The impact of perceived social support, loneliness, and physical activity on quality of life in South Korean older adults

Depression, Loneliness and Quality of Life in Institutionalised and Non-Institutionalised Older Adults in Portugal: A Cross-Sectional Study

Our study aims to estimate the prevalence of depressive symptomatology among older adults and to assess their association with loneliness and quality of life according to institutionalisation status in a Portuguese sample.

BACKGROUND

The World Health Organisation estimates that by 2050, the world's population over 60 will number two billion people, which poses complex challenges in terms of maintaining the mental health of older adults. The COVID-19 pandemic has increased the prevalence of depressive symptoms in this population, but the post-pandemic phase has not yet been studied much.

METHODS

A cross-sectional survey was carried out in 2023 among institutionalised and non-institutionalised older adults (total n = 525; institutionalised = 458; non-institutionalised = 67) who were selected by convenience sampling. The Patient Health Questionnaire (PHQ-9) was used to assess the presence of depressive symptoms, the WHOQOL-BREF to assess perceived quality of life and the Loneliness Scale (UCLA) to assess negative feelings of loneliness. Unconditional logistic regression models were fitted to compute crude adjusted odds ratios (ORs) and the respective 95% confidence intervals (95%CIs) for the association between sociodemographic, clinical and psychosocial characteristics and depressive symptomatology, according to institutionalisation status. The final model was adjusted for sex, age, QoL and feelings of loneliness.

RESULTS

Of the 525 participants, 74.6% of the non-institutionalised participants had no or minimal depressive symptoms, while 55.4% of the institutionalised participants fell into this category. Mild to moderately severe depressive symptoms were present in 25.4% of the non-institutionalised participants. 26.9% of the institutionalised participants had mild symptoms, 11.8% had moderate symptoms, 3.9% had moderately severe symptoms, and 2.0% had severe depressive symptoms. Overall, a higher quality of life was associated with lower levels of depressive symptoms. Participants describing feelings of loneliness were more likely also to present depressive symptoms (OR = 78.10; 95%CI 2.90-2106.08 and OR = 3.53; 95%CI 1.72-6.91 for non-institutionalised and institutionalised older adults, respectively), independently of institutionalisation status.

CONCLUSIONS

The prevalence of depressive symptoms is high in older adults, which means that it has not decreased after the increase seen due to the COVID-19 pandemic. A lower perception of quality of life and the presence of negative feelings of loneliness are associated with the presence of depressive symptoms. These conclusions suggest that plans should be developed to intervene in the dimensions of depressive symptoms, perceived quality of life and negative feelings of loneliness.

Impact of the medical fitness model on long term health outcomes in older adults

BACKGROUND

Physical inactivity is common among older adults and is associated with poor health outcomes. Medical fitness facilities provide a medically focused approach to physical fitness and can improve physical activity in their communities. This study aimed to assess the relationship between membership in the medical fitness model and all-cause mortality, health care utilization, and major adverse cardiac events in older adults.

METHODS

A propensity weighted retrospective cohort study linked individuals that attended medical fitness facilities to provincial health administrative databases. Older adults who had at least 1 year of health coverage from their index date between January 1st, 2005 to December 31st 2015 were included. Controls were assigned a pseudo-index date at random based on the frequency distribution of index dates in members. Members were stratified into low frequency attenders (< 1 Weekly Visits) and regular frequency attenders (> 1 Weekly Visits). Time to event models estimated the hazard ratios (HRs) for risk of all-cause mortality and major adverse cardiac event. Negative binomial models estimated the risk ratios (RRs) for risk of hospitalizations, outpatient primary care visits and emergency department visits.

RESULTS

Among 3,029 older adult members and 91,734 controls, members had a 45% lower risk of all-cause mortality (HR: 0.55, 95% CI: 0.50 - 0.61), 20% lower risk of hospitalizations (RR: 0.80, 95% CI: 0.75 - 0.84), and a 27% (HR: 0.72, 95% CI: 0.66 - 0.77), lower risk of a major adverse cardiovascular event. A dose-response effect with larger risk reductions was associated with more frequent attendance as regular frequency attenders were 4% more likely to visit a general practitioner for a routine healthcare visit (RR: 1.04, 95% CI: 1.01 - 1.07), but 23% less likely to visit the emergency department (RR: 0.87, 95% CI: 0.82 - 0.92).

CONCLUSIONS

Membership at a medical fitness facility was associated with a decreased risk of mortality, health care utilization and cardiovascular events. The medical fitness model may be an alternative approach for public health strategies to promote positive health behaviors in older adult populations.

The relationship between physical activity and anxiety in college students: exploring the mediating role of lifestyle habits and dietary nutrition

Background

Physical activity has been shown to be effective in treating and improving anxiety in college students. However, no studies have been conducted to examine the relationship between physical activity and anxiety in college students through mediating factors such as dietary nutrition and lifestyle habits. Therefore, the aim of this study was to examine the mediating role of lifestyle and dietary nutrition in the relationship between physical activity and anxiety.

Methods

This study used a stratified random sampling method to survey 498 college students from three universities in Fujian, China. Data on participants' demographic characteristics, physical activity, lifestyle habits, and dietary nutrition were collected and analyzed using SPSS software. The proposed structural equation model was analyzed using Amos software.

Results

The results of the study showed that dietary nutrition and lifestyle habits had significant independent mediating effects and continuous multiple mediating effects (p < 0.01) in the effects of physical activity on college students' anxiety. Dietary nutrition and lifestyle habits played an independent mediating role, accounting for 24.9% of the total effect; there was also a continuous multiple mediating effect between dietary nutrition and lifestyle habits, accounting for 13.27% of the total effect value. In addition, physical activity had a direct effect value on anxiety in college students, accounting for 36.93% of the total effect value.

Conclusion

By increasing the behavior and awareness of college students to participate in physical activity, supplemented by guiding them to develop regular lifestyle habits and correct dietary nutritional patterns, the anxiety level of college students can be effectively improved and reduced. This type of regulation is an important reference for the self-management and rehabilitation of college students with anxiety disorders. Future studies can experimentally develop a combined intervention of physical activity, lifestyle habits, and dietary nutritional to help college students better cope with anxiety.

Physical activity and functional social support in community-dwelling older adults: a scoping review

BACKGROUND

Globally, the population of older people is increasing and is estimated to reach nearly 2.1 billion by 2050. Physical activity (PA) is one of the key components for successful ageing. However, PA decreases with age and many older adults do not meet PA guidelines. Previous research has shown that social support (SOSU) is related to PA in older people. The aim of this scoping review is to identify and map all of the available evidence and to explore the association between functional SOSU and PA in older adults. Functional SOSU consists of emotional, informational, instrumental and companionship SOSU and social comparison.

METHODS

A scoping review was conducted using the Joanna-Briggs manual. Quantitative and qualitative studies investigating associations between functional SOSU and PA levels in older adults (mean age ≥ 60 years) were identified through a systematic search in seven electronic databases up to August 2023. After removing duplicates, 20,907 articles were screened for titles and abstracts. The results were analysed separately for different types of SOSU.

RESULTS

116 articles met the inclusion criteria; 72% were quantitative studies and 28% were qualitative studies. Most studies used self-reported PA measures, only 23% of the studies used objective-reported PA measures. Most studies of SOSU for PA reported positive associations but the evidence is inconclusive when the source of support is considered. PA is positively associated with general, emotional, informational, and companionship SOSU, while instrumental support may occasionally be negatively associated. Companionship support is particularly influential on PA, especially in group settings, as it promotes social connectedness. Qualitative studies show that social comparison also supports PA. Different forms of SOSU generally show positive associations with PA.

CONCLUSIONS

While the evidence on the association between functional SOSU and PA is mixed, most studies show that there is a positive association. PA may also be a strategy for improving social contact and social integration. This study offers a comprehensive overview of measures for SOSU and PA and thereby informs future research and policy-making.

An exploratory study on material deprivation and loneliness among older adults in Hong Kong

BACKGROUND

Poverty, as a risk factor for loneliness, has been understudied, and there is a need to gain a better understanding of the relationship between poverty examined by material deprivation and loneliness among older adults in Hong Kong. It also aimed to explore the possible mediation and moderation effects of social support, social networks, neighborhood collective efficacy, and social engagement in the link between material deprivation and loneliness.

