Loneliness and depressive symptoms among older adults: The moderating role of subjective life expectancy

Social isolation, loneliness, and subjective wellbeing among Chinese older adults during the COVID-19 pandemic

The COVID-19 pandemic has brought unprecedented challenges to the wellbeing of the older adults worldwide. Both social isolation and loneliness are associated with decreased subjective wellbeing, but it is uncertain whether their effects are independent or if loneliness represents the affective pathway through which social isolation impairs subjective wellbeing. We therefore assessed the extent to which the association between social isolation and subjective wellbeing is mediated by loneliness. We utilized data from the 2020 China Family Panel Studies (CFPS) and focused on a sample of 3,821 individuals aged 60 and above as the participants for our study. The results revealed a significant negative association between social isolation and subjective wellbeing among the older adults during the COVID-19 pandemic. Furthermore, loneliness was found to mediate this relationship, indicating that social isolation led to increased feelings of loneliness, which in turn negatively impacted subjective wellbeing. These findings highlight the detrimental effects of social isolation and loneliness on the wellbeing of the older adults in China during the pandemic. The implications of these results emphasize the need for interventions and support systems that address social isolation and loneliness among the older adults, promoting their wellbeing and overall mental health during challenging times such as the COVID-19 pandemic.

"Meaning in Life" Mediates the Relationship between Loneliness and Depressive Symptoms among Older Adults during the COVID-19 Pandemic

BACKGROUND

Loneliness was found to be a commonly experienced feeling among older adults during the COVID-19 pandemic and is considered to be a high-risk factor for depressive symptoms. Maintaining meaning in life has been found to be a protective resource for mental health among older adults. The purpose of this study was to examine the mediating effects of an individual's meaning in life in the relationship between loneliness and depressive symptoms among older Korean adults.

METHODS

The data were obtained from a sample of 213 community-dwelling older adults aged over 65. The instruments were the UCLA Loneliness Scale, the Center for Epidemiologic Studies Depression Scale, and the Meaning in Life Questionnaire.

RESULTS

Loneliness was positively associated with depressive symptoms and negatively associated with the presence of and search for meaning among older adults. The presence of meaning mediated the relationship between loneliness and depressive symptoms but the search for meaning did not. The search for meaning mediated the relationship between loneliness and depressive symptoms through the presence of meaning.

CONCLUSIONS

Our study findings suggest that efforts to reduce loneliness and improve meaning in life should be undertaken to prevent depressive symptoms among older adults.

A meta-analysis of the association between loneliness and all-cause mortality in older adults

Despite the well-established association between loneliness and all-cause mortality in older adults, it remains unknown whether this association holds for older adults of different sex and whether it is influenced by different samples and study characteristics. Thus, this meta-analysis aims to examine moderators of the association between loneliness and all-cause mortality in older adults. To this end, relevant literature was retrieved from the PubMed, Embase, PsycINFO, Web of Science, Chinese National Knowledge Infrastructure, Weipu, and Wanfang databases (inception to May 2023) and was processed in the Comprehensive Meta-Analysis 3.3 software. Moreover, subgroup analysis was performed to explore the sources of heterogeneity and further explore potential moderators. Funnel plots, Begg's test, and Egger's linear regression test were used to examine the publication bias, and sensitivity analysis was used to test the robustness of the results. Thirty-six studies involving 128,927 older adults were included in this meta-analysis. In general, loneliness was related to an increase in all-cause mortality in older adults (HR = 1.09, 95% CI = 1.06-1.12, I2 = 63.31%, p < 0.001). The overall effect size for older men was 1.18 (95% CI = 1.04-1.33, p = 0.010). The association between loneliness and all-cause mortality was found to be significantly influenced by the source country of the data, follow-up length, and covariates for chronic disease as moderators. In conclusion, loneliness among older adults deserves more attention, and services are needed to improve their mental health.

Risk, Resilience, and the Two-Track Model of Dementia Grief Among Spouses of People Living With Cognitive Decline

Pre-death grief in the context of dementia caregiving is a significant risk factor for depression, burden, anxiety, and adjustment difficulties. The Two-Track Model of Dementia Grief (TTM-DG) provides a bifocal perspective addressing the nature of the emotional attachment to a loved one living with cognitive impairment, along with a medico-psychiatric perspective associated with stress, trauma, and change in life. The aims of the present study were to empirically validate the components of the model as to identify salutary and risk factors for maladaptive grief responses. Participants were 62 spouses of people living with cognitive impairment, and a control group of 32 spouses. All completed a battery of self-report questionnaires. Structural Equation Modeling yielded six variables consistent with the TTM-DG: partner's behavioral disorders; caregiver's burden; social support; physical health; attachment anxiety; and dementia grief as an outcome measure. Additional findings addressed participants at risk for grief difficulties. The findings provide empirical support for the utility of the TTM-DG in the identification of risk factors associated with maladaptive responses and pre-death grief following a spousal cognitive decline. The TTM-DG can assist in the formulation of evidence-based evaluations and interventions to assist spouses caring for their loved ones living with dementia.

Prevalence of depressive symptoms and associated factors among foreign caregivers: A cross-sectional study

AIM

To understand the prevalence of depressive symptoms among foreign caregivers and the associated factors.

DESIGN

A cross-sectional study.

