at a Hispanic-Serving Institution

Objective. Past research suggests that eating alone is associated with less social support and poorer physical health. The current study examines the comparative health and well-being of Hispanic/Latino(a/x) and non-Hispanic/Latino(a/x) students, with a focus on comparing self-reported well-being to the observed marker of social well-being that is eating alone.Participants. Undergraduate students from a college dining hall completed online surveys in exchange for a gift card.Methods. Participants completed measures of eating alone in the dining hall, food choices, social support, quality of life, and overall health.Results. Although, compared to their non-Hispanic/Latino(a/x) peers, Hispanic/Latino(a/x) students were much more likely to be eating with others, both groups reported similar levels of social support and life satisfaction. Furthermore, Hispanic/Latino(a/x) students reported poorer physical health and chose unhealthier meals.Conclusion. Although Hispanic/Latino(a/x) students appeared to be more socially connected than their peers, these connections did not translate to better well-being.

How Does the Frequency of Eating-Alone among Older People in Korea Affect Their Health and Dietary Behavior?

This study examined the relationship between general population characteristics and diet-related factors pertaining to eating alone for older adults (65 years and older) in Korea. This study used the Korea National Health and Nutrition Examination Survey (KNHANES), 2016-2020, and the target population was 7037 Koreans aged 65 years or older who participated in the nutritional survey and health interview. Eating alone variables were classified as follows. Eating together all day means "eating together", eating only one meal a day means "1/day", eating two meals a day alone means "2/day", and "3/day" means eating three meals a day alone. The main results are as follows. The rate of moderate or severe food insecurity was 3.41% in the "eating together" group to 7.86% in the "3/day" group, which was 4.45% higher in the "3/day" group. Fruit + vegetable intake among food intake lowered by about 35 g from 301.2 g in the "eating together" group to 266.2 g in the "3 day" group. In addition, as a result of analyzing the prevalence of depression using the PHQ-9 score, the "3/day" group had a 1.775 to 2.464 times higher risk of depression than the "eating together" group. Finally, EQ-5D variables and quality of life scores were significantly lowered from the "eating together" group to the "3/day" group. Overall, higher frequency of eating alone was associated with food safety, essential food intake, and quality of life. Based on these results, it is thought that a dietary life support program such as the eating together program is necessary to improve the quality of life of the older people who eat alone.

Factors Associated With Dietary Risks in Older Korean Americans

Given the importance of healthy eating in the later years of life, the present study examined factors associated with dietary risks in older Korean Americans. We hypothesized that dietary risks would be associated with sociodemographic disadvantages, adverse health conditions, and limited sociocultural resources. Dietary risks were assessed with a scale covering five behavioral and situational risk factors (eating alone, skipping meals, functional challenges, oral health problems, and financial difficulties). Analyses of the data from the Study of Older Korean Americans (N = 2,150) showed that the sample on average had 1.13 risks (SD = 1.31), eating alone having the highest frequency (35.6%). Supporting the hypothesis, higher levels of dietary risks were found in individuals with sociodemographic disadvantages, poorer physical and mental health status, smaller social networks, and lower acculturation. Findings suggest concerted efforts to promote dietary behaviors and call attention to older immigrants who are socially and culturally isolated.

Depression and oral health-related quality of life: A longitudinal study

Objectives

Geriatric oral health-related quality of life is a relatively new but rapidly growing concept as it is directly related to the general wellbeing and self-esteem of older adults. This study assessed the impact of worsening depression symptoms on oral health-related quality of life using representative nationwide data of Korean older adults.

Methods

This study comprised a longitudinal sample of older adults aged ≥60 from the Korean Longitudinal Study of Aging (2016-2020). After applying the exclusion criteria, 3,286 participants were included in the study. Depression status was determined through the biennial assessment of the short-form Center for Epidemiologic Studies Depression Scale (CESD-10); oral health was measured using the Geriatric Oral Health Assessment Index (GOHAI). We employed the lagged general estimating equations to assess the temporal effect of the CESD-10 score change on the GOHAI score.

Results

A decrease in CESD-10 score over a 2-year period was significantly associated with a decrease in GOHAI score in men and women: β = -1.810 and β = -1.278, respectively (p-values < 0.0001). Furthermore, compared to the same or improved CESD-10 score, worsening of the score on 1-2 points detected the β = -1.793 in men and β = -1.356 in women, and worsening on ≥3 points: β = -3.614 in men and β = -2.533 in women.

Conclusions

This study found that depression exacerbation is negatively associated with oral health-related quality of life in later life. Further, a more significant worsening of depression symptoms was correlated with lower scores for oral health-related quality of life in our study population.

Healthy Aging at Family Mealtimes: Associations of Clean Cooking, Protein Intake, and Dining Together with Mental Health of Chinese Older Adults amid COVID-19 Pandemic

The present study aims to examine whether multiple dietary factors affect the mental health of older adults amid the COVID-19 pandemic. It proposes an integrative dietary framework that highlights environmental, nutritional, and social aspects of diet for healthy aging. Based on a sample of 7858 Chinese older adults, the associations between diet and depressive symptoms, along with the rural-urban divide, were examined using zero-inflated negative binomial regression. Overall, protein intake (incidence-rate ratio [IRR] = 0.89, p < 0.001), frequency of family dining together (IRR = 0.98, p < 0.001), and using tap water for cooking (IRR = 0.92, p < 0.01) were associated with lower incidence rates of depressive symptoms among older adults. Among rural older adults, frequency of family dining together (IRR = 0.97, p < 0.001) and tap water use (IRR = 0.89, p < 0.001) were associated with fewer depressive symptoms. However, urban residents who had a higher frequency of family dining together (IRR = 0.98, p < 0.05) and protein intake (IRR = 0.81, p < 0.001) exhibited fewer depressive symptoms. The findings revealed multifaceted dietary pathways towards healthy aging, which call for policies and interventions that improve diet quality for community-dwelling older adults.

Poor Health Behaviors among Housebound Japanese Community-Dwelling Older Adults Due to Prolonged Self-Restraint during the First COVID-19 Pandemic: A Cross-Sectional Survey

BACKGROUND

Prolonged self-restraining behaviors induced by the coronavirus disease 2019 (COVID-19) pandemic's containment measures can limit various positive health behaviors.

OBJECTIVE

We examined the decline in going-out and certain other positive health behaviors and investigated the relationship between excessive decreases in going-out frequency and declining engagement in positive health behaviors among community-dwelling older adults during the self-restraint period.

DESIGN

This study employed a cross-sectional survey design.

SETTING

This study was conducted in Nishi Tokyo City, Tokyo, Japan.

PARTICIPANTS

The participants were 294 respondents (150 women) aged 50 years and older who lived in public housing that were permitted to be surveyed during the self-restraint period.

MEASUREMENTS

Their pre-pandemic going-out frequency around February 2020 and going-out frequency during the self-restraint period starting in April 2020 were reported. We mainly assessed the existence of home health behaviors (i.e., exercise, in-person and phone conversations, and healthy diet). A self-report questionnaire was used to obtain data.