METHODS

1696 Chinese older adults aged 60 years and above (Mage = 74.61; SD = 8.71) participated in a two-wave study. Older adults reported their loneliness level, material deprivation, perceived level of social support, social network, neighborhood collective efficacy, social engagement, and sociodemographic information. Logistic regression was conducted to examine the effect of material deprivation on loneliness, as well as the mediation and moderation models.

RESULTS

The results indicated that material deprived older adults reported a significantly higher level of loneliness 2 years later when controlling for demographic variables, health-related factors, and loneliness at baseline. We also found that engagement in cultural activities partially mediated the effect of material deprivation and loneliness. Furthermore, neighborhood collective efficacy and engagement in cultural activities were significant moderators that buffer the relationship between material deprivation and loneliness.

CONCLUSIONS

Our results suggested the need to alleviate the negative impact of material deprivation on loneliness by developing interventions focused on promoting neighborhood collective efficacy and social engagement, which could be aimed at building meaningful bonds among Chinese older adults in Hong Kong.

Relationship Between Square Dancing and Meaning in Life Among Older Adults: Examining an Age-Based Moderation Model

PURPOSE

Square dancing may help older adults experience meaning in life (MIL). However, it remains unclear how square dancing facilitates MIL. To address this question, we examined whether participation frequency, transcendent experiences, and social support correlated positively with MIL, and whether age moderated the correlation between transcendent experiences and MIL.

METHOD

We studied 268 older adults using in-person surveys to collect data on age, participation frequency, transcendent experiences, social support, and MIL. We analyzed data using hierarchical regression.

RESULTS

High frequency of participation and high levels of transcendent experiences and social support simultaneously predicted high levels of MIL, and age decreased the positive relationship between transcendent experiences and MIL.

CONCLUSION

Based on the hierarchical regression results, we recommend strategies to increase older adults' MIL by providing square dancing opportunities; working with them to improve square dancing skills that facilitate transcendent experiences; and guiding them in seeking sources of social support. [Research in Gerontological Nursing, 17(3), 141-147.].

The Migrant-Local Difference in the Relationship Between Social Support, Sleep Disturbance, and Loneliness Among Older Adults in China: Cross-Sectional Study

BACKGROUND

Driven by the accelerated aging of the population of China, the number of older adults has increased rapidly in the country. Meanwhile, following children, migrant older adults (MOA) have emerged as a vulnerable group in the process of fast urbanization. Existed studies have illustrated the association between social support and loneliness and the relationship between sleep disturbance and loneliness; however, the underlying mechanisms and the migrant-local difference in the association between social support, sleep disturbance, and loneliness have not been identified.

OBJECTIVE

This study aimed to clarify the migrant-local difference in the relationship between social support, sleep disturbance, and loneliness in older adults in China.

METHODS

Multistage cluster random sampling was used to select participants: 1205 older adults (n=613, 50.9%, MOA and n=592, 49.1%, local older adults [LOA]) were selected in Weifang City, China, in August 2021. Loneliness was assessed with the 6-item short-form University of California, Los Angeles Loneliness Scale, social support was evaluated with the Social Support Rating Scale, and sleep disturbance was measured with the Pittsburgh Sleep Quality Index. The chi-square test, t test, and structural equation modeling (SEM) were adopted to explore the migrant-local difference between social support, sleep disturbance, and loneliness among the MOA and LOA.

RESULTS

The mean score of loneliness was 8.58 (SD 3.03) for the MOA and 8.00 (SD 2.79) for the LOA. SEM analysis showed that social support exerts a direct negative effect on both sleep disturbance (standardized coefficient=-0.24 in the MOA and -0.20 in the LOA) and loneliness (standardized coefficient=-0.44 in the MOA and -0.40 in the LOA), while sleep disturbance generates a direct positive effect on loneliness (standardized coefficient=0.13 in the MOA and 0.22 in the LOA).

CONCLUSIONS

Both MOA and LOA have a low level of loneliness, but the MOA show higher loneliness than the LOA. There is a negative correlation between social support and loneliness as well as between social support and sleep disturbance among the MOA and LOA (MOA>LOA), while loneliness is positively associated with sleep disturbance in both populations (MOA Collapse

Key Words

• loneliness
• migrant-local difference
• older adults
• sleep disturbance
• social support
• structural equation modeling

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MESH Headings

• Child
• Humans
• Aged
• Cross-Sectional Studies
• Loneliness
• Transients and Migrants
• China/epidemiology
• Sleep Wake Disorders/epidemiology
• Social Support
• Sleep

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Grants Collapse

Affiliation(s)

Mingli Pang Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Jieru Wang Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Mingyue Zhao Human Resource Department, The Second Hospital of Shandong University, Jinan, China
Rui Chen Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Hui Liu Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Xixing Xu Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Shixue Li Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Fanlei Kong Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China

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Physical activity and health-related quality of life in older adults: depression as a mediator

BACKGROUND

Physical activity(PA) is associated with health-related quality of life (HRQoL) among older adults, and both are associated with mood, such as depression. However, the indirect effects of PA on HRQoL in older adults have not been clearly established. This study explained how different types and intensities of PA were associated with HRQoL while considering the effects of depression in older adults.

METHODS

A cross-sectional study was conducted with 7,518 community-dwelling older adults aged 60 years and older. PA (leisure-time, household, and work-related), depression, and HRQoL were measured using the Physical Activity Scale for the Elderly (PASE), the 30-item Geriatric Depression Scale (GDS-30), and the 36-Item Short-Form Health Survey (SF-36), respectively. Information on age, gender, education, monthly income, activities of daily living, smoking, and alcohol drinking was also collected. Regression analysis was used to explore the relationship between PA, depression and HRQoL, and a mediation effect test process was used to verify the mediating mechanism of the depression on this relationship.

RESULTS

The study showed that after adjusting for a set of covariates, SF-36 Physical Component Summary (PCS) scores were negatively associated with depression (B = -2.046, 95% CI [2.584, -1.509]) and positively with PA (p < 0.001). Similarly, SF-36 Mental Component Summary (MCS) scores were negatively associated with depression (B = -11.657, 95% CI [-12.190, -11.124]). In mediation analyses, we found that depression partially mediated the relationship between different types and intensities PA and PCS (moderate leisure-time PA: B = 0.223, 95%CI [0.153,0.293], P < 0.001; vigorous leisure-time PA: B = 0.323, 95%CI [0.232,0.413], P < 0.001; moderate household PA: B = 0.092, 95%CI [0.045,0.139], P < 0.001; vigorous household PA: B = 0.137, 95%CI [0.085,0.190], P < 0.001; work-related PA: B = 0.193, 95%CI [0.658,0.190], P < 0.001) and MCS (moderate leisure-time PA: B = 1.243, 95%CI [1.008,1.479], P < 0.001; vigorous leisure-time PA: B = 1.800, 95%CI [1.585,2.015], P < 0.001; moderate household PA: B = 0.496, 95%CI [0.274,0.718], P < 0.001; vigorous household PA: B = 0.742, 95%CI [0.521,0.963], P < 0.001; work-related PA: B = 1.026, 95%CI [0.819,1.234], P < 0.001).

CONCLUSIONS

This study suggested that leisure-time, household, and work-related PA were negatively associated with depression, while positively affecting HRQoL in Chinese older adults. The relationships between different types and intensities of PA and HRQoL were mediated by depression. Interventions aimed at promoting purposeful exercise and different types of PA may have mental health benefits. It is recommended that geriatric health managers and healthcare planners prioritize interventions to help improve PA intensities, alleviate depressive symptoms to promote beneficial effects on HRQoL in older adults.

Psycho-social and health predictors of loneliness in older primary care patients and mediating mechanisms linking comorbidities and loneliness

BACKGROUND

Aging is associated with many personal, social, and environmental challenges that increase the risk of loneliness. Loneliness is a painful emotional experience associated with a perceived lack of connection and intimacy. Loneliness accelerates health deterioration, but the presence of chronic health conditions (comorbidities) in older individuals may potentiate the feeling of loneliness. The relationships between health status and loneliness in older individuals have not been assessed in an integrated manner, although it is necessary for planning efficient interventions. The aim of this study was to fill in this knowledge gap, by attempting to create an integrated model of loneliness in older individuals.