METHODS

Data from 178 Indonesian foreign caregivers, selected based on convenience and snowball sampling in Taiwan, were collected between July 2019 and February 2020 using questionnaires. Stepwise multiple linear regression was used to identify the factors associated with depressive symptoms.

RESULTS

Approximately 30.3% of the foreign caregivers displayed depressive symptoms. The symptoms were more prevalent among the participants who were younger; had more social support; shared a bed with others; and experienced higher work-related stress, more loneliness and physical discomfort. The findings suggest that nurses or nurse practitioners visiting patients at home should not only deliver care for them but also show concern for the psychological well-being of the foreign caregivers of these patients. Moreover, interventions should be developed to alleviate or prevent the emergence of depressive symptoms among foreign caregivers.

Associations between existing and newly diagnosed chronic health conditions and change in subjective life expectancy: Results from a panel study

Background

Subjective life expectancy (SLE) is a vital predictor of mortality, health and retirement. Nevertheless, we have sparse knowledge about what drives changes in SLE. Having a chronic health condition (CHC) is probably associated with a change SLE. However, how CHCs are associated with changes in SLE may depend on whether the CHC was newly diagnosed and the type of CHC.

Aim

We hypothesize that newly diagnosed CHCs will be strongly negatively associated with changes in SLE than existing CHCs. As CHCs vary in their presentation and prognosis, we differentiate associations between five CHCs - arthritis, cardiovascular diseases, sleep disorders, psychological disorders and life-threatening conditions - and changes in SLE.

Method

Data from two waves of a Dutch pension panel survey, collected 3 years apart in 2015 and 2018, were used. The analytical sample included 4824 older workers between the ages of 60-65 years at wave 1. Data were analysed longitudinally using a conditional change ordered logistic regression model.

Results

In general, newly diagnosed CHCs were strongly negatively associated with changes in SLE, relative to having no CHCs. Existing CHCs were also negatively associated with changes in SLE, but to a weaker strength. Interestingly, associations between CHCs and the change in SLE differed based on the CHC in question.

Conclusion

Newly diagnosed life-threatening conditions, psychological disorders and cardiovascular diseases are strongly negatively associated with changes in SLE. These results provide insight into the differences in how older workers with CHCs experience late career work and how these experiences influence their SLE.

Subjective life expectancy of middle-aged and older adult cancer survivors: A cross-sectional study in Korea using age-specific subgroup analysis

OBJECTIVE

As the population ages and the survival rate of cancer patients increases, long-term management of older adult cancer survivors has become important. Subjective life expectancy (SLE) is a concept that refers to an individual's particular predicted lifespan, which enables individuals to live an active life with hopeful expectations for the extension of a healthy life. Therefore, this study aims to identify the factors related to SLE according to age group, to help enable middle-aged and older adult cancer survivors to actively live out their lives with a sense of control.

DESIGN

A descriptive, cross-sectional study was used.

METHODS

This study included 538 participants in the fifth to seventh survey data of the Korean Longitudinal Study of Aging dataset. Moreover, we conducted multivariable regression analyses.

RESULTS

The participants of this study were 137 middle-aged (under 64 years), 196 young-old (65-74 years), 164 old-old (75-84 years) and 41 oldest-old (over 85 years) cancer survivors. The mean age of the participants was 71.22 ± 9.4 years. The factors related to SLE were employment status (β = 7.43, p = 0.018) and quality of life (QOL) (β = 0.25, p = 0.010) for the middle-aged group and age (β = -1.50, p = 0.002) and employment status (β = 10.44, p = 0.003), and QOL (β = 0.31, p < 0.001) in the young-old group; in the old-old group and oldest-old group, the predictors of SLE were QOL (β = 0.35, p = 0.004) and social network (β = 2.76, p = 0.018).

CONCLUSION

The SLE of middle-aged and older adult cancer survivors was different by age group, and related factors also varied by it. Therefore, an individual approach for each age group is required to effectively promote SLE.

IMPLICATIONS FOR PRACTICE

By developing and applying differentiated nursing interventions suitable for each age group for middle-aged and older adult cancer survivors, it should be possible to help them make a healthy transition with positive expectations for life extension.

Impact of digital social media on the perception of loneliness and social isolation in older adults

OBJECTIVE

to synthesize knowledge about the use of social media and the perception of loneliness and/or social isolation in older adults.

METHOD

integrative literature review with primary studies published in full, in Portuguese, English or Spanish, between September 2014 and July 2020 in the databases: American Psychological Association Database, Cumulative Index to Nursing & Allied Health Literature, Latin American and Caribbean Health Sciences Literature databases, Web of Science and PubMed.

RESULTS

11 articles were included, categorized based on the types of technologies: "the use of the Internet", encompassing social networking sites, the internet and applications; "communication devices", with the use of smartphones, tablets and iPads and "types of communication" covering the use of interpersonal means of communication in the digital age, such as video calls and emails. There were positive results (63.6%) regarding the use of social media to minimize the perception of loneliness and/or social isolation in the older adults.

CONCLUSION

the scientific evidence shows that the use of digital social media can reduce the perception of loneliness and/or isolation in older adults. Furthermore, the internet can favor greater contact between the older adults and family members and can serve as a source of support, provide a greater sense of belonging in the community and reduce loneliness.