RESULTS

Going-out frequency decreased in 41.2% of the 294 respondents owing to the government's request for self-restraint. In total, 13 individuals had been going out less than one time per week (housebound) before the request. Of the 281 people who were not housebound before the government's self-restraint request, 13.9% were newly housebound. Newly housebound individuals were 5.3 times less likely to exercise, had 2.1 times fewer social contacts, and 2.6 times less balanced or healthy diets than those who maintained their frequency of going out.

CONCLUSIONS

Prolonged self-restraint due to the COVID-19 pandemic may lead to housebound status and poor health behaviors. Public health intervention is needed to prevent excessive self-restraint, along with new measures integrating information and communication technologies to enable older adults to live active lives.

Mental Disorders and Oral Diseases: Future Research Directions

The poor physical health (including oral health) of people with mental disorders is a global problem. The burden of oral diseases among this group is substantial given their high prevalence and ability to increase the personal, social, and economic impacts of mental disorders. This article summarizes causes of mental disorders and oral diseases, critically reviews current evidence on interventions to reduce the burden of oral diseases in people with mental disorders, and suggests future research directions. The relationship between mental disorders and oral diseases is complex due to the shared social determinants and bidirectional interaction mechanisms that involve interconnected social, psychological, behavioral, and biological processes. Research has, to date, failed to produce effective and scalable interventions to tackle the burden of oral diseases among people with mental disorders. Transformative research and actions informed by a dynamic involvement of biological, behavioral, and social sciences are needed to understand and tackle the complex relationship between mental disorders and oral diseases, as well as inform the design of complex interventions. Examples of future research on complex public health, health service, and social care interventions are provided. The design and testing of these interventions should be carried out in real-world settings, underpinned by the principles of coproduction and systems thinking, and conducted by a transdisciplinary team. We propose this starts with setting research priorities and developing complex intervention theory, which we report to support future research to improve oral health and hence physical and mental health in this disadvantaged group.

Impact of the Comprehensive Awareness Modification of Mouth, Chewing and Meal (CAMCAM) Program on the Attitude and Behavior Towards Oral Health and Eating Habits as Well as the Condition of Oral Frailty: A Pilot Study

OBJECTIVES

Preserving sufficient oral function and maintaining aadequate nutrition are essential for preventing physical frailty and the following long-term care. We recently developed the 6-month Comprehensive Awareness Modification of Mouth, Chewing And Meal (CAMCAM) program, in which participants gather monthly to learn about oral health and nutrition while eating a textured lunch together. This study examined whether the CAMCAM program could improve attitude and behavior towards oral health, mastication, and diet as well as ameliorate oral frailty in community-dwelling older adults.

DESIGN

Single-arm pre-post comparison study.

SETTING AND PARTICIPANTS

A total of 271 community-dwelling adults (72.3 ± 5.7 years of age; 159 women [58.7%]) in 4 Japanese municipalities were recruited, of which 249 participants (92%) were assessed at the final evaluation.

INTERVENTION

Participants gathered once a month at community centers to learn about oral health and nutrition while eating a "munchy" textured lunch containing proper nutrition.

MEASUREMENTS

Oral frailty, frailty, and eating behavior were evaluated with the Oral Frailty Index-8 (OFI-8), Kihon checklist (KCL), and CAMCAM checklist, respectively. Participants were divided into Oral frailty (OF) and Robust groups according to OFI-8 scores. The differences in KCL and CAMCAM checklist results between the OF and Robust groups were statistically tested along with changes in scores after the program.

RESULTS

KCL and CAMCAM checklist scores were significantly lower in the OF group at the initial assessment. OFI-8 and KCL findings were significantly improved in the OF group after completing the program (all P <0.05). Regarding the CAMCAM checklist, awareness of chewing improved significantly in the Robust group (P=0.009), with a similar tendency in the OF group (P=0.080).

CONCLUSION

The findings of this pilot study suggest that the CAMCAM program may improve both oral and systemic frailty in addition to attitudes towards chewing, oral health, and meals, especially in individuals with oral frailty. The CAMCAM program merits expansion as a community-based frailty prevention program.

Dietary Problems Are Associated with Frailty Status in Older People with Fewer Teeth in Japan

This study aimed to investigate the association between dietary problems and frailty according to tooth loss in older Japanese people. This cross-sectional study included 160 older people (mean age 82.6 years) from Japan. Frailty status was assessed using the Study of Osteoporotic Fractures (SOF) criteria, which consists of (i) weight loss > 5% in the past year, (ii) inability to perform five chair stands, and (iii) self-perceived reduced energy level. Frailty was defined as the presence of ≥2 items of SOF criteria. Multivariate logistic regression analyses were performed with frailty as the dependent variable and dietary problems as the independent variable, stratified according to having <20 teeth. Low appetite and no enjoyment of eating were associated with frailty after adjusting for covariates in participants with <20 teeth. Dietary problems, including low appetite, eating alone, and negative attitudes toward enjoyment of eating were associated with a self-perceived reduced energy level in participants with <20 teeth. However, this association was not observed in participants with ≥20 teeth. In older people with fewer teeth, dietary problems have been suggested to be associated with frailty. Therefore, it may be necessary to pay attention to dietary problems, especially in older people with tooth loss.

Mealtime Behavior and Depressive Symptoms in Late-Life Marriage

This study examined whether one spouse's mealtime behaviors were associated with their own and their partner's depressive symptoms among older, married couples. We examined gender differences in these associations and tested marital satisfaction as a mediator of these associations. 101 couples self-reported mealtime behavior (number of meals, snacks, fast-food meals, and meals eaten alone), depressive symptoms, and marital satisfaction. Results of the Actor Partner Interdependence Model revealed a statistically significant actor effect of number of fast-food meals on depressive symptoms and a significant partner effect of number of fast-food meals and number of meals eaten alone on depressive symptoms. There were gender differences. Husbands' marital satisfaction mediated the effect of meals eaten alone on depressive symptoms. Wife's marital satisfaction mediated the effect of the husband's meals eaten alone, and wife's number of fast-food meals on the wife's depressive symptoms. Findings have implications for dyadic interventions to improve depressive symptoms.

Association between meal frequency with others and psychological distress during the COVID-19 pandemic: A cross-sectional study

Aim

Previous studies evaluated the association between eating alone and mental health mainly in older people and adolescents. This study aimed to evaluate the association between dinner frequency with others and psychological distress during the COVID-19 outbreak among the Japanese working population.

Methods

Data were acquired from a prospective online cohort study (the Employee Cohort Study in the COVID-19 pandemic in Japan) conducted in February 2021 as a cross-sectional design. Dinner frequency with others was categorized into five groups: "almost daily," "4-5 times per week," "2-3 times per week," "once per week," and "less than once per week," setting them as a predictor variable. Modified Poisson regression was performed to calculate the prevalence ratio of psychological distress with multiple imputation for missing data. Global fear and worry about COVID-19 were adjusted as a covariate.