METHODS

The sample consisted of 189 (58% F) older individuals (> 60 years) (mean ± SD, 78.47 ± 6.65), attendees in Primary Health Care. Different factors associated with loneliness in the older population were assessed, and classified as demographic, environmental, physical (health-related), and psychological, in addition to functional abilities. A set of standard questionnaires was used to assess psychological factors and functional abilities. The hierarchical regression model assessed the effect of particular blocks of factors on status loneliness. The second aim was to analyze how psychological factors mediate associations between health status (comorbidity level) and loneliness.

RESULTS

Indicated that increasing comorbidity, anxiety, lack of positive moods, not having hobbies/activities, low perception of social support, impaired cognitive function, and suppression of emotion expression, are significant predictors of loneliness. Mediation analysis informed us of how to help patients with comorbidities feel less lonely. Interventions that were suggested were those that can reduce anxiety and depression, improve cognitive abilities and emotional regulation control, and enhance social support.

CONCLUSIONS

Results can help understand the pathophysiology loops linking poor health status (comorbidity level) of older individuals and loneliness, and have significant potentials from the translational perspectives, as a decision-support tool.

Community engagement and loneliness in older adults in China: mediation effects of social support in the wake of COVID-19

Introduction

Loneliness is a key indicator of well-being in older adults. Drawing from the ecological model of aging, the active aging perspective, and the convoy model of social relations, this study investigates the extent community engagement influences loneliness and whether the relationship is mediated by social support during the COVID-19 pandemic.

Methods

Data was collected from 1,067 retired older adults in a cross-sectional design in Chengdu, China in 2022. Structural equation modeling was conducted to examine the direct and indirect effects of community engagement on loneliness through the hypothesized mediator of social support.

Results

The results show community engagement was positively associated with social support (β = 0.26, p < 0.001) and social support was negatively related to loneliness (β = -0.41, p < 0.001). Social support fully mediated the relationship between community engagement and loneliness. Additionally, community engagement had an indirect effect on loneliness via social support (β = -0.11, p < 0.001).

Discussion

The findings from the moderation analysis suggests community engagement and social support are likely to have large effects on loneliness for older adults over the age of 70 and who have low educational attainment. The findings suggest community engagement could be an important factor for improving social support and reducing loneliness amongst retired, older adults in China, especially in the wake of the COVID-19 pandemic where millions of individuals were isolated for extended periods of time.

Higher physical activity level and perceived social support is associated with less psychological distress in people with anxiety

Introduction

Anxiety is one of the most prevalent mental illnesses in first world societies, generating discomfort in the people who suffer from it, and high expenses and economic losses in the society. The physical activity (PA) performed, together with the perceived social support (PSS) by people with anxiety could be related to the psychological distress of people with anxiety.

Objectives

To study the relationships between mental health and its dimensions, through Golberg's General Health Questionnaire (GHQ12), and the level of PA (PAL) and the PSS in the Spanish adult population with anxiety.

Hypothesis

A higher PAL, and a higher PSS, is related to a lower psychological distress in this population.

Design and Methodology

This study included 1,661 adults with anxiety, residents in Spain. It was a cross-sectional study with data obtained from the Spanish National Health Survey. A Kolmogorov-Smirnov test was applied to examine the data distribution of the variables. The median and interquartile range were used to characterize the sample for continuous variables, and absolute and relative frequencies were used for categorical variables. The Mann-Whitney U test was used to examine the differences between sexes. Dependence between PAL and sex was studied using the chi-square statistic. A Krustal-Wallis test was used to evaluate the existence of differences in the baseline medians on the GHQ-12, according to PAL level. Finally, the correlations between mental health and its dimensions with PAL and the Duke-UNC-11 scores were analysed, obtaining Spearman's rho and Pearson's correlation coefficient.

Results

Moderate inverse correlations were found between the GHQ-12 and: PAL (rho: -0.219); PSS (r: -0.347). PAL and PSS presented moderate inverse correlations with successful coping (rho: -0.206 and r: -0.325), self-esteem (rho: -0.222 and r: -0.333) and stress (rho: -0.158 and r: -0.288).

Conclusions

Greater PAL and social support are associated with reduced psychological distress in people with anxiety.

Effectiveness of INOSEL program consisting of Integrative Nursing and Omaha System for older women feeling loneliness: a randomised controlled trial

OBJECTIVES

To evaluate the effectiveness of an intervention combining Integrative Nursing and Omaha System on physical, mental, social, spiritual health of older women living with high level of loneliness. The second aim was to determine the effect of Omaha System interventions on knowledge, behaviour and status scores.

METHODS

A randomised controlled trial was conducted with 69 older women feeling loneliness (INOSEL n = 36, control n = 33 groups). INOSEL group received group-based and person-centered intervention and control group received routine care.

RESULTS

INOSEL and control groups showed an improvement in loneliness score. The decrease in loneliness score and level was higher in the INOSEL group. The physical activity, health status perception, social support, social inclusion, well-being, and spirituality scores increased in the INOSEL group. INOSEL group experienced an increase in the knowledge, behaviour and status.

DISCUSSION

INOSEL program, a theoretical structure, reduced loneliness and positively affected women's health.

IMPLICATIONS FOR PRACTICE

Health professionals can use this program based on Integrative Nursing and Omaha System in nursing caring.

CLINICAL TRIAL REGISTRATION

NCT03695133.

Factors influencing emotional support of older adults living in the community: a scoping review protocol

BACKGROUND

Emotional support is key to improve older adults' subjective health, and psychological, social and emotional well-being. However, many older adults living in the community lack emotional support, increasing the risk for loneliness, depression, anxiety, potentially avoidable healthcare use and costs, and premature death. Multiple intersecting factors may influence emotional support of older adults in the community, but these are poorly understood. Studies have focused on specific populations (e.g., older adults with depression, cancer). Although relevant, these studies may not capture modifiable factors for the wider and more diverse population of older adults living in the community. Our scoping review will address these important gaps. We will identify and synthesize the evidence on factors that influence emotional support of older adults in the community.

METHODS

We will use the Johanna Briggs Institute updated methodological guidance for the conduct of scoping reviews to guide our review process. We will search MEDLINE, EMBASE, APA Psycinfo, CINAHL, Dissertations and Theses Global, and Scopus from inception. We will include studies published in English, examining factors influencing emotional support of older adults residing in community, without restrictions on the study design or year of publication. We will also include gray literature (dissertations and reports). Two independent reviewers will conduct title, abstract, and full-text screening, as well as risk of bias assessment, using validated quality appraisal tools based on study designs. Discrepancies will be resolved by consensus. The primary reviewer will extract the data from all studies, and the second reviewer will check the extractions of all the studies. We will use descriptive statistics and narrative synthesis for analysis. Family/friend caregivers and older adults involved as an advisory group will help with explaining the findings in terms of whether associations observed reflect their experiences and reality. We will analyze the discussion and generate themes, and summarize in a narrative form.

DISCUSSION

This scoping review may identify factors that could be modified or mitigated to improve emotional support provision for older adults residing in community. The knowledge will inform the development of tailored interventions directed to older adults and their caregivers.

SYSTEMATIC REVIEW REGISTRATION

https://doi.org/10.17605/OSF.IO/4TAEB (associated project link: osf.io/6y48t).

Perceived Social Support and Sustained Physical Activity During the COVID-19 Pandemic

BACKGROUND

COVID-19 lockdown introduced substantial barriers to physical activity, providing a unique 'natural experiment' to understand the social factors associated with sustained physical activity. The objectives of this study were to identify the proportion of people who successfully sustained physical activity during lockdown and to explore whether social support, loneliness and social isolation were associated with maintenance of physical activity during COVID-19 lockdown.

METHOD

Longitudinal data from 16,980 participants, mean age 51.3 years (SD = 14.3) from the COVID-19 Social Study was used to identify a sample of participants who maintained their physical activity despite lockdown.

RESULTS

Seventeen percent were consistently active whilst 42% were completely inactive. After adjustment for multiple confounders, high social support was associated with a 64% (95% CI 50-80%) increased odds of sustaining physical activity and medium social support was associated with 32% (95% CI 20-44%) increased odds. Associations between physical activity and loneliness and social isolation were not found.