Depressive Symptoms and Mortality Among Middle-Aged and Older Adults in South Korea

OBJECTIVE

This study's aim is to verify the longitudinal effect of depressive symptoms on all-cause mortality depending on the age group.

METHODS

The Korean Longitudinal Study of Aging's data from 2006 to 2016 were assessed using longitudinal data analysis, and 10,145 participants (age [mean±standard deviation], 61.7±11.1 years; males, 4,426 [43.6%]; females, 5,719 [56.4%]; middle-aged adults, 6,036 [59.5%]; older adults, 4,109 [40.5%]) were included at baseline. The chi-square test, log-rank test, factor analysis, and Cox proportional hazards models were used to investigate the association between depressive symptoms and mortality. To verify that which feelings and behaviors are associated with mortality, factor analysis was used to Center for Epidemiologic Studies Depression (CES-D) scale and it was divided into two factors: negative and positive affects.

RESULTS

The hazard ratio (HR) of all-cause mortality for the Q1 (high) of the negative affect factor was higher than the Q3 (low) of this factor (HR, 1.489; 95% confidence interval, 1.284-1.728). Additionally, the association between negative affect and all-cause mortality was stronger in middle-aged adults than older adults.

CONCLUSION

The study provided evidence of the longitudinal effect of depressive symptoms on all-cause mortality regardless of age. However, middle-aged adults could be more sensitive to negative feelings and behaviors than older adults.

Comparing actuarial and subjective healthy life expectancy estimates: A cross-sectional survey among the general population in Hungary

Background

Healthy life expectancy (HLE) is becoming an important indicator of population health. While actuarial estimates of HLE are frequently studied, there is scarcity of research on the subjective expectations of people about their HLE. The objective of this study is to compare actuarial and subjective HLE (sHLE) estimates in the ≥50-year-old Hungarian general population. Furthermore, we assessed subjective life expectancy (sLE) and explored determinants of the individual variance of sHLE and sLE.

Methods

We conducted a cross-sectional online survey in 2019. Subjective health expectations were measured at 60, 70, 80 and 90 years of age via the Global Activity Limitation Indicator (GALI). Point-estimates of sLE and background variables were also recorded. sHLE was estimated from GALI and sLE responses. Actuarial estimates of life expectancy (LE) and HLE for 2019 were provided by the Central Statistical Office of Hungary.

Results

Five hundred and four respondents (female 51.6%) were included. Mean (±SD) age was 63 (±7.5) years. Median LE (81.5 years, 95%CI 81.1–81.7) and sLE (82 years, 95%CI 80–85) were similar (p = 0.142), while median sHLE (66.8 years, 95%CI 65.5–68.3) was lower than HLE (72.7 years, 95%CI 82.4–82.9) by 5.9 years (p<0.001). Despite the greater median actuarial LE of women compared to men (p<0.001), we found no gender differences between the median sLE (p = 0.930), HLE (p = 0.417) and sHLE (p = 0.403) values. With less apparent gender differences among the predictors when compared to sLE, sHLE was mainly determined by self-perceived health, age and place of residence, while self-perceived health, close relatives’ longevity, social conditions, happiness and perceived lifestyle influenced sLE.

Conclusions

Along subjective life expectancy, subjective healthy life expectancy may be a feasible indicator and provide insights to individuals’ subjective expectations underlying the demographic estimates of the healthy life expectancy of the population.

The Roles of Life Satisfaction and Community Recreational Facilities in the Relationship between Loneliness and Depression in Older Adults

OBJECTIVES

This study examined the mediating effect of life satisfaction and the moderating effect of the availability of community recreational facilities (CRF) in the association between loneliness and depression in rural older adults and urban older adults, respectively.

METHODS

Quantitative data collected from 7547 Chinese older adults were analyzed using the SPSS macro PROCESS to test a moderated mediation model with life satisfaction as the mediator and CRF availability and residency type (rural vs. urban) as moderators.

RESULTS

Loneliness negatively predicted life satisfaction, life satisfaction negatively predicted depression, and loneliness positively predicted depression. The interaction of loneliness and CRF availability had a significant effect on depression for urban older adults but not for rural older adults. The direct impact of loneliness on depression differed significantly between rural and urban older adults.

CONCLUSIONS

Life satisfaction mediated the association between loneliness and depression in both rural and urban older adults; CRF availability unexpectedly boosted the effect of loneliness on depression in urban older adults but not in rural older adults. Given the same level of loneliness, urban older adults were more likely to be depressed than rural older adults.

CLINICAL IMPLICATIONS

Psychogeriatric practitioners may embed life satisfaction into intervention programs to minimize depression among older adults. Public administrators should examine the utilization of public facilities to avoid wasted resources and counterproductive effects on older adults. Lonely urban older adults deserve special attention.