Results

A total of 1171 participants completed the questionnaire. Respondents who ate dinner with others "almost daily" had the least psychological distress than those who ate with others "4-5 times," "2-3 times," and "once per week" in the crude model (prevalence ratio (95% CI): 1 [reference], 1.34 [1.08-1.67], 1.40 [1.15-1.69], 1.44 [1.12-1.85], respectively). The association was comparable after adjusting for global fear and worry about COVID-19.

Conclusions

Among those who ate dinner with others at least once a week, those who ate with others "almost daily" had the least psychological distress. The association was comparable after adjusting for global fear and worry about COVID-19. Further study is needed on why those who eat with others less than once a week may have a lower prevalence ratio of having mental distress.

The association between leftover food consumption and depression among older adults: Findings from a cross-sectional study

BACKGROUND

Leftover food consumption is very prevalent among the Chinese older adults, however, the potential effects of leftover eating consumption on depression have not yet been investigated.

OBJECTIVES

The study aims to determine the association between leftover consumption on depression among older adults.

METHODS

Data of leftover consumption frequency was collected in a cross-sectional study with a provincial representative sample of 5992 older adults (aged 60 or older) in 2019. Depression symptoms were assessed by the 9-item screener Patient Health Questionnaire (PHQ-9). Multiple logistic regression models were applied to analyze the association of the frequency of leftover eating consumption and the presence and the severity of depression.

RESULTS

After controlling for all the covariates, the participants who consume leftover food everyday had higher risk of having depression symptom comparing to those who had the lowest frequency of leftover eating (OR: 1.675, 95% CI: 1.435-1.956, p < 0.001). The participants who consume leftover food every day was also associated with more severe depression symptoms (OR: 1.621, 95% CI: 1.397-1.881, p < 0.001), when comparing to the reference group. The associations seemed stronger in men than women.

LIMITATIONS

The causal relationship between leftover consumption behavior and depression could not be determined due to the cross-sectional design. Moreover, the variety or handling method of the leftover food was not specified.

CONCLUSION

Leftovers eating frequency was associated with the presence and severity of depression symptoms among older adults.

Association of poor dental status with eating alone: A cross-sectional Japan gerontological evaluation study among independent older adults

Eating alone is reported to deteriorate health; however, the relationship between eating alone and poor dental health remains unclear. This cross-sectional study aimed to investigate the association between poor dental health and eating alone. Data of participants (n = 156,287) aged ≥65 years from the Japan Gerontological Evaluation Study were evaluated using logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the association between dental status, including prosthesis use, and eating status. Differences in these associations according to living status were also examined. The mean age of participants was 73.7 (SD = 6.0) years. The percentages of participants eating alone with 20 or more teeth, 10-19 teeth with dental prostheses, 0-9 teeth with dental prostheses, 10-19 teeth without dental prostheses, and 0-9 teeth without dental prostheses were 13.8%, 16.0%, 18.6%, 18.9%, and 27.0%, respectively. After adjusting for covariates, participants with 0-9 teeth without any dental prosthesis showed a significantly higher odds ratio for eating alone (OR = 1.81, 95% CI = 1.58-2.07) than those with 20 or more teeth. Among participants with poorer dental status, the probability of eating alone was higher in those living alone than in those living with others. Among older adults, poor dental status was significantly associated with eating alone, and this association was stronger among those living alone. Maintaining better dental status by using a dental prosthesis might reduce the risk of eating alone, especially for those living alone.

Combined impacts of physical activity, dietary variety, and social interaction on incident functional disability in older Japanese adults

BACKGROUND

This 3.6-year prospective study examined combined impacts of physical activity, dietary variety, and social interaction on incident disability and estimated population-attributable fraction for disability reduction in older adults.

METHODS

Participants were 7,822 initially non-disabled residents (3,966 men; 3,856 women) aged 65-84 years of Ota City, Tokyo, Japan. Sufficiency of moderate-to-vigorous-intensity physical activity (MVPA) ≥150 min/week, dietary variety score (DVS) ≥3 (median), and social interaction (face-to-face and/or non-face-to-face) ≥1 time/week was assessed using self-administered questionnaires. Disability incidence was prospectively identified using the long-term care insurance system's nationally unified database.

RESULTS

During a follow-up of 3.6 years, 1,046 (13.4%) individuals had disabilities. Independent multivariate-hazard ratios (HRs) and 95% confidence intervals of MVPA, DVS, and social interaction sufficiency for incident disability were 0.68 (0.59-0.78), 0.87 (0.77-0.99), and 0.91 (0.79-1.03), respectively. Incident disability HRs (95% CIs) gradually reduced with increased frequency of satisfying these behaviors (any one: 0.82, 0.65-1.03; any two: 0.65, 0.52-0.82; and all three behaviors: 0.54, 0.43-0.69), in an inverse dose-response manner (P < 0.001 for trend). Population-attributable fraction for disability reduction in satisfying any one, any two, and all three behaviors were 4.0% (-0.2, 7.9), 9.6% (4.8-14.1), and 16.0% (8.7-22.8), respectively.

CONCLUSION

Combining active physical activity, dietary variety, and social interaction substantially enhances the impacts on preventing disability among older adults, with evidence of an inverse dose-response manner. Adding the insufficient behavior element to individual habits and preexisting social group activities may be effective in preventing disability in the community.

Oral health and depressive symptoms among older adults: longitudinal study

OBJECTIVE

The aim of this study was to describe the prevalence of depressive symptoms and determine the association with oral health variables in older adults belonging to an oral health cohort.

METHOD

A prospective longitudinal study was conducted between 2009 and 2015. A standardized questionnaire was administered to collect demographic-socioeconomic variables and self-perceived oral health status. The clinical oral examinations were performed by examiners who had undergone training and calibration exercises. Depressive symptoms (outcome) were measured using the Geriatric Depression Scale (GDS-15), with a score of five points or higher considered indicative of the presence of depressive symptoms.

RESULTS

A total of 439 and 163 older adults (≥60 years of age) were evaluated in 2009 and 2015, respectively. The prevalence of depressive symptoms was 18.3% in 2009 and 28.5% in 2015. In the adjusted Poisson regression model, older adults who experienced tooth loss between 2009 and 2015 (PR = 1.86; 95% CI: 1.01-3.53) and those with a sensation of dry mouth in 2015 but not in 2009 (PR = 3.25 95% CI: 1.56-6.72) were at greater risk of exhibiting depressive symptoms.

CONCLUSION

In this study, the prevalence of depressive symptoms was considerable. Older adults with tooth loss between 2009 and 2015 and those with a perception of dry mouth were at greater risk of exhibiting depressive symptoms, which underscores the importance of including a dentist as part of the health team for the prevention and treatment of mental health problems.