CONCLUSION

This study supports previous research showing the importance of social support for the long-term maintenance of physical activity behaviour but shows that such effects extend to contexts of social restrictions.

Postpartum Depression and Health: Role of Perceived Social Support among Pakistani Women

Postpartum depression (PPD) can predispose to physical and mental health problems in Pakistani women. However, PPD is associated with health and perceived social support, yet their causal relationship is unclear. Therefore, this study intended to evaluate the association of PPD with insomnia, mental health, and physical health. The convenience sampling technique was used to collect data from 320 (52.8%) young and middle-aged postpartum women, at the outpatient departments of obstetrics and gynecology of the Government Maula Bakhsh Hospital, District Head Quarter in Sargodha, Pakistan. The Edinburgh Postnatal Depression Scale, Pittsburgh Sleep Quality Index, Warwick–Edinburgh Mental Well-being Scale, patient health questionnaire, and Multidimensional Scale of Perceived Social Support were used to measure study variables. The results revealed a significant positive relationship between PPD and physical health (r = 0.45, p = 0.001), negative relationships with insomnia (r = −0.24, p < 0.001), and perceived social support (r = −0.38, p = 0.001). Results further confirmed that perceived social support played a moderating role (β = 0.97, p = 0.01) in the relationship between PPD and mental health among Pakistani women. This study concluded that perceived social support has an important role in PPD and the health of Pakistani women. The study also concluded that poor health is a risk indicator for the identification of aid in the early stages of postpartum among Pakistani women.

Associations between vigorous physical activity, social ties, social support, and self-reported health among older adults in Accra, Ghana

Meeting recommended vigorous physical activity (VPA) levels represents a hallmark for healthy living, but VPA in older populations is likely to lead to casualties that may compel older adults to underscore their health. This study examined the associations between VPA, social ties, social support, and self-reported health in an African sample of older adults. This study adopted the cross-sectional design. The study population was community-dwelling older adults aged 60 years or higher in Accra, Ghana. A total of 686 older adults responded to self-reported questionnaires. Data were analysed with the Pearson's chi-square test and binary logistic regression. The study found that older adults who had above 5 children were 3 times (AOR = 3.169; p = .002) more likely to participate in VPA for 30 minutes or more a day compared with their peers without children. Having social support from between 1 and 5 people was 28 times (AOR = 28.215; p = .000) more likely to result in good health compared to not having anyone to source social support from. Older adults who participated in VPA for 30 minutes or more were less likely (AOR = 0.129; p = 0.000) to report good health compared with those who participated in VPA for less than 30 minutes. We conclude that when social ties and other personal characteristics are adjusted for, prolonged VPA does not necessarily enhance self-reported health, and not all social ties contribute to VPA and self-reported health.

Mechanism of online emotional support accompany group for stress: The role of social support

Objective

To investigate the effect of social support on stress, and to clarify the effect and mechanism of Online Emotional Support Accompany Group (OESAG).

Methods

The group members who signed up for the public welfare project "Psychological Rehabilitation Group Psychological Service under the COVID-19 Pandemic" were divided into the treatment group, the control group, and the blank group with 37 members each. The treatment group received OESAG intervention, the control group received online time management group intervention, and the blank group was the waiting group. The three groups of subjects were synchronously tested before and after the intervention group.

Results

After the OESAG intervention, compared with the control group and the blank group, the treatment group showed that perceived social support was improved, and loneliness and stress were decreased.

Conclusion

Improving social support can effectively reduce stress. OESAG can effectively improve social support and so too decrease stress. This study could help in designing effective psychological intervention measures to reduce the degree of stress symptoms and enhance both personal and social levels of coping with stressful events.

Perceived COVID-19 susceptibility and preventive behaviors: moderating effects of social support in Italy and South Korea

BACKGROUND

The COVID-19 pandemic hit Italy much harder than South Korea. As a way of explaining the different impact in the two countries, this study examines the moderating role of social support on the relationship between perceived susceptibility and preventive behaviors in the two countries.

METHODS

Surveys were conducted in South Korea (n = 1396) and Italy (n = 487) of participants aged 50 to 89 years.

RESULTS

South Koreans felt higher levels of perceived social support than their Italian counterparts. As would be expected, greater perceived susceptibility was associated with increased preventive behavior. Furthermore, a significant three-way interaction effect was found for perceived susceptibility, social support, and country. For Italians, a person who feels him/herself highly susceptible will increase preventive behaviors, if there is a lot of social support. On the other hand, for South Koreans, those with a low level of susceptibility perform more preventive measures than people with a high level of susceptibility if there is a lot of social support.

CONCLUSIONS

This study provides insights into how cognitive factors, such as susceptibility and severity, as well as social and environmental factors can be taken into account, and the public be told the real risk and given behavioral guidelines when a pandemic is approaching. Given the critical role of social support as a coping mechanism in crisis situations, societies should mull over ways to increase emotional and instrumental support.

Social support and quality of life in migrant workers: Focusing on the mediating effect of healthy lifestyle

Objective

To investigate the relationship between social support and quality of life of Chinese migrant workers and to explore the mediating role of healthy lifestyles in social support and quality of life.

Methods

Using a stratified multi-stage sampling method, 1, 298 migrant workers and 983 urban workers across 110 neighborhood committees in five economic development zones in eastern China were surveyed. The social support level of participants was quantified using the Social Support Rating Scale, and quality of life was evaluated using the SF-8. Healthy lifestyle was evaluated based on a combination of sleep, smoking, alcohol consumption, and exercise. Multiple linear regression analysis was used to assess the relationship between quality of life and social support. Stepwise regression was used to analyze the mediating effect of healthy lifestyle, social support, and quality of life among migrant workers.

Results

Total SSRS and total SF-8 scores of migrant workers were significantly higher than those of urban workers (P < 0.001). After controlling for confounders, social support showed an independent positive association with quality of life for both migrant (β = 0.50, P < 0.05) and urban workers (β = 0.62, P < 0.05). Mediation effect analysis revealed that healthy lifestyle partially mediated the relation between social support and quality of life of migrant workers with a mediation effect of 0.07, accounting for 11.70% of the total effect.

Conclusions

This study showed a significant correlation between social support and quality of life of Chinese migrant workers, with healthy lifestyle playing a mediating role. Improving the social support and health literacy of migrant workers and developing a healthy lifestyle are key to improving their quality of life.

The Impact of Chronic Pain, Stiffness and Difficulties in Performing Daily Activities on the Quality of Life of Older Patients with Knee Osteoarthritis

Osteoarthritis causes a number of physical ailments, which result in the deterioration of a persons' general health and reduction of their ability to move freely. This cross-sectional study was designed to assess the impact of physical ailments in the course of knee osteoarthritis (KOA) on the quality of life (QoL) of patients in early old age. An anonymous survey was conducted by the use of the recognized research tools: Western Ontario scale and McMaster Osteoarthritis Index (WOMAC), The Index of Severity for Knee Disease (ISK) and World Health Organization Quality of Life-BEFF (WHOQOL-BREF). The study involved 300 people aged between 60 and 75 years old, including 150 patients diagnosed with gonarthrosis and 150 people without lower limb complaints. The significant intensification of the symptoms of knee osteoarthritis was associated with a worse assessment of health (p < 0.001), overall quality of life (p < 0.001) and in the following domains: physical (p < 0.001), mental (p < 0.001) and environmental (p < 0.001) in a group of patients with KOA. These findings suggest that taking measures to reduce knee pain and improve function may have an impact on improving the overall quality of the life of people in their early old age.

Individual differences among older adults with mild and moderate dementia in social and emotional loneliness and their associations with cognitive and psychological functioning

Background

Loneliness is a major health issue among older adults. The aim of this study was to assess the relationship between loneliness, in its social and emotional facets, and the cognitive (language), and behavioral/psychological functioning as well as quality of life (QoL) in people with mild and moderate dementia, i.e., considering dementia severity as an individual characteristic.

Methods

This cross-sectional study involved 58 people with mild dementia and 55 people with moderate dementia. Participants completed the Social and Emotional Loneliness scale, along with measures assessing their language skills, the frequency and severity of their behavioral and psychological symptoms, and their QoL.