Impacto de los medios de comunicación social digitales en la percepción de soledad y aislamiento social en las personas mayores

Resumen Objetivo: sintetizar el conocimiento sobre el uso de medios de comunicación social en la percepción de la soledad y/o aislamiento social en personas mayores. Método: revisión integradora de la literatura, con estudios primarios publicados integralmente, en portugués e inglés, entre septiembre de 2014 y julio de 2020, en las bases de datos: American Psychological Association Database, Cumulative Index to Nursing & Allied Health Literature, Literatura Latino-Americana y del Caribe en Ciencias de la Salud, Web of Science y PubMed. Resultados: fueron incluidos 11 artículos categorizados con base en los tipos de tecnologías: “el uso de la Internet”, englobando las páginas electrónica de redes sociales, Internet y aplicativos; “dispositivos de comunicación”, con uso de smartphones, tablets e iPads; y, “tipos de comunicación” con uso de medios de comunicación interpersonal en la era digital, tales como, videollamadas y e-mails. Hubo resultados positivos (63,6%) sobre el uso de medios de comunicación social para minimizar la percepción de la soledad y/o el aislamiento social de las personas mayores. Conclusión: las evidencias científicas demostraron que el uso de medios de comunicación social digitales puede reducir la percepción de soledad y/o aislamiento en personas mayores. La Internet puede favorecer un mayor contacto entre personas mayores y sus familias, servir como fuente de apoyo, dar mayor sentido de pertenecer a una comunidad y reducir la soledad.

Difficulties in Emotion Regulation and Cyberbullying Among Chinese Adolescents: A Mediation Model of Loneliness and Depression

Recent research has ascertained some risk factors for cyberbullying. However, few studies have investigated the potential influence of difficulties in emotion regulation (DER) on cyberbullying, and there is little knowledge about the mediating mechanisms underlying this association. This study investigated whether DER would be significantly related to adolescent cyberbullying and whether loneliness and depression would sequentially mediate the link between DER and adolescent cyberbullying. A sample of 719 Chinese middle school students completed measures regarding demographics, DER, loneliness, depression, and cyberbullying. After controlling for the demographic covariates, the results showed that (a) DER was positively associated with adolescent cyberbullying; (b) loneliness and depression sequentially mediated the relation between DER and adolescent cyberbullying. This study emphasizes the underlying mediating mechanisms between DER and adolescent cyberbullying, which is of great significance for the prevention and intervention of adolescent cyberbullying in the digital age.

Impact of digital social media on the perception of loneliness and social isolation in older adults

Objective:

to synthesize knowledge about the use of social media and the perception of loneliness and/or social isolation in older adults.

Method:

integrative literature review with primary studies published in full, in Portuguese, English or Spanish, between September 2014 and July 2020 in the databases: American Psychological Association Database, Cumulative Index to Nursing & Allied Health Literature, Latin American and Caribbean Health Sciences Literature databases, Web of Science and PubMed.

Results:

11 articles were included, categorized based on the types of technologies: “the use of the Internet”, encompassing social networking sites, the internet and applications; “communication devices”, with the use of smartphones, tablets and iPads and “types of communication” covering the use of interpersonal means of communication in the digital age, such as video calls and emails. There were positive results (63.6%) regarding the use of social media to minimize the perception of loneliness and/or social isolation in the older adults.

Conclusion:

the scientific evidence shows that the use of digital social media can reduce the perception of loneliness and/or isolation in older adults. Furthermore, the internet can favor greater contact between the older adults and family members and can serve as a source of support, provide a greater sense of belonging in the community and reduce loneliness.

A systematic review of the impacts of intergenerational engagement on older adults' cognitive, social, and health outcomes

BACKGROUND

Intergenerational engagement could benefit health and wellbeing within an ageing population. This systematic review evaluated the impacts of intergenerational engagement on cognitive, social, and health outcomes in healthy older adults and older adults with mild cognitive impairment.

RESEARCH DESIGN AND METHODS

Comprehensive literature searches were undertaken, with records filtered according to pre-registered criteria. Study quality was formally assessed, and a narrative synthesis of the findings produced.

RESULTS

Forty-four studies were reviewed. Regarding quantitative evidence, 4 out of 8 studies found significant intergenerational engagement effects on cognitive outcomes, 15 of 24 on social outcomes, and 21 of 31 on health-related outcomes. Qualitative evidence was also important for understanding perceived impacts and experiences of intergenerational programmes. Only 11 studies fully met criteria for high quality research, of which the majority focused on social outcomes.

DISCUSSION AND IMPLICATIONS

There are a range of potential benefits of intergenerational engagement, most notably regarding anxiety, generativity, cross-age attitudes, and physical activity. However, heterogeneity in programme context, sample design, dosage, and duration indicate that more research is required to enable wider implementation and generalisability. Scientific rigour in both quantitative and qualitative research should also be employed as far as possible, to provide the highest quality evidence.

Loneliness, social isolation, and pain following the COVID-19 outbreak: data from a nationwide internet survey in Japan

The aim of cross-sectional study was to investigate the association between loneliness, increased social isolation, and pain following the COVID-19 outbreak. A total of 25,482 participants, aged 15–79 years, were assessed using an internet survey; the University of California, Los Angeles Loneliness Scale (Version 3), Short Form 3-item (UCLA-LS3-SF3) was used to assess loneliness, and a modified item of the UCLA-LS3-SF3 was used to measure the perception of increased social isolation during the pandemic. The outcome measures included the prevalence/incidence of pain (i.e., headache, neck or shoulder pain, upper limb pain, low back pain, and leg pain), pain intensity, and the prevalence of past/present chronic pain. Pain intensity was measured by the pain/discomfort item of the 5-level version of the EuroQol 5 Dimension scale. Odds ratios of pain prevalence/incidence and past/present chronic pain prevalence according to the UCLA-LS3-SF3 scoring groups (tertiles) and the frequency of the perceived increase in social isolation (categories 1–5) were calculated using multinomial logistic regression analysis. The mean pain intensity values among different loneliness and social isolation levels were tested using an analysis of covariance. Increased loneliness and the severity of the perceived social isolation were positively associated with the prevalence/incidence of pain, pain intensity, and the prevalence of past/present chronic pain.