Association between functional disability and depressive symptoms among older adults in rural China: a cross-sectional study

Objectives

The aim of this study was to explore the relationship between functional disability and depressive symptoms, focusing on whether an interaction exists between functional disability, demographic characteristics and depressive symptoms among older adults in rural China.

Design

A cross-sectional study using multistage, stratified random sampling.

Setting

Data from 18 villages in Anhui Province of China between January to July 2018.

Participants

3491 Chinese participants aged 60 and over.

Primary and secondary outcome measures

The 30-item Geriatric Depression Scale and WHO Disability Assessment Schedule 2.0 were used to evaluate depressive symptoms and functional disability, respectively. Data were analysed using SPSS statistics V.25.0 program with χ2 test, Mann-Whitney U test, binary logistic regression analysis and classification and regression tree (CART) model.

Results

The prevalence of depressive symptoms in 3336 interviewed older people was 52.94%. After adjustment, subjects who had problems in mobility domain (adjusted OR (AOR) 1.842, 95% CI 1.503 to 2.258), getting along domain (AOR 1.616, 95% CI 1.299 to 2.010), life activities domain (AOR 1.683, 95% CI 1.370 to 2.066) and participation domain (AOR 3.499, 95% CI 2.385 to 4.987) had an increased depressive symptoms risk. However, cognition domain (AOR 0.785, 95% CI 0.647 to 0.953) negatively correlated with depressive symptoms. Additionally, the CART model showed that those who had problems in mobility domain, getting along domain and were unemployed, the possibility of having depressive symptoms was the highest.

Conclusions

More attention should be paid to unemployed older adults, and those with problems in participation, life activities, getting along and mobility and no problems in cognition to maintain a good psychological state.

Association between eating alone and cardiovascular diseases in elderly women: a cross-sectional study of KNHANES 2016 data

OBJECTIVE

To investigate differences in health behaviors, nutritional status, and the likelihood of having cardiovascular diseases and its risk factors according to the presence of an eating companion in older women.

METHODS

Using 2016 Korean National Health and Nutrition Examination Survey VII-1 data, 590 menopausal women aged ≥65 years were analyzed in this cross-sectional study. Participants who ate more than two meals a day alone were assigned to an eating-alone (EA) group and those who ate more than two meals a day with others were assigned to an eating-with-others (EO) group. Complex-samples general linear analysis, t tests, and logistic regression were used for the analysis of the data.

RESULTS

Awareness of nutrition labels (P = 0.012), using of nutrition labels (P = 0.014), and impact of nutrition labels (P = 0.016) were lower in the EA group than in the EO group. The intake of energy, carbohydrates, dietary fiber, sodium, and potassium was lower in the EA group than in the EO group (P < 0.05). The likelihood of having angina was 2.58 times higher in the EA group than in the EO group (95% CI, 1.20-5.55).

CONCLUSIONS

Older women who ate alone had poorer nutritional knowledge and intake. In addition, eating alone in older women was strongly associated with the prevalence of angina. Thus, it is necessary to consider nutrition education and cardiovascular disease screening for older women who mainly eat alone.

Eating alone and depressive symptoms among the Japanese working population: The Furukawa nutrition and health study

The aim of this study was to determine the cross-sectional associations between frequency of eating with others and depressive symptoms in Japanese employees while accounting for lifestyle and dietary factors. We also examined the relationship with stratification by living arrangement. Participants were 1876 workers aged 18-74 years who participated in a health survey at a periodic checkup. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale. Frequency of eating with others was categorized into ranges between daily and <1 day/week. Associations between frequency of eating with others and depressive symptoms were assessed using logistic regression analysis, with adjustment for lifestyle and dietary factors. The prevalence of depressive symptoms was 32.9%. The prevalence of depressive symptoms tended to increase with decreasing frequency of eating with others, with multivariate-adjusted odds ratios (95% confidence intervals) for the highest through lowest frequency groups of eating meals with others being 1.00 (reference), 1.27 (0.92-1.74), 1.56 (1.11-2.21), 1.86 (1.29-2.67), and 2.22 (1.53-3.22), respectively (P for trend<0.001). In analysis stratified by living arrangement, a significant association was found with those living with others but not those living alone (P for interaction <0.001). Lower frequency of eating with others may be associated with higher odds of depressive symptoms among Japanese workers living with others, even after controlling for lifestyle and dietary factors.

Association between swallowing function, malnutrition and frailty in community dwelling older people

BACKGROUND & AIMS

Swallowing function decreases with age and impacts nutritional state and frailty. The aim of the study was to test the relationship between swallowing function, dysphagia, frailty, malnutrition and depression in community dwelling older participants.

METHODS

Community dwelling older participants (n = 180), were enrolled (74 men aged 75.9 ± 7.8, 65-91 years, and 107 women aged 75.9 ± 8.0, 65-95 years). Swallowing function was assessed by the Test of Mastication and Swallowing Solids (TOMASS) and the Timed Water Swallow Test (TWST). Dysphagia was identified using Hebrew 10-Item Eating Assessment Tool (H-EAT-10). Frailty was assessed by grip strength and the FRAIL Questionnaire. The Mini Nutritional Assessment - Short Form (MNA-SF) was used to identify nutritional status. Depression was screened with the Geriatric Depression Scale - Short Form (GDS-SF).

RESULTS

18.3% of the participants had a score of 3 or above in H-EAT-10, indicating suspected dysphagia. 17.8% of the participants were malnourished or at risk of malnutrition, and 48.3% were defined as frail or pre-frail. The odds of being malnourished/at risk of malnutrition were 3 times greater in those with suspected dysphagia. The odds of being frail/pre-frail were also 3 times greater in those with suspected dysphagia. Moreover, suspected dysphagia and frail/pre-frail health status coincided in 69.7% of participants. Participants that were malnourished/at risk of malnutrition required more masticatory cycles (p < .05) and more time (p < .05) to eat a cracker and drink 150 mL of water (p < .05), and had reduced swallowing capacity (volume/sec) in the TWST (p < .05) than those who were at normal nutritional statues. Similar results were found for frail/pre-frail participants versus robust health status. A decrease in grip strength was associated with increased (worse) frailty score, decreased nutritional score, decreased chewing function in TOMASS and decreased water drinking function in TWST (p < .05). MNA-SF score, age, GDS-SF score and EAT-10 were the best predictors of FRAIL score.

CONCLUSION

A simple multi-dimensional screen should be employed by trained allied health professionals, nurses and their assistants to improve early identification and early referral to relevant health providers in order to provide preventive intervention for dysphagia, nutrition, frailty and depression.

Preference to Eat Alone: Autistic Adults' Desire for Freedom of Choice for a Peaceful Space

Backgrounds

Autistic adults tend to prefer eating alone, which may result in further social isolation. This study aims to understand contexts of challenges autistic adults face when eating with other people outside home.