Results

Socio-demographic characteristics and depression, but not loneliness or its social and emotional facets, contributed to explain participants’ behavioral and psychological symptoms, regardless of dementia severity. Loneliness explained, though to a small extent (8% of variance), language skills in people with moderate dementia, with social loneliness only accounting for language skills (18% of variance) in this group. Loneliness also modestly accounted for dysphoria symptoms in both the mildly and moderately impaired (6% and 5% of variance, respectively) individuals with social loneliness predicting dysphoric mood in the former group only (7% of variance). Loneliness also explained, to a larger extent, QoL in both the mildly impaired and moderately impaired individuals (27% and 20% of variance, respectively), its social facet predicting QoL in the mildly impaired (30% of variance), and its emotional facet in the moderately impaired (21% of variance) group.

Conclusion

These findings suggest that loneliness and its facets have a clear impact on perceived QoL, and influence the language skills and dysphoria symptoms of people with dementia, to a degree that depends on dementia severity. The assessment of loneliness and its facets in people with dementia considering dementia severity, and the promotion of social inclusion to reduce it should be considered by professionals.

Effect of horticultural activities on quality of life, perceived stress, and working memory of community-dwelling older adults

This study sampled 86 community-dwelling older adults to investigate the effect of horticultural activities on their quality of life, perceived stress, and working memory. The results demonstrated that after 8 weeks of horticultural activities, the effect sizes (Cohen's d) of their quality of life, perceived stress, and working memory were 0.92, -1.32, and 0.62, respectively. Among the four domains of quality of life, the social relationships domain improved the most. For perceived stress, the score of the experimental group decreased from 1.70 (0.48) to 1.29 (0.58). For working memory, the score increased from 3.43 (1.13) to 4.14 (1.27), whereas the score of the control group did not change substantially. Statistical analysis conducted using a generalized estimating equation revealed a significant interaction effect between group and time (P < 0.001). This study provides a reference for improving the quality of life, perceived stress, and working memory in older people.

The Effectiveness of Interventions to Increase Participation and Physical Activities in Parks: A Systematic Review of the Literature

Although a variety of interventions in many countries have been developed to increase park use and to improve public participation in physical activities in parks, knowledge of their overall effectiveness is lacking. A systematic literature review was undertaken to further understand the effectiveness of various interventions that aim to increase the use of parks and physical activity participation in parks. This systematic review utilized the standard Preferred Reporting Items for Systematic Reviews and Meta-Analysis procedure, and of the 3801 studies identified, 60 studies were reviewed in-depth, with 44 studies assessed for quality of evidence and risk of bias. Most of the 44 reviewed studies found that various interventions had positive impacts on park use and physical activity participation in parks. Interventions were classified into both demand and supply, with more studies focusing on the supply side. The strongest evidence on the effectiveness of various interventions was found for park prescriptions; safe access to parks; playgrounds, and park renovation and renewal/design. However, the assessment of quality of evidence and risk of bias showed that most studies suffer from potential biases and evidence weaknesses, suggesting a need to further establish external validity.

Benefits of sustained physical activity from middle age to early old age on quality of life in early old age

This study aimed to examine changes in physical activity (PA) over time (2009-2017) in the same participants and to determine an association between changes in PA and health-related quality of life (HRQoL) in early older adults (n = 994) using data from the Korea Health Panel Survey. HRQoL was measured using the EuroQol system, and the amount of PA was grouped into four activity levels: remained inactive, became inactive, became active, and remained active. The association of changes in PA over 8 years with HRQoL was examined using logistic regression analysis while controlling for socioeconomic and behavioral factors. Total PA decreased from 1859.72 ± 1760.01 MET-minutes in 2009 to 1264.80 ± 1251.14 MET-minutes in 2017 (P < 0.001). In 2017, 142 (14.3%) remained inactive, whereas 419 (42.2%) remained active. Participants who remained inactive in early old age were more likely to be in the lowest 10% HRQoL of the sample (odds ratio = 1.95, 95% confidence interval = 1.09-3.48). These findings indicate that health education and promotion must be prioritized for middle-aged adults, who are relatively inactive, so that they increase their current PA and improve their HRQoL to maximize the benefits of PA in old age.

Associations between Psychological Distress, Perceived Social Support and Physical Activity Level in Spanish Adults with Depression

Perceived social support (PSS) and physical activity (PA) could help to reduce psychological distress in people with depression. This study aims to analyse the associations between (a) mental health and its dimensions through the Goldberg General Health Questionnaire (GHQ-12), (b) the PA level (PAL), and c) the PSS in the Spanish adult population with psychological distress. This cross-sectional study is based on Spanish National Health Survey 2017 data, including 1670 adults with depression. A descriptive analysis was performed. Differences in medians between sexes were analysed using the Mann–Whitney U test. The Chi-square test was used to assess the independence between sex and PAL. The Kruskal–Wallis’ test was performed to analyse possible baseline differences between PAL and continuous variables derived from the GHQ-12. Finally, a correlation study was conducted between the generated variables and the GHQ-12 items, together with the PAL and the Duke-UNC-11, using Spearman’s rho correlation coefficients. Weak inverse correlations were found between the GHQ-12 and PAL (rho: −0.214); and PSS (r: −0.286). PAL and PSS showed weak inverse correlations with successful coping (rho: −0.216 and r: −0.265), self-esteem (rho: −0.209 and r: −0.283), and stress (rho: −0.130 and r: −0.232). Thus, higher PAL and SSP is associated with lower psychological distress.

Exploring Korean Middle- and Old-Aged Citizens’ Subjective Health and Quality of Life

The goal of this research is to investigate the determinants of subjective health and quality of life with a particular focus on middle- and old-aged citizens. Subjective health is an antecedent of quality of life. For both attributes, travel frequency, economic activity, and cultural activity frequency are the main explanatory variables. Korean middle- and old-aged citizen research panel data was used to derive the data; the study periods are 2008, 2010, 2012, 2014, and 2016. The present work used an econometric method to analyze this panel data. The results show that subjective health positively affects quality of life; meanwhile, economic activity positively affects both subjective health and quality of life. It is also found that cultural activity and travel exert inverted U-shape impacts on subjective health and quality of life. The control variables in this research were gender, body mass index, birth year, and personal assets. These results could help guide policy makers in designing more efficient welfare policies for middle- and old-aged citizens.

How Does the Parent–Adolescent Relationship Affect Adolescent Internet Addiction? Parents’ Distinctive Influences

Although previous research has demonstrated that parent–adolescent relationships have a significant effect on adolescent Internet Addiction (IA), the mechanisms underlying these associations and parental differences in these effects have received insufficient attention. We investigated the mediating role of Perceived Social Support and Dual System of Self-Control (DSSC) in the relationship between Father-Adolescent Relationships/Mother-Adolescent Relationships (FAR/MAR) and adolescent IA, as well as the differences in the effects of FAR and MAR. A cross-sectional survey of 732 Chinese adolescents was conducted using the Adolescent Pathological Internet Use Scale, Parent–Adolescent Relationship Scale, Multidimensional Scale of Perceived Social Support, and Dual System of Self-Control Scale. Multiple linear regression analysis, Pearson correlation analysis and structural equation modeling were used. The results of structural modeling analysis showed that neither FAR nor MAR directly predicted adolescent IA. In contrast, FAR/MAR had an impact on adolescent IA mainly through the mediating effects of Perceived Social Support and Impulsive System. Furthermore, in the relationship between FAR/MAR and adolescent IA, the Impulsive System and Perceived Social Support both served as chain mediators, as did Perceived Social Support and the Reflective System. And more importantly, unlike FAR, MAR affects adolescent IA through the mediating effect of the Reflective System. Multiple linear regression showed that the regression coefficient of MAR on adolescent IA had stronger significance compared to FAR, MAR is deserving of more attention than FAR. These findings contribute to our understanding of the mechanisms underlying the association between FAR/MAR and adolescent IA and suggest that family relationship-focused training approaches are critical for suppressing adolescent IA. These interventions should be tailored to the unique circumstances of each family.