Long-Term Conditions in Older People are Linked with Loneliness, but a Sense of Coherence Buffers the Adverse Effects on Quality of Life: A Cross-Sectional Study

BACKGROUND

The impact of disability, long-term conditions, rurality, living alone, and being a carer on health has some evidence base, but the extent to which a strong sense of coherence (SoC), a factor hypothesised to promote wellbeing, may moderate these associations is unknown. A model of physical, environmental and social factors on quality of life was tested, with particular emphasis on whether a strong SoC buffered (mitigated) these determinants of quality of life.

MATERIAL AND METHODS

A cross-sectional postal survey was undertaken of a random sample of 1471 respondents aged over 65 years, across a population of rural individuals. Physical, environmental, and psychological variables were assessed against quality of life using ANOVA and a generalised linear model including the interaction effects of SoC.

RESULTS

ANOVA demonstrated that age, gender, long-term conditions or disability (LTC-D), living alone, >20 hours unpaid care for others per week, SoC, and loneliness, were associated with lower quality of life (p<0.01). There were strong correlations (p>0.01), between age and LTC-D, living alone, and poor SoC. Living alone was correlated with emotional and social loneliness; but those with higher SoC were less likely to experience loneliness. In an adjusted generalised linear model, significant associations with a lower quality of life were observed from: LTC-D, emotional loneliness and social loneliness (B= -0.44, -0.30, and -0.39, respectively, all p<0.001). The only interaction with SoC that was statistically significant (at p<0.05) was LTC-D. A stronger sense of coherence buffered the negative effects of long-term condition/disability on quality of life.

DISCUSSION

The physical, environmental and social factors examined, identified LTC-D and loneliness to be the strongest factors associated with poor quality of life.

CONCLUSION

SoC somewhat buffered the adverse effect of LTC-D on quality of life, but did not do so for loneliness.

Dual trajectories of loneliness and depression and their baseline correlates over a 14-year follow-up period in older adults: Results from a nationally representative sample in Taiwan

AIMS

To explore the codevelopment between loneliness and depression in older adults, and to identify its potential baseline individual, family and extrafamilial correlates.

BACKGROUND

The number of older adults around the world has steadily increased over the last decades. Later life is a particularly vulnerable life stage due to multiple unfavourable conditions, and mental health in this stage appears to become an inescapable issue. Previous research has found the cross-sectional association between loneliness and depression, but their codevelopment has been understudied. Therefore, exploring the codevelopment and its correlates has significant implications for prevention and healthcare professionals.

DESIGN

A longitudinal follow-up study.

METHODS

The study used nationally representative data over a 14-year follow-up period from the Taiwan Longitudinal Study on Ageing focused on Taiwanese aged 60 years and above (n = 4049). Group-based trajectory modelling, group-based dual-trajectory modelling and multinomial logistic regression were the primary analytical methods.

RESULTS

We identified three distinct dual trajectories of loneliness and depression: longitudinal low-frequency lonely depressed (29.3%), longitudinal moderate-frequency lonely depressed (59.4%) and longitudinal high-frequency lonely depressed (11.3%). After considering several demographic and background characteristics, difficulty in physical functioning, number of physical symptoms and diseases, sleep quality and number of child deaths were found to be significantly associated.

CONCLUSION

Across the three identified dual-trajectory groups, they all showed a stable loneliness frequency pattern over time; however, the moderate-frequency group and high-frequency group both had a trajectory of increasing depression. It seems that depression tends to change over time in a worsening direction, especially for those with a certain frequency of loneliness. Furthermore, differences in individual and family correlates were found across the groups.

IMPLICATIONS FOR PRACTICE

Interventions focusing on the specific factors may help hinder coexisting loneliness and depression, and have implications for developing health promotion strategies and chronic disease care plans.

Culturally Responsive Companion Program for a Japanese Woman with Dementia in a U.S. Nursing Home

The older foreign-born population is predicted to increase in the United States. As a whole, this population in the long-term care setting is more likely to face greater challenges associated with loneliness and social isolation due to their smaller social networks, language and cultural differences. The benefits of person-centered care have been widely recognized and may be a potential remedy for such challenges felt by older immigrants. Using a qualitative case study approach, this study explored the staff perceptions of a culturally responsive companion program provided to an older Japanese woman with advanced dementia in the long-term care setting to understand the potential benefits of such a program. The first theme that emerged was that the client benefitted from the program in regard to her physical wellbeing, emotional wellbeing, language communication and cultural support. Given the support of Japanese companions, the client was able to express her needs and health symptoms effectively and the staff were subsequently able to provide culturally-sensitive care. The second theme that emerged was the perceived benefits received by the staff. The companion program improved the staff's ability to provide quality care for the resident. This study implies that culturally responsive companion programs may benefit foreign-born older individuals in improving their wellbeing in long-term care settings.