Methods

We explored autistic subjectivities actively situated in eating environments. We conducted follow-up individual email interviews with autistic adults diagnosed with an autism spectrum disorder in adulthood (n = 10) and autistic adults without a formal diagnosis (n = 6), both of whom had participated in our prior online survey with Brazilian autistic adults. We used a thematic analysis to gain an in-depth understanding of challenging characteristics of social situations in the eating space.

Results

To eat out comfortably, many participants did not talk while eating, chose places without sensory overload, chose places with eatable foods, ate at off-peak hours, used sensory tools, and/or left places when stressed. Participants developed these coping strategies to negotiate incongruences between their autistic personal characteristics and their physical environments. However, there were incongruences between the coping strategies and social contexts with codiners. Participants often could not freely use the strategies-both in work and in casual social situations. This lack of freedom of choice often resulted in feeling uncomfortable, sick, or having meltdowns during or after social dining. Because of these experiences, many participants decided to avoid social dining.

Conclusions

The preference to eat alone in autistic adults may reflect their desire for freedom of choice to use coping strategies to eat in a peaceful food space. Creating a peaceful eating environment may be a feasible and humanistic approach to reduce unwanted aloneness and social isolation in autistic adults.

Lay summary

Why was this study done?: Eating together with other people is a common activity to socialize and feel a sense of belonging. But autistic adults often prefer to eat alone, though they have a desire to socialize.What was the purpose of this study?: To study challenging aspects of eating out with other people, to understand why some autistic adults prefer to eat alone.What did the researchers do?: We interviewed adults who considered themselves to be on the autism spectrum. Of the 16 interview participants, 10 were formally diagnosed with an autism condition and 6 were not. They once participated in our online survey with Brazilian autistic adults. The interviews were done by email. We asked about eating places and experiences in eating out. We looked for the common themes over all the interview responses.What were the results of the study?: When eating out alone, participants had strategies to eat comfortably. They could eat without talking, choose places without sensory overload, choose places with eatable foods, eat at off-peak hours, use tools such as earphones, or leave the place when stressed. However, they often could not freely do so in both work and casual social situations. They knew that their coping strategies would be considered inappropriate by others. For example, many participants felt pressured to talk while eating. Also, other people had different preferences for the times and places to eat from participants. It was difficult for participants to deal with the stressful environment without using their coping strategies. So, participants often felt uncomfortable, sick, or had meltdowns during or after eating out with others. For these reasons, many of them avoided eating out with others.What do these findings add to what was already known?: Autistic adults' preference to eat alone and difficulty in social situations involving eating have been understood as eating problems in autism. Our findings suggest that some dining companions reduce autistic persons' freedom to eat in comfortable social and physical environments, and that the preference expresses a desire to have such freedom.What are potential weaknesses in the study?: Because we used email interviews, the study did not include any participant without access to email, and participants were all college educated, unlike most Brazilian adults with an autism diagnosis.How will these findings help autistic adults now or in the future?: The findings will help autistic adults by letting others know ways that dining companions potentially reduce autistic persons' freedom to eat comfortably and by inspiring them not to do so. The findings also suggest that society should focus on creating a peaceful eating environment instead of focusing on finding ways to treat autistic aloneness as if aloneness in autism is caused by problems inside of the autistic individual.

Social frailty and longitudinal risk of depressive symptoms in a Chinese population: the Rugao Longevity and Aging Study

AIM

To explore the cross-sectional and longitudinal associations between social frailty (SF) and incident depressive symptoms in a Chinese population.

METHODS

SF was measured with 6 questions (6 points maximum; 0-1 = non-SF, 2-3 = pre-SF, 4-6 = SF). Depressive symptoms were defined as a score of ≥6 on the Geriatric Depression Scale. Compared to baseline, participants with a ≥2-point increase in the Geriatric Depression Scale score were considered to have worsening depressive symptoms.

RESULTS

At baseline, among 1764 participants, 9.9% (n = 175) had depressive symptoms, 3.6% (n = 61) were SF, and 38.2% (n = 650) were pre-SF. The percentage of depressive symptoms increased with SF status from 5.1% (non-SF) to 12.9% (pre-SF), to 41.0% (SF). In cross-sectional analysis, after adjustments for multiple covariates, depressive symptoms were significantly associated with both pre-SF (odds ratio (OR) = 2.94, 95% confidence interval (CI) 2.01-4.32) and SF (OR = 16.70, 95% CI 8.80-31.71). During the 3-year follow-up period, 10.0% (n = 117) of the participants developed depressive symptoms. In longitudinal analyses, after multiple adjustments, SF and pre-SF were associated with a 2.31-fold (95% CI 1.10-4.88) and 1.58-fold (95% CI 1.05-2.38) increased risk of incidence of depressive symptoms, respectively. Among participants without depressive symptoms at baseline, 23.2% had worsening depressive symptoms, and SF was associated with increased risk of worsening depressive symptoms (OR = 2.07, 95% CI 1.18-3.65).

CONCLUSIONS

Our findings suggested that SF may be a predictor of depression among Chinese community-dwelling older adults. In addition, in elders with no depressive symptoms at baseline, those with SF had greater odds of worsening depressive symptoms 3 years later.

Oral health-related quality of life is associated with the prevalence and development of depressive symptoms in older Japanese individuals: The Ohasama Study

OBJECTIVE

This prospective study investigated the cross-sectional association between impaired oral health-related quality of life (OHRQoL) and the prevalence of depressive symptoms, and the longitudinal association between impaired OHRQoL and development of depressive symptoms among older adults.

BACKGROUND

Previous studies have shown a relationship between poor oral health and depression among older adults; however, findings are inconsistent.

MATERIALS AND METHODS

Participants were 669 community-dwelling older Japanese individuals aged≥55 years (mean: 67.8 ± 7.2 years). Data of 296 participants were used for longitudinal analyses. OHRQoL was evaluated using the Oral Impacts on Daily Performances scale. Impaired OHRQoL was defined as the presence of at least one impact on the scale. Depressive symptoms were assessed using the Japanese version of the Zung self-rating depression scale with a cut-off score of 40.

RESULTS

The cross-sectional logistic regression model demonstrated that impaired OHRQoL was significantly associated with depressive symptoms (odds ratio [OR], 5.17; 95% confidence interval [CI], 2.99-8.95) independent of age, sex, body mass index, hypertension, cerebrovascular/cardiovascular disease, smoking, drinking alcohol, education, cognitive function, objective oral health (dentition status) and oral health behaviour (dental visit within 1 year). Similarly, impaired OHRQoL predicted the development of depressive symptoms within 4 years in a fully adjusted longitudinal model (OR, 6.00; 95% CI, 1.38-26.09).

CONCLUSION

Impaired OHRQoL was identified as a potential comorbidity of depressive symptoms and a predictor for depressive disorder later in life. OHRQoL may be a useful clinical outcome for elder patients with regard to their mental and oral health.