Common psychological disorders in elderly and their correlations with social support, Shiraz, Iran, 2018†

Objective

To recognize and screen common mental disorders in elderlies and determine their relationship with social support in Shiraz, Iran.

Methods

In this cross-sectional analytical study, 400 elderlies aged >60 years from Shiraz were selected through stratified random sampling. Data collection was done by 3 demographic data, Medical Outcome Study (MOS), social support, and standardization of mental disorders symptoms checklist 90 (SCL-90) questionnaires. The collected data were analyzed with SPSS 22, using descriptive statistics, Pearson correlation coefficient, and univariate and multivariate linear regression analyses. A P value <0.05 was regarded as statistically significant.

Results

A total of 400 elderlies (mean age = 67.39 ± 6.89), among whom 204 individuals were female (51%), participated in the study. Somatization and phobic anxiety were the most (68.9%) and least (14.2%) prevalent disorders, respectively. The average total score of social support was 85.59 + 3.5. Social support and its 5 subscales showed statistically significant negative correlation with SCL-90 total scores and its 9 domains (P < 0.05). A 1-point increase in social support score results in reduction in the psychological disorders score by 0.35 point (P < 0.001).

Conclusions

It seems necessary to plan and make policies by the authorities to increase social support and reduce the burden of common mental disorders in the elderly.

Development and validation of the geriatrics health behavior questionnaire (GHBQ)

BACKGROUND

Considering the importance of health behaviors in health outcomes, it is necessary to assess health behaviors precisely. This study aimed to develop and validate The Geriatrics Health Behavior Questionnaire among Iranian older adults.

METHODS

This cross-sectional and methodological study was conducted on 420 community older adults (age ≥ 60) through random multi-stage sampling. The initial questionnaire has been developed with 22 items and seven subscales based on an extensive literature review, evaluation of related questionnaires, and experts' opinions. Face and content validity were evaluated by interviewing 10 older adults and 18 specialists. The construct validity was evaluated via Known-groups validity and convergent validity. The reliability of the questionnaire was calculated by internal consistency, test-retest, and absolute reliability.

RESULTS

The face validity was conducted by using interviews with older adults and gathering the specialists' opinions. The items were grammatically and lexically corrected accordingly. Two items were deleted due to CVR < 0.44. Modified Kappa statistic (K*) and I-CVI for all items were higher than 0.88. The average content validity index (S-CVI/Ave) value was 0.94. Three items were deleted to improve the internal consistency; the final GHBQ consisted of 17 items with Cronbach α = 0.72. Acceptable convergent validity was approved by a significant correlation between GHBQ and SF8™ health survey (r = 0.613, P value< 0.001). Independent t-test showed that older adults with education level ≥ high school have significantly higher health behavior scores than those with education level < high school (11.93 ± 2.27 vs. 9.87 ± 2.35, t = - 9.08, p < 0.001). Intra-class correlation coefficient (ICC) for the total questionnaire was 0.92 (95% CI =0.84 to 0.96). Standard Error Measurement (SEM) and Minimal Detectable Change (MDC95) were 0.71 and 1.98, respectively.

CONCLUSION

The present study results showed that the Geriatrics Health Behavior Questionnaire had suitable validity and reliability among Iranian older adults. It is recommended to consider its comprehensiveness and yet its briefness in other populations after passing validation.

Prospective associations between multiple lifestyle behaviors and depressive symptoms

BACKGROUND

Our aim was to analyze the associations between multiple lifestyle behaviors and depressive symptoms.

METHODS

We included 4,725 adults (18-59y), that provided data in routine health evaluations of a hospital in Brazil, followed for a mean period of 3.1 ± 1.6 years. Physical activity, alcohol consumption (measured using Alcohol Use Disorders Identification Test) and tobacco smoking were categorized as: (1) absence of the behavior (inactivity i.e. not complying with 150 min of moderate-to-vigorous PA/week, not smoking, no risky drinking, i.e. AUDIT<5) during baseline and follow-up; (2) Absence during baseline and presence during follow-up; (3) Presence during baseline and absence during follow-up; (4) Presence during both time points. Depressive symptoms were measured with the Beck Inventory was adopted to analyze patterns of depressive symptoms over time (as exposure). C-reactive protein [HS-CRP]) was assessed and its role in the association was tested. Incidence indicators of behaviors and depressive symptoms were created and used as outcomes. We used crude and adjusted Poisson regression analysis.

RESULTS

Fully adjusted models revealed that persistently physical inactive participants (RR:1.71;95%CI:1.33-2.21), those who became physically inactive (1.68;1.19-2.26), with consistently risky drinking (1.62;1.15-2.30), and who became risky drinkers (1.62;1.15-2.30) had higher risk for incidence of elevated depressive symptoms. Vice versa participants with incidence of depressive symptoms over time presented higher risk for physical inactivity (1.44;1.11-1.87) and risky drinking (1.65;1.16-2.34) incidence. HS-CRP did not influence the associations.

LIMITATIONS

Self-reported physical activity, binary tobacco smoking, and non-probabilistic sampling.

CONCLUSIONS

There is a prospective relationship between elevated depressive symptoms and adverse lifestyle behaviors.

The Role of Altered Sensory Processing and Its Association with Participation in Daily Activities and Quality of Life among Older Adults in the Community

To identify variables that contribute to fall risk in older adults, this study examined the relationship between fall risk, sensory processing, participation in daily activities, and quality of life (QoL). Of the 123 participants, those at high-risk were significantly less able to register sensory input and had increased sensory sensitivity, restricted participation and overall lower QoL. Altered sensory processing was related with risk of falling. Additionally, both sensory process and fall risk were subsequently related with lower daily participation and, together, were related with lower QoL. Thus, sensory processing, participation and QoL assessments need to be included in occupational therapy evaluations and interventions for fall risk among older adults.

Perceived Social Support, Reinjury Anxiety, and Psychological Readiness to Return to Sport in Soccer Players

The burden of sports injury in soccer is high, and return to sport outcomes following injury are often poor. This is compounded by a current lack of understanding surrounding the factors that may optimize psychological readiness to return to sport. Consequently, in the present study, we aim to further our understanding of these issues by examining the role of perceived social support in predicting psychological readiness to return to sport. In doing so, we extend previous research by examining whether reinjury anxiety is a mediating factor in this relationship. A sample of 150 previously injured soccer players (mean age = 25.32 y) completed measures of perceived social support, reinjury anxiety during rehabilitation, and psychological readiness to return to sport. Mediation analyses showed that reinjury anxiety partly accounted for the positive relationship between perceived social support and psychological readiness to return to sport. These findings suggest that injured soccer players with higher perceptions of social support will experience less reinjury anxiety during rehabilitation and, as a consequence, will be more psychologically ready upon return to sport.

Social Relationships and Adaptation in Later Life

Social relations encompass a complex and dynamic set of characteristics that have been shown to distinctly affect health and quality of life across the lifespan and especially in older adulthood. In this chapter we begin with a brief review of several prominent theories of social relations. Next, we consider how social relations can be understood based on the resource they provide (e.g., contact frequency, social support), the relationship they stem from (e.g., friends, family), the strength of the tie (e.g., strong, weak) as well as the means of communication (e.g., offline, online). We briefly summarize how these characteristics have been shown to uniquely influence health and quality of life in older adulthood. Finally, we contemplate potential clinical applications, provide recommendations for the future and offer final concluding comments.