Subjective life expectancy and associated factors among cancer survivors over 45 years old: evidence from the CHARLS

PURPOSE

Associations between subjective life expectancy (SLE) and a variety of factors are well documented, but the relationship regarding cancer is limited. The purpose of this study was to disclose this potential relationship and identify the covariates that might influence this relationship.

METHODS

Data were extracted from the China Health and Retirement Longitudinal Study (CHARLS), and a sample of 448 cancer survivors and 43,795 individuals without cancer were analyzed. Multilevel mixed-effects logistic regression was performed to examine the SLE associated with cancer survivors and participants without cancer after controlling for demographic, socioeconomic, health-related, and psychosocial factors.

RESULTS

The findings revealed that cancer survivors had a 39% reduction in longer life expectancy compared to respondents without cancer. Disparities in SLE existed based on diverse individual characteristics. The rate of high SLE in urban citizens was 75% higher compared to that of rural residents, while the rate of high SLE in participants with disability fell by 55%. The rate of high SLE decreased by 22% and 35% in respondents with high blood pressure and diabetes, respectively. The proportion of respondents with high SLE was reduced by 70% when depression was present. Furthermore, the out-of-pocket expenditures of participants with and without cancer showed a significant difference, but discrepancies with respect to SLE among different cancer treatment options were not found.

CONCLUSION

The more challenging one's socioeconomic status is and the unhealthier one's physical and mental conditions are, the lower one's prospect of subjective life expectancy is. Further work is warranted to confirm the causal association between subjective life expectancy and certain characteristics in cancer survivors.

The relationship between perceived loneliness and depression in the elderly and influencing factors

PURPOSE

This study was carried out to determine the relationship between perceived loneliness and depression in the elderly and influencing factors DESIGN AND METHODS: This cross-sectional descriptive study was conducted with 501 elderly. Data were collected with the questionnaire form, the elderly loneliness scale and the geriatric depression scale.

FINDINGS

A positive relationship was found between depression and loneliness. Loneliness, applying to a family health center/hospitalization, educational level, social loneliness, and age were found to be the predictors of depression. Depression, applying to a family health center/hospitalization, and marital status were found to be the predictors of loneliness.

PRACTICAL IMPLICATIONS

Loneliness is the major factor affecting depression in elderly. It is recommended that attempts should be made to enable the elderly to live more actively.

Age is not just a number: age awareness, subjective nearness-to-death, self-esteem, and depressive symptoms among older adults

Objectives: Humans often hold structured generalizations about themselves, which include attributes of qualities or characteristics they consider as important to their personal self-definitions. In this regard, holding one's age as an important defining personal category (high age awareness) was demonstrated to be connected with increased distress in older adults. However, little is known about the manner by which this connection is affected by individuals' perceptions regarding how close they are to their death on the one hand, and their personal resources on the other hand. Accordingly, the current research examined whether the connection between age awareness and depressive symptoms is mediated by subjective nearness-to-death, and whether this mediation is moderated by self-esteem.Method: A convenience sample of 386 older adults was collected using an online panel survey (age range 60-97, M = 71.62, SD = 6.88). Participants were requested to fill out scales assessing age awareness, subjective nearness-to-death, self-esteem, and depressive symptoms, as well as various sociodemographic scales.Results: Age awareness was associated with increased subjective nearness-to-death and depressive symptoms. In line with the hypotheses, subjective nearness-to-death mediated the age awareness-depressive symptoms connection, and this mediation was moderated by self-esteem.Conclusion: Age awareness is an important concept in old age, and is connected with increased depressive symptoms. We discuss this issue in line with Terror Management Theory, and emphasize the relevance of personal resources, such as feeling far from death and holding a positive view of oneself, in this regard.

Associations of Despair With Suicidality and Substance Misuse Among Young Adults

IMPORTANCE

Deaths of despair is a term that has recently been used to describe the increases in premature mortality from suicides, drug overdoses (particularly from opiates), and alcohol-related liver disease among US adults. Despite the use of the term despair, its role in these causes of premature death has not been empirically tested.

OBJECTIVE

To test whether despair among young adults is associated with suicidal thoughts and behavior, alcohol misuse, and drug misuse.

DESIGN, SETTING, AND PARTICIPANTS

The Great Smoky Mountains Study is a Southeastern, mixed urban-rural population-based cohort study conducted from November 10, 1992, to September 22, 2015. A total of 1420 participants originally 9, 11, and 13 years of age were followed up 11 times to 30 years of age (11 230 person-observations). A total of 1154 of 1400 living participants (82.4%) were assessed at 30 years of age. Statistical analysis was performed from May 7, 2019, to April 10, 2020.

EXPOSURES

Participants were assessed with structured interviews for indicators of despair (eg, hopelessness, helplessness, low self-worth, and feeling unloved). Despair was assessed with items from structured interviews: the Child and Adolescent Psychiatric Assessment and the Young Adult Psychiatric Assessment.

MAIN OUTCOMES AND MEASURES

Structured interviews were used to assess suicidal thoughts and behavior, substance use, and Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) alcohol use disorder and drug use disorder (including opioids) in young adulthood (2424 observations of 1266 individuals between 25 and 30 years of age).