The use of ICT devices as part of the solo eating experience

An increasing number of people tend to eat alone due to social changes and an altered attitude towards cooking and eating practices. Anecdotal reports indicate that solo diners tend to use information and communication technology devices, for example, the smartphone, as part of the eating experience. While lab studies suggest that the devices contribute to an increased high-calorie food intake and decreased feeling of satiety, these studies disregard the everyday experience and motivation of solo diners. We conducted an exploratory study to investigate how solo diners use digital devices as part of their daily eating experience. Semi-structured interviews with solo diners (N = 12) were analyzed using thematic analysis in an inductive approach leading to six themes. The themes focus on (1) the perception of a meal; (2) the experience of a solo diner; (3) the purpose of using an information and communication technology device; (4) the perceived influence of the devices; (5) factors decreasing and increasing the use; (6) and the potential to promote healthier food consumption. Our results indicate that the use of digital devices while eating alone can lead to distraction, being unaware of the food texture and the amount that is eaten. The devices can also induce a positive influence by providing entertainment and mitigating negative emotions like loneliness and boredom. The devices have the potential to contribute to healthy eating practices by providing education and by influencing the speed of eating through elements of sound. Although the use of devices might negatively affect eating behavior, their ubiquitous presence also offers the opportunity to reach specific, vulnerable populations.

Do Living Arrangements and Social Network Influence the Mental Health Status of Older Adults in Malaysia?

Living arrangement has been reported to have a significant influence on several mental health statuses of older adults, but their social network may confound this association. This study is aimed at examining the interactive effect of living arrangements and social network on the mental health status among older adults in Malaysia. A total of 2,188 Malaysian older adults living nationwide were included in this cross-sectional study. Participants were classified into four groups according to their living arrangements (living alone or not living alone) and social network size (assessed using Lubben's Social Network Scale-6). Poor social network was defined as the lowest quartile (fourth quartile) of the score. Mental health statuses, which include flourishing in life, life satisfaction, cognitive functions, loneliness, depression, and perceived stress, were measured. Multiple linear regression models, adjusted for age, gender, education, and comorbidities, revealed that a good social network was significantly associated with an increase on the flourishing scale scores, regardless of living arrangements. Not living alone and having good social network was significantly associated with increased Montreal Cognitive Assessment scores and decreased loneliness scores. This study found that living arrangements are not always a risk factor for the mental health status of older adults. However, it may be confounded by the level of their social networks. The results suggested that the effects of social network may exceed the impact of living arrangements. It is recommended that health professionals pay more attention to the social networks of older Malaysians to harness its benefits in improving their mental health status.

Association of Eating Alone with Depressive Symptoms and Suicidal Ideation among Korean Adults

BACKGROUND

In recent years, eating dinner alone has become a rising social issue in Korea. Depression is one of the primary health problems that can lead to numerous negative consequences. However, few studies have focused on people who eat alone and the effect of eating alone on depression. We investigated the association between eating dinner alone and depression.

METHODS

Our cross-sectional study included data from 14,093 Korean adults aged above 19 years old; data were sourced from the Korea National Health and Nutrition Examination Survey in 2014, 2016, and 2018, when the Patient Health Questionnaire (PHQ-9) was used. We classified participants based on their dinner habits: eating alone or social eating. Depression and suicidal ideation among participants were measured using the PHQ-9. Multivariate logistic regression analysis was used to investigate whether eating alone was related to depression or suicidal ideation after adjusting for age, sex, household income, education, alcohol, smoking, exercise, frequency of eating out, and living arrangement.

RESULTS

Individuals who ate dinner alone (22.9%) had higher depression and suicidal ideation rates than those who ate with others. Those who ate alone had greater odds ratios (ORs) of depressive symptoms (depression: OR, 1.42; 95% confidence interval [CI], 1.27-1.58; suicidal ideation: OR, 1.49; 95% CI, 1.25-1.78) after adjustment for covariates. The subgroup analysis shows that the odds of suicidal ideation among individuals who eat alone were nonexistent among those who performed regular aerobic exercise.

CONCLUSION

Eating dinner alone is closely associated with depressive symptoms, particularly suicidal ideation. Therefore, providing opportunities to eat with others may be effective for maintaining the mental health of adults.

Eating Alone or Together among Community-Living Older People-A Scoping Review

Research on healthy aging commonly concerns problems related to loneliness and food intake. These are not independent aspects of health since eating, beyond its biological necessity, is a central part of social life. This scoping review aimed to map scientific articles on eating alone or together among community-living older people, and to identify relevant research gaps. Four databases were searched, 989 articles were identified and 98 fulfilled the inclusion criteria. In the first theme, eating alone or together are treated as central topics of interest, isolated from adjoining, broader concepts such as social participation. In the second, eating alone or together are one aspect of the findings, e.g., one of several risk factors for malnutrition. Findings confirm the significance of commensality in older peoples' life. We recommend future research designs allowing identification of causal relationships, using refined ways of measuring meals alone or together, and qualitative methods adding complexity.

Characteristics of Eating Alone Affecting the Stress, Depression, and Suicidal Ideation

This study aimed to identify the characteristics of eating alone that influence stress, depression, and suicidal ideation in Korean adults. This study was a cross-sectional survey using the raw data of the sixth Korea National Health and Nutrition Examination Survey (KNHANES VI) conducted in 2015. The survey sampled 7380 adults, of whom 3515 were included in this analysis. The odds of stress were 1.308 times higher in individuals who ate dinner alone than those who ate dinner with others. The odds of having depressive symptoms were 1.711 times and 1.531 times higher in individuals who ate lunch and dinner alone, respectively, than those who ate lunch or dinner with others. The association between eating alone and suicidal ideation was statistically significant only in the simple model. There is a need for interventional programs that can reduce negative relationships of eating alone behaviors for preventing mental health problems.

Eating Alone at Each Meal and Associated Health Status among Community-Dwelling Japanese Elderly Living with Others: A Cross-Sectional Analysis of the KAGUYA Study

This cross-sectional study investigated the association between eating alone at each meal and health status, including functional capacity among community-dwelling Japanese elderly living with others. A self-administered questionnaire was mailed to all 8004 residents aged 65 or older, residing in the same Japanese town in March 2016. Eating alone was assessed by first asking whether participants ate three separate meals each day (i.e., breakfast, lunch, and dinner), and those who answered affirmatively were then asked how many people were usually present at each meal. Health status was assessed in terms of subjective health, medical history, care needs, body mass index, depression, and functional capacity. Data from 2809 respondents were analyzed. Those who reported not being in good subjective health and a history of hypertension were significantly more likely to eat alone at breakfast (odds ratio 1.27; 95% confidence interval 1.01–1.61, and 1.26; 1.06–1.49). Depressive symptoms and many subscales of functional capacity were also significantly associated with eating alone at breakfast, lunch, and dinner (p < 0.05). Many health status indicators were related to eating alone at each meal, especially breakfast.

Eating Together and Health-Related Quality of Life Among Korean Adults

OBJECTIVE

To investigate the association between frequency of eating together and health-related quality of life (HRQoL).

DESIGN

Population-based cross-sectional study.