Lifestyle Behaviors and Quality of Life Among Older Adults After the First Wave of the COVID-19 Pandemic in Hubei China

Background: Older adult quality of life (QoL) is facing huge challenges during the COVID-19 pandemic. New normal lifestyle behaviors, including getting adequate physical activity (PA), consuming sufficient fruits and vegetables (FV) and enacting individual preventive behaviors (frequent hand washing, facemask wearing, and social distancing), as a significant determinant for QoL, have not been adequately addressed in older adults during the pandemic. This study aimed to investigate the characteristics of QoL in Chinese older adults after the first wave of the COVID-19 pandemic in Hubei China. The objective of the study was to examine any associations of lifestyle behaviors with QoL, and to identify the moderating role of socioeconomic indicators in the associations identified. Methods: A cross-sectional study was conducted in Hubei, China, from June 15, 2020, to July 10, 2020. Five hundred sixteen older adults completed an online survey (mean age = 67.6 ± 6.6; 57.9% women). The questionnaire consisted of demographic information, covariates (chronic diseases and infected cases of acquaintances), lifestyle behaviors [PA stage, FV intake (FVI) stage and three preventive behaviors], and QoL. T-tests, ANOVA tests, multiple linear regression models with simple slope analyses were used to test the hypotheses. Results: QoL significantly differed in relation to economic situation, chronic diseases, marital status, education, living situation, age group, and professional status. Participants' economic situation (βaverage vs. below average = 0.17, p < 0.01; βabove average vs. below average = 0.15, p < 0.01), chronic diseases (βyes vs. no = 0.19, p < 0.001), FVI stage (β = 0.21, p < 0.001), and preventive behaviors (β = 0.10, p < 0.05) indicated a significant association with QoL. Education level and economic situation significantly interacted with preventive behaviors on QoL, respectively (βpreventive behaviors × educational level = -1.3, p < 0.01; βpreventive behaviors × economic situation = -0.97, p < 0.05). Conclusions: Findings emphasize the importance of enhancing FVI and preventive behaviors on QoL improvement in older adults during the COVID-19 pandemic. Older adults who are in a lower economic situation with lower education levels should be given priority when implementing interventions to improve preventive behaviors and QoL in older adults.

Loneliness as a mediator of social relationships and health-related quality of life among refugees living in North Rhine-Westphalia, Germany

Background

Since 2015, more than one million people fled to Germany – mainly from war-affected countries. Nevertheless, little is known about social determinants in refugees located in Germany. This study aims to test the mediation effect of loneliness between social relationships, comprising social integration and social support, and health-related quality of life among refugees living in North Rhine-Westphalia, Germany.

Methods

The investigation utilizes data from the FlueGe Health Study (N=326), a cross-sectional study conducted by Bielefeld University. The data was collected between February and November 2018 and included interviews and examinations. Participants were recruited from shared and private accommodation in several cities in North Rhine-Westphalia, Germany. We first analyzed correlations between social integration, social support, loneliness, and physical and mental component of health-related quality of life. We then conducted mediation analyses using structural equation modeling.

Results

The majority of respondents were socially isolated, perceiving a moderate degree of loneliness and social support. In addition, the physical and mental components of health-related quality of life indicate that participants predominantly experienced mental rather than physical impairments. Results from mediation analyses showed indirect effects of loneliness on the association between social integration and mental health (ß = 0.495, 95% bias-corrected and accelerated confidence interval (BCa CI) = [0.018, 0.972]), and between social support and both physical (ß = 0.022, 95% BCa CI = [0.004, 0.040]) and mental health (ß = 0.067, 95% BCa CI = [0.037, 0.097]).

Conclusions

Loneliness played a mediating role in the association between social relationships and health-related quality of life among refugees living in North Rhine-Westphalia, Germany. The results provide implications for both, health policy and the host society.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12303-5.

Loneliness and frailty among nursing home older adults: the multiple mediating role of social support and resilience

BACKGROUND

Loneliness has been considered as a risk factor for frailty. Social support (as an external protective resource) and resilience (as an inner protective resource) might play protective roles on the association between loneliness and frailty. In this study, the mediating roles of social support and resilience between loneliness and frailty were explored among older adults living in nursing homes.

METHODS

Older adults (N = 210) from three nursing homes in China were recruited in this cross-sectional study. Information for sociodemographic variables, frailty, loneliness, social support and resilience were collected. The bootstrap analyses by PROCESS macro were conducted to test the multiple mediating role of social support and resilience between loneliness and frailty.

RESULTS

The prevalence of frailty was 34.8% among older adults in nursing homes. Also, social support and resilience mediated the association between loneliness and frailty, respectively. Furthermore, the multiple mediating testing results showed that social support and resilience played sequential mediating roles in the link of loneliness to frailty.

CONCLUSIONS

The findings underscore the protective role of social support and resilience of loneliness and frailty among nursing home older adults.

The Influence of Health Literacy and Social Support on Loneliness Among Patients With Severe Mental Illness in Rural Southwest China

Loneliness is an important risk factor for poor health outcomes among adults, especially among those with severe mental illnesses (SMIs). Existing research has shown that adults with SMIs often lack health literacy, which contributes to more restricted social networks and low levels of social support. The objective of this cross-sectional study was to examine the influence of health literacy and social support on the loneliness of patients with SMI in rural Southwest China. We recruited 300 patients with SMI in rural Southwest China between December, 2017 to May, 2018 via a multi-stage stratified random sampling approach. We used structural equation modeling (SEM) test the hypothesized relationships among the variables of the 270 patients who completed the survey. Results of the SEM showed that health literacy was both directly and indirectly associated with loneliness, with social support playing a mediating role. These findings suggest psychoeducation for SMI patients, and their informal caregivers, may offer beneficial effects toward reducing loneliness in this vulnerable population. Further, social support is another potential target for intervention development for improving patient outcomes.

A Qualitative Investigation on the Roles of Social Support on Physical Activity Behaviour among the Rural-Dwelling Older Women in Malaysia

Despite many health benefits of physical activities, both physically and mentally, the majority of the older women in the rural areas of Malaysia are showing a low prevalence of physical activities. Understanding the roles of social support to improve physical activities is imperative to promote active and healthy ageing among the rural-dwelling older women in Malaysia. Hence, this qualitative study adopted an inductive design using 17 in-depth interviews to understand the role of social support on physical activity behaviour among the rural community-dwelling older woman in Kuala Pilah District, Negeri Sembilan, Malaysia from December 2019 to January 2020. Three categories of themes were identified in this study. Firstly, adaptive social support in terms of informational, companionship and emotional supports reported enhancing physical activity levels among older women. Secondly, the absence of help and assistance from the social network asserts independence and triggers the older women to perform the activities by themselves, thus engage in physically active lifestyles. Thirdly, lacking social support demotivate older women to be engaged in physical activities. In particular, loss of companionship support, poor acceptance or appraisal support, logistic issues to attend exercise programmes and neighbourhood safety and security issues were among the main barriers of physical activities reported by the older women. The main findings of this study shed some light on the exigency of strengthening social support from the social network to engage the older women in physical activities. The roles of social media, effective patient-doctor communication and interventions targeting the spouses and family members must be strengthened to create a supportive atmosphere to enhance physical activity levels among older women.

Investigating the Effect of Home-based Physical Activity Schedule on the Quality of Life, Sleep Quality, and Mood of the Elderly at Risk of Depression as Compared to the Control Group

Background:

This study aimed at investigating the effect of home-based physical activity schedule on the quality of life (QOL), sleep quality, and mood of the elderly at risk of depression as compared to the control group.

Materials and Methods:

The open-label randomized controlled trial was performed on 61 elderly people at risk of depression who were divided into two groups. In addition to routine care provided by the health-care center (relaxation techniques), the elderly in the intervention group were given a home-based physical activity booklet. The control group only received the routine care of the health-care center. Moreover, before and after the intervention, the results of the QOL questionnaire, petersburg sleep quality questionnaire index (PSQI), and depression questionnaire were assessed and recorded.

Results:

The depression scores in the 1^st and 3^rd months during the intervention and 1 month after the intervention were significantly lower in the intervention group with the means of 3.60 ± 3.91, 2.03 ± 2.43, and 2.66 ± 3.37 as compared with the control group with the means of 5.39 ± 2.88, 4.96 ± 2.77, and 5.13 ± 3.14, respectively (P < 0.05). Furthermore, the QOL and total PSQI scores in the physical and mental dimensions in the 3^rd months during and 1 month after the intervention were higher in the intervention group as compared with the control group (P < 0.05).

Conclusion:

According to the findings of the study, the addition of home-based physical activity schedule to the routine care of the elderly can play a significant role in reducing the severity of their depression and improving their physical–psychological quality and sleep quality.