RESULTS

This study included 1420 individuals (790 male individuals). During young adulthood (25 and 30 years of age), the 3-month weighted prevalence of any despair was 19.5% (476 of 2424 observations) with 7.6% of participants (201 of 2424 observations) reporting 2 or more despair items. In longitudinal, lagged models, despair scores (range, 0-3) were associated with more suicidal thoughts and behaviors (odds ratio [OR], 1.5; 95% CI, 1.1-2.0), illicit drug use (OR, 1.7; 95% CI, 1.2-2.5), and opioid use (OR, 1.9; 95% CI, 1.1-3.3) but not alcohol use disorder (OR, 0.8; 95% CI, 0.6-1.2). These associations persisted after accounting for sociodemographic factors (eg, poverty and educational level), lagged outcome status, and lagged depression status. The associations between despair and study outcomes were stronger in models accounting for long-term measures of despair extending back to childhood. There was no consistent pattern of moderation by sociodemographic factors.

CONCLUSIONS AND RELEVANCE

This study's findings suggest an empirical basis for longitudinal associations between despair and several, but not all, precursors of "deaths of despair" in rural Appalachia. Individual despair should be studied as a potential factor associated with morbidity and impairment in young adulthood.

Subjective nearness-to-Death, filial obligations, and depressive symptoms: the case of Jews and Arabs in Israel

Objectives: Research has examined the link between subjective perceptions of life and death and psychological well-being. However, while cultural values were shown to provide a defense against death-related thoughts, little is known about specific cultural expectations with regard to this issue. Accordingly, the current study focused on two sub-cultures within the Israeli society, and examined whether filial obligations moderate the connection between subjective nearness-to-death and depressive symptoms. Moreover, the study also examined whether this moderating effect is culture-dependent, by examining differences between Jewish and Arab citizens of Israel.Method: Data were collected from 337 participants, two-thirds of which were Jewish. Age ranged from 45 to 65 (M = 52.32, SD =4.49). All participants filled out scales examining subjective nearness-to-death, filial piety, and depressive symptoms.Results: Filial piety did not moderate the connection between subjective nearness-to-death and depressive symptoms for the entire cohort. However, a significant three-way interaction of cultural group × filial piety × subjective nearness-to-death was found, and further analyses demonstrated that filial piety served as a significant moderator among Jews, but not among Arabs.Conclusions: This study highlights the importance of examining subjective perceptions of mortality in a cultural context, as culture was shown to affect how such perceptions are connected with depressive symptoms. These effects are discussed from the framework of terror management theory within the context of the Israeli society, and future directions are suggested.

Inventory of complicated grief: Factor structure among middle-aged and older bereaved parents

This study examines the psychometric properties and factorial structure of the Hebrew version of Prigerson's Inventory of Complicated Grief (ICG), on 116 middle-aged and older Israeli bereaved parents. Analysis revealed a three-factor structure: emotional distress, yearning for the dead and social-emotional detachment. A high percentage of explained variance and sound internal consistency were found for the entire scale and for all factors, as well as adequate convergent and construct validity. These findings suggest that the Hebrew version of the ICG questionnaire is reliable, valid and appropriate for evaluation of grief in later life.

Impact of perceived social support on depression in Chinese rural-to-urban migrants: The mediating effects of loneliness and resilience

The present study aimed to examine whether loneliness and resilience played the roles of mediators on the relationship between perceived social support and depression. A total of 712 Chinese rural-to-urban migrants from Nanjing, who were measured with perceived social support, resilience, loneliness, and depression, participated in the study. Results indicated that perceived social support and resilience were negatively associated with depression. Loneliness was a significant and negative predictor for depression. In addition, we also revealed that resilience and loneliness partially mediated the relationship between perceived social support and depression. These findings might develop a better understanding of depression in the course of migration.

Social Dysfunction in Older Age and Relationships with Cognition, Depression, and Apathy: The GreatAGE Study

BACKGROUND

Most studies focused on only one measure of social dysfunction in older age, without proper validation and distinction across different dimensions including subjectivity, structural, and functional aspects.

OBJECTIVE

We sought to validate the Social Dysfunction Rating Scale (SDRS) and its factorial structure, also determining the association of SDRS with cognitive functions, global psychopathology, and social deprivation.

METHODS

The SDRS was administered to 484 Italian community-dwelling elderly, recruited in the GreatAGE study, a population-based study on aging conducted in Castellana Grotte, Bari, Southern Italy. We determined objective and subjective psychometric properties of SDRS against the gold standard evaluation of social dysfunction according to the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders (SCID-I) criterion.

RESULTS

The SDRS showed a moderate accuracy with an optimal cut-off of 26 maximized with higher sensitivity (0.74,95% CI:0.63-0.84) than specificity (0.57,95% CI:0.50-0.64). A five-factor structure was carried out and five dimensions of SDRS were identified (loneliness; social isolation; feeling of contribution/uselessness; lack of leisure activities; anxiety for the health). Education and global cognitive functions were inversely correlated to SDRS, while a direct association with global psychopathology, depression, and apathy was found. The prevalence of higher SDRS scores was major in subjects with current psychiatric disorders versus other subjects.∥Conclusion: The SDRS could be a valid instrument to capture both size and quality of social dysfunction, both in subjects with psychiatric disorders and in normal subjects. Several categories of social dysfunction differed only in the degree of health deprivation, not in social or material deprivation.