PARTICIPANTS AND SETTING

A total of 13,920 adults (≥19 years). Data obtained from the Korea National Health and Nutrition Examination Survey conducted from 2014 to 2016. The European Quality of Life-5 Dimensions index was used to assess the HRQoL.

MAIN OUTCOME MEASURES

Relation between the frequency of eating together (eating alone, 1 time/d, and ≥2 times/d) and HRQoL.

ANALYSIS

ANOVA, correlations, and multivariable logistic regression.

RESULTS

A significantly positive association was observed between the frequency of eating together and the European Quality of Life-5 Dimensions index (P < .001). An increase in the frequency of eating together was associated with decreased odds ratios of having problems in subdimensions (self-care, usual activities, and anxiety or depression; P for trend <.005).

CONCLUSIONS AND IMPLICATIONS

A decreased frequency of eating together is associated with low HRQoL. Additional work is warranted to confirm the association between the frequency of eating together and HRQoL in young adults, aged 19-64 years. Further studies are required to identify whether an intervention to increase the frequency of eating together would improve HRQoL in individuals who usually eat alone.

Social Frailty Is Independently Associated with Mood, Nutrition, Physical Performance, and Physical Activity: Insights from a Theory-Guided Approach

Notwithstanding the increasing body of evidence that links social determinants to health outcomes, social frailty is arguably the least explored among the various dimensions of frailty. Using available items from previous studies to derive a social frailty scale as guided by the Bunt social frailty theoretical framework, we aimed to examine the association of social frailty, independently of physical frailty, with salient outcomes of mood, nutrition, physical performance, physical activity, and life–space mobility. We studied 229 community-dwelling older adults (mean age 67.22 years; 72.6% females) who were non-frail (defined by the FRAIL criteria). Using exploratory factor analysis, the resultant 8-item Social Frailty Scale (SFS-8) yielded a three-factor structure comprising social resources, social activities and financial resource, and social need fulfilment (score range: 0–8 points). Social non-frailty (SNF), social pre-frailty (SPF), and social frailty (SF) were defined based on optimal cutoffs, with corresponding prevalence of 63.8%, 28.8%, and 7.4%, respectively. In logistic regression adjusted for significant covariates and physical frailty (Modified Fried criteria), there is an association of SPF with poor physical performance and low physical activity (odds ratio, OR range: 3.10 to 6.22), and SF with depressive symptoms, malnutrition risk, poor physical performance, and low physical activity (OR range: 3.58 to 13.97) compared to SNF. There was no significant association of SPF or SF with life–space mobility. In summary, through a theory-guided approach, our study demonstrates the independent association of social frailty with a comprehensive range of intermediary health outcomes in more robust older adults. A holistic preventative approach to frailty should include upstream interventions that target social frailty to address social gradient and inequalities.

A qualitative study on the reasons for solitary eating habits of older adults living with family

Eating alone while living with family members is a risk factor for mental health decline in old age. However, little is known as to why older adults choose to eat alone, even with family present. This study therefore aimed to explore reasons for older adults eating alone despite living with family members, using a qualitative approach. Fifteen people aged 65 years and older (11 men and 4 women) who were eating alone while living with family members were included in the study. These individuals were selected from the participants of the Kashiwa cohort study conducted in 2016. Individual interviews were conducted using an open-ended format. All interviews were recorded and transcribed. The data were further thematically analyzed using a qualitative software package, NVivo 11. We extracted six themes as reasons for eating alone and hypothesized interactions among these themes. The extracted themes were: “age-related changes,” “solo-friendly environment,” “family structure changes,” “time lag for eating,” “bad relationships with family members” and “routinization.” To assess interactions, the themes were categorized as “background factors,” “triggers,” and “stabilizers.” The aforementioned themes could lead to the development and sustained behavior of eating alone among older adults living with family members. As most themes describe conditions that are likely to remain static, it may not be realistic to encourage such individuals to begin eating with family members. The promotion of meals with neighbors or friends could be effective in alleviating the negative consequences of eating alone.

Association of Eating Alone With Depression Among Older Adults Living Alone: Role of Poor Social Networks

Objectives

Eating alone is associated with an increased risk of depression symptoms. This association may be confounded by poor social networks. The present study aimed to determine the role of poor social networks in the association of eating alone with depression symptoms, focusing on cohabitation status.

Methods

Seven hundred and ten community-dwelling older adults were categorized according to their eating style and social network size, evaluated using an abbreviated version of the Lubben Social Network Scale, with poor social network size (defined as the lowest quartile). Living arrangements and depression symptoms, detected using the Zung Self-Rating Depression Scale, were also assessed.

Results

A mixed-design two-way analysis of covariance (eating style and social network size factors) for the depression scale score, adjusted by covariates, yielded significant effects of social network size and eating style without interaction. Greater depression scores were observed in eating alone and poor social network size. Analysis of participants living with others showed the same results. However, among older adults living alone, only a significant main effect of social network size was observed; poor social network size resulted in greater depression scores irrespective of eating style.

Conclusions

Poor social network size, and not eating alone, was associated with greater depression symptoms among older adults living alone, whereas both factors may increase depression symptoms among older adults living with others. Poor social network size may show a stronger influence on depression than eating alone in older adults living alone; thus, social network size is an important health indicator.

Nutritional intervention and functional exercises improve depression, loneliness and quality of life in elderly women with sarcopenia: a randomized clinical trial

Abstract Introduction: Loneliness interferes with the eating habits and functionality of the elderly, compromising their quality of life. Objective: This study aimed to evaluate the effects of eating and performing functional group-based exercises on depressive symptoms, loneliness and quality of life in patients with sarcopenia treated at a public health service. Method: This is a randomized clinical trial with a convenience sample of elderly women with sarcopenia according to the European Work Group of Sarcopenia on Older People (EWGSOP), divided into three groups of 20 subjects each: a control group (CG), functional exercise group (FEG), monitored using the Home-based Older People’s Exercise (HOPE) program, and functional exercise and nutritional intervention group (NIG), which in addition to HOPE, received pre-training fruit juice (fast-absorbing carbohydrates) and post-training banana smoothie reinforced with peanut (leucine). These groups met twice a week for 12 weeks, the control group (CG) received health guidance at weekly meetings for 12 weeks. The results of the interventions were analyzed using the geriatric depression scale and UCLA loneliness scale, and quality of life using the EQ-5D. Results: Significant post-intervention differences were observed in the NIG group in depressive (p=0.008) and loneliness symptoms (0.04) and quality of life (0.009), demonstrating the effects of group exercise and eating as a social activity. Conclusion: Nutritional intervention and functional group-based exercises were effective at minimizing depressive symptoms, social isolation, and improving the quality of life of elderly women with sarcopenia.

Exercise Arrangement Is Associated with Physical and Mental Health in Older Adults

PURPOSE

Although exercising with others might have health benefits, no previous study has comprehensively examined associations of exercise arrangement with physical activity (PA), physical function (PF), and mental health (MH). We examined whether PA, PF, and MH are better when exercising with others than when exercising alone or not exercising.