Pickleball for Inactive Mid-Life and Older Adults in Rural Utah: A Feasibility Study

Many diseases, disabilities, and mental health conditions associated with aging can be delayed or prevented through regular exercise. Several barriers to exercise, many of which are exacerbated in rural communities, prevent mid-life and older adults from accessing its benefits. However, recently, a racquet sport named pickleball has become popular among older adults, and it appears to overcome some of these barriers. We conducted a feasibility study to evaluate the impact of a six-week pickleball intervention on measures of muscle function, cognitive function, perceived pain, and cardio-metabolic risk, as well as several psychosocial factors contributing to adherence in sedentary rural participants. Participants improved their vertical jump, cognitive performance, and reported a decrease in self-reported pain, suggesting improved physical and cognitive health across the sample. Participants also reported high levels of satisfaction and demonstrated good adherence over the duration of the study. Perhaps of greatest value was the overwhelmingly positive response from participants to the intervention and follow-up interviews reporting a desire to continue pickleball play beyond the study period. Overall, pickleball appears to be a promising intervention to, (1) elicit functional- and cognitive-related improvements, and (2) motivate mid-life and older adults to adhere to exercise sufficiently long to benefit their health.

Loneliness, Wellbeing, and Social Activity in Scottish Older Adults Resulting from Social Distancing during the COVID-19 Pandemic

This study examined the impact of social distancing during the COVID-19 pandemic on loneliness, wellbeing, and social activity, including social support, in Scottish older adults. A mixed methods online survey was used to examine these factors during social distancing mid-lockdown, July 2020. Participants were asked to state whether loneliness, wellbeing, social activity, and social support had changed since pre-social distancing, and to provide details of strategies used to keep socially active. A total of 1429 adults (84% aged 60+ years) living in Scotland took part. The majority reported that social distancing regulations made them experience more loneliness and less social contact and support. Loneliness during lockdown was higher than reported norms for this age group before the pandemic. A larger social network, more social contact, and better perceived social support seemed to be protective against loneliness and poor wellbeing. Positive coping strategies reported included increasing online social contact with both existing social networks and reconnecting with previous networks, as well as increasing contact with neighbours and people in the community. This underlines the importance of addressing loneliness and social support in older adults but particularly during situations where risk of isolation is high.

Thai Older People's Willingness (Intention) to Participate in a Care Prevention, Community Group Exercise Program: An Assessment before Implementing an Intervention Trial in Chiang Mai, Northern Thailand

BACKGROUND

Sustainability of a current family-based long-term care model in Thailand has been challenged by demographic aging, and the rising burden of non-communicable diseases and age-related morbidities. In order to overcome these challenges, a community-integrated intermediary care (CIIC) service model, including functional training as one of the interventions, was introduced. To increase program uptake and adherence, it is vital to understand the facilitators and barriers for joining this group exercise. Therefore, we aimed to explore the determinants of older adults' willingness to participate in it.

METHODS

A total of 1509 participants from an intervention arm of a cluster randomized trial were interviewed with a structured questionnaire. A descriptive analysis and binary logistic regression were applied.

RESULTS

More than half of participants (51.4%) were willing to join community-based care prevention, functional training exercise program. Significant associated motivators were being of younger age, female, married, working seniors, original community residents, having (regular and irregular) exercise habits, history of a fall in the last six months, needs for walking aids and secondary caregivers.

CONCLUSION

Our findings highlighted both personal and social factors motivated old people to access health promotion activities. It might help design or implement effective programs to promote healthy aging among community-dwelling seniors in Thailand. This research is analysis of baseline results from a Community Integrated Intermediary Care project. TCTR20190412004.

Quality of life among different types of Chinese lonely elderly: A social isolation based analysis

This study aimed to understand the types and characteristics of lonely elderly from the perspective of social isolation and compare their differences in quality of life (QOL). A cross-sectional survey of 2148 lonely elderly in Shanxi province, China was conducted. The latent profile analysis was used to classify the lonely elderly and describe their characteristics. A hierarchical multilinear regression method was applied to evaluate their differences in QOL. The lonely elderly can be divided into two categories: Class-Ⅰ, in low social isolation with a significant correlation between social isolation and loneliness (p < 0.05), and Class-Ⅱ, in high social isolation with no significant correlation between social isolation and loneliness (p > 0.05). QOL of Class-Ⅰ was significantly higher than that of Class-Ⅱ. Class-Ⅱ was in a state of self-imposed isolation with poor QOL and should be the focus-group during practical intervention.

Physical Activity, Loneliness, and Meaning of Friendship in Young Individuals - A Mixed-Methods Investigation Prior to and During the COVID-19 Pandemic With Three Cross-Sectional Studies

Meaningful social interactions and regular physical activity are inversely associated with loneliness. Using a mixed-methods research design employing quantitative and qualitative research approaches, this research aimed to explore loneliness, physical activity, friendship, and experiences relating to the COVID-19 pandemic both prior to and during the pandemic. Quantitative data of (1) n = 363 first-year university students assessed in 2018/2019 and of (2) n = 175 individuals aged 18-29 years assessed in 2020 were gathered using independent self-administered online surveys. In addition, (3) n = 4 students were recruited for semi-structured, qualitative interviews in 2020 during the onset phase of the COVID-19 pandemic. Correlation and regression analyses as well as analyses of variance were conducted. Thematic analysis as a qualitative method was used to explore the role physical activity, friendship, and social interactions played in loneliness, particularly in times of social isolation and social distancing. Results revealed associations of varying strength between physical activity and loneliness in 2018/2019 (r = -0.09, p ≤ 0.05) and 2020 (r = -0.20, p < 0.01). In 2020, n = 73 (41.7%) participants felt that their loneliness had increased since the COVID-19 social and physical distancing guidelines were introduced, but this was not associated with a perceived change in physical activity (r = -0.05, p > 0.05). Analyses of qualitative data revealed three main themes: (1) the lack of deep friendships at university, (2) the positive perceived impact of team sports on feelings of loneliness, and (3) the need for real connection in times of crisis. Thus, with regard to feelings of loneliness during the pandemic, being physically active seems to be a small but potentially relevant factor among young individuals. The qualitative study suggests that first-year university students might buffer the lack of deep friendships and meaningful interactions by building social bonds in team sports. In times of physical distancing, young individuals vulnerable to loneliness may therefore require special support such as doing sports with physical distance and perceiving connected with their team for instance by digital devices and emotional coping.

Play Mode Effect of Exergames on Subthreshold Depression Older Adults: A Randomized Pilot Trial

BACKGROUND

Subthreshold depression is a common mental disorder in late life. Increasing studies have supported the positive effects of exergames to subthreshold depression. The current study aims to investigate how play mode potentially affects exergames' effects on subthreshold depression among older adults.

METHOD

A between-group experiment was carried out to compare the effect of exergames with different play modes. Fifty-two Singaporean older adults with subthreshold depression were randomly assigned into two conditions, and performed either single-player or multiple-player Nintendo Wii Tennis exergames for 6 weeks, while the key variables of depression, social support and loneliness were measured at both pre- and post-study period.

RESULTS

Findings from path analysis suggested that older adults in multiple-player exergames experienced lower levels of loneliness, and further more reduction on subthreshold depression, when compared to those in single-player exergames. Although social support was not affected by play mode, the significant relationship among social support, loneliness, and depression was found in the context of exergaming.

CONCLUSION

This study not only provides additional insight into a possible causal association lining play mode and health outcomes of exergames, but also opens the discussion of how to optimize antidepressive effect of exergames for older adults.

Older Men With Living Spouses Versus Men Without Spouses: An Example From the Arab World-Kuwait

This research is concentrated on elderly Kuwait men and the effect that losing wife, a major determinant of social support, has on their general health. A sample of 472 older male adults aged 60 years and older have been included in this study. A questionnaire was the major tool of the study. The questionnaire included sociocultural information and social support scales (Degree of Religiosity, Social Support Scale, Frequency of Contact, and Strength of Relation scales). Health measurements also were used: two, one-item self-reported health scales in the current year and last year and a Somatic Symptoms Inventory (SSI) were used. Systolic and diastolic blood pressure and glucose levels were taken. Statistical Package for Social Sciences (SPSS, version 21) was used for data entry and analysis. t-test and regression were the major statistical procedures. Data show that there are differences between elderly men with a living wife compared to those without a living wife. Having a living wife was positively associated with better social support and health in Kuwaiti elderly men. Data show that a living wife is an important factor of men's health and well-being in general and that a wife is one of the major social support elements of elderly men.