METHODS

We analyzed cross-sectional data from 7759 (4007 men and 3752 women) nondisabled residents age 65 to 84 yr. PA, PF, and MH were assessed with the International Physical Activity Questionnaire-Short Form (PA sufficiency defined as ≥150 min·wk of moderate-to-vigorous PA), Motor Fitness Scale (higher PF defined as total score ≥12 in men and ≥10 in women), and World Health Organization-Five Well-Being Index (better MH defined as a total score ≥13), respectively. Exercise arrangement was classified as "nonexerciser," "exercising alone," and "exercising with others." Using multilevel logistic regression analyses, we examined independent associations of exercise arrangement with PA, PF, and MH.

RESULTS

Compared with exercising alone, the multivariate-adjusted odds ratios (95% confidence interval) among nonexercisers and those exercising with others were 0.21 (0.17-0.25) and 1.32 (1.04-1.67), respectively, for PA sufficiency, 0.47 (0.40-0.57) and 1.12 (0.94-1.34) for higher PF, and 0.69 (0.58-0.82) and 1.45 (1.17-1.79) for better MH, respectively, in men. In women, the corresponding odds ratios were 0.37 (0.30-0.46) and 1.31 (1.01-1.70) for PA sufficiency, 0.66 (0.54-0.80) and 1.08 (0.88-1.32) for higher PF, and 0.70 (0.58-0.85) and 1.27 (1.03-1.56) for better MH, respectively.

CONCLUSIONS

Exercising alone and with others were better than no exercise for maintaining better PA, PF, and MH in both sexes. Although exercise arrangement had little effect on maintaining PF, exercising with others appears to enhance PA levels and MH in both sexes.

Which Aspects of Dining Style are Associated with Depressive Mood? A Study at an Assisted Living Facility in Japan

Previous research indicated that dining style is associated with depressive mood in community-dwelling older adults; however, the nature of this relationship in care facilities is unclear. The association between dining style and depressive mood was examined in Japanese assisted living facility. A questionnaire survey was conducted among residents older than 65 years. Dining style was assessed by objective (the number of people with whom one eats) and subjective (feelings of enjoyment during mealtimes) factors. The odds ratio of participants who ate alone but enjoyed meals having depressive mood were not statistically different from the reference group (eating with others and enjoying). In contrast, participants who ate with others and did not enjoy meals, and participants who ate alone and did not enjoy meals were more likely to have depressive mood compared to the reference group. Although a cross-sectional study, findings suggested that caregivers should consider residents' subjective dining styles to provide optimal support at mealtimes.

Eating Alone Yet Living With Others Is Associated With Mortality in Older Men: The JAGES Cohort Survey

Objectives

Eating by oneself may be a risk factor for poor nutritional and mental statuses among older adults. However, their longitudinal association with mortality in relation to coresidential status is unknown.

Method

We conducted a 3-year follow-up of participants in the Japan Gerontological Evaluation Study, a population-based cohort of 65 years or older Japanese adults. We analyzed mortality for 33,083 men and 38,698 women from 2010 to 2013 and used. Cox regression models were used to estimate hazard ratios (HR) for mortality.

Results

A total of 3,217 deaths occurred during the follow-up. Compared with men who ate and lived with others, the HRs after adjusting for age and health status were 1.48 (95% confidence intervals [CI]: 1.26–1.74) for men who ate alone yet lived with others and 1.19 (95% CI: 1.01–1.41) for men who ate and lived alone. Among women, the adjusted HR was 1.18 (95% CI: 0.97–1.43) for women who ate alone yet lived with others and 1.10 (95% CI: 0.93–1.29) for women who ate and lived alone.

Discussion

A setting in which older adults eat together may be protective for them. Promotion of this intervention should focus on men who eat alone yet live with others.

Temporary Workers' Skipping of Meals and Eating Alone in South Korea: The Korean National Health and Nutrition Examination Survey for 2013-2016

Available evidence suggests that social disadvantages are inextricably linked to unhealthy eating behaviors. Given that temporary workers face insecure employment and uncertainty in their work’s terms and conditions, issues relevant to maintaining healthy eating behavior are likely to be affected. This study investigated the association between temporary employments and, specifically, the status and frequency of meal skipping and of eating alone among temporary and permanent Korean workers. We used data from the 2013–2016 Korean National Health and Nutrition Examination Survey. A total of 5912 working people were included as the study population. We classified them as temporary workers (n = 3036) and permanent workers (n = 2876). Eating behaviors included meal skipping and eating alone. The rate and frequency of meal skipping and eating alone were higher in temporary workers. After adjustment for potential confounders, the likelihoods for temporary workers’ skipping lunch was twice as high (OR = 1.95, 95% CI 1.45–2.63) as for permanent workers. In particular, temporary workers had four-fold-increased odds (OR = 4.12, 95% CI 2.29–7.41) of eating alone three times per day relative to permanent workers. We found that temporary workers were more likely to skip meals and eat alone than were permanent workers.

Eating Alone is Differentially Associated with the Risk of Metabolic Syndrome in Korean Men and Women

Few studies have examined overall patterns of eating alone in relation to the risk of metabolic syndrome (MetS) in Korean populations. The present study aimed to examine the relationship between patterns of eating alone and the risk of MetS in Korean adults. Data from the Korea National Health and Nutrition Examination Survey (KNHANES) for 2013–2015 were used, with 8988 Korean adult participants, including 3624 men and 5364 women, aged 18 to 64 years. Patterns of eating alone were categorized into eight groups based on the total frequency of eating alone on a daily basis in the past one year: (1) three times for breakfast, lunch, and dinner; (2) twice for breakfast and dinner; (3) twice for lunch and dinner; (4) twice for breakfast and lunch; (5) once for breakfast only; (6) once for lunch only; (7) once for dinner only; and (8) never eating alone. The presence of MetS has been defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and International Diabetes Federation (IDF). Multivariable logistic regression analyses were performed to assess the association between patterns of eating alone versus the risk of MetS after controlling for age, income, occupation, number of family members, generation types, marital status, smoking status, and physical activity. The prevalence of MetS was the highest in men and women aged 40–64 who had breakfast, lunch, and dinner alone (50.1% and 36.8%, respectively). Men who had dinner alone or lunch and dinner alone compared with those who eat with others had a significantly higher risk of MetS, with adjusted odds ratios (AOR) of 1.51, and a 95% confidence interval (CI) of 1.06–2.16; and an AOR of 1.54, with a 95% CI of 1.05–2.25, respectively. Women who had breakfast alone compared with those who ate with others had a significantly lower risk of MetS (AOR 0.70, 95% CI 0.53–0.94). In conclusion, patterns of eating alone are differentially associated with the risk of MetS in a representative sample of Korean adults. Future studies are warranted to identify dietary patterns across the different eating alone patterns in relation to various health outcomes in Korean adult populations.