Social Engagement and Elderly Health in China: Evidence from the China Health and Retirement Longitudinal Survey (CHARLS)

This study examines the impact of social engagement on elderly health in China. A two-stage residual inclusion (2SRI) regression approach was used to examine the causal relationship. Our dataset comprises 9253 people aged 60 or above from the China Health and Retirement Longitudinal Survey (CHARLS) conducted in 2011 and 2013. Social engagement significantly improved the self-rated health of the elderly and reduced mental distress, but had no effect on chronic disease status. Compared with the rural areas, social engagement played a more important role in promoting the elderly health status in urban areas. Social engagement could affect the health status of the elderly through health behavior change and access to health resources. To improve the health of the elderly in China and promote healthy aging, the government should not only improve access to effective medical care but also encourage greater social engagement of the elderly.

Loneliness, Stress, and Depressive Symptoms Among the Chinese Rural Empty Nest Elderly: A Moderated Mediation Analysis

This study aimed to explore the relationship of loneliness, perceived stress, and depressive symptoms among the Chinese rural empty nest elderly. The role of sense of coherence (SOC) as a moderating variable was investigated in a representative sample of older adults in Henan, China, from November 2016 to February 2017. Results indicated that perceived stress mediated the relationship between loneliness and depressive symptoms, and SOC acted as a moderator on this mediating model. The mediation effect of perceived stress was significant only when SOC was lower. The results emphasized the importance of perceived stress in older adults. SOC was a protective factor with regard to depressive symptoms, and improving SOC should be a focus of health promotion with the elderly.

Elderly caregivers of the elderly: frailty, loneliness and depressive symptoms

ABSTRACT Objective: to investigate the association between frailty, loneliness and depressive symptoms of elderly caregivers. Method: a cross - sectional study carried out with 341 elderly caregivers enrolled in Family Health Units of a city in the countryside of São Paulo State. The interviews were domiciliary and included questionnaire for characterization of the caregiver, Fried’s frailty phenotype, family APGAR (family functionality), Geriatric Depression Scale (depressive symptoms) and item 3 of the Herth Hope Scale (loneliness). Logistic regression was used to analyze the association between depressive symptoms and solitude (independent variables), and frailty and pre-frailty (dependent variables). Results: there was an association between frailty, loneliness and depressive symptoms. Elderly caregivers had increased odds of 158% presenting pre-frailty, and 360% of frailty. Elderly caregivers with depressive symptoms had an increased chance of 242% of presenting fragility. Conclusion: elderly and lonely caregivers with depressive symptoms are more likely to be frail and pre-frail.

Future time perspective, loneliness, and depressive symptoms among middle-aged adults: A mediation model

BACKGROUND

Recent studies have demonstrated the relevance of subjective time perceptions with regard to depressive symptoms among aging and older adults. Moreover, loneliness was found to bear a strong connection to such symptoms. However, little is known about the connection between the three constructs. Accordingly, the current research examines whether the connection between future time perspective and depressive symptoms is mediated by loneliness.

METHODS

Data was collected from 1021 participants aged 50-67 (mean age = 57.89), who completed the Future Time Perspective Scale, a scale measuring loneliness, and the Center for Epidemiological Studies Depression Scale (CES-D), and provided relevant socio-demographic information.

RESULTS

Future time perspective was negatively linked with both loneliness and depressive symptoms. Moreover, loneliness was a significant mediator for the connection between future time perspective and depressive symptoms.

LIMITATIONS

The study focused on a specific age range, and employed a cross-sectional design.

CONCLUSIONS

This study provides a view into the manner by which subjective perceptions of time are linked with depressive symptoms during the aging process, and highlights the clinical importance of such perceptions to depressive symptoms.

Loneliness and depression symptoms among the elderly in nursing homes: A moderated mediation model of resilience and social support

Loneliness has been identified as a risk factor for depressive symptoms. Resilience and social support have been regarded as underlying protective factors. Little is known about the complex relations among these factors in the nursing home elderly. This study aimed to assess the prevalence of depressive symptoms, explore whether resilience mediated the association between loneliness and depressive symptoms, and investigate whether social support moderated the indirect or direct effect of mediation model. A total of 323 nursing home elderly were recruited in Jinan City, China. Loneliness, resilience, social support and depressive symptoms were measured. Results shown the association between loneliness and depressive symptoms was partially mediated by resilience. Besides, the indirect effect of the mediation model was moderated by social support. When the level of social support was higher, the indirect effect of loneliness on depressive symptoms through resilience was weaker. The incidence of depressive symptoms among the nursing home elderly could not be neglected. The findings suggest that interventions, such as improving resilience and social support, may help break the link between loneliness and depressive symptoms among the elderly in nursing homes.

Subjective nearness to death and end-of-life anxieties: the moderating role of ageism

OBJECTIVES

Subjective nearness to death (SNtD), or individuals' subjective evaluation of how close they are to death, has been demonstrated to be an important predictor for different aspects of the individual's aging process across the life cycle. However, the relationship between SNtD and anxieties linked with the aging process has not been examined among individuals who may be in the initial stages of experiencing the first physical and cognitive signs of aging. Thus, this study examined the association between SNtD and aging, dying, and death anxieties. Moreover, the role of ageism, or negative attitudes toward older adults, as a moderator for these perceptions regarding the end of life has not been addressed. Moreover, we examined whether ageism serves as a moderator for the aforementioned association.

METHOD

A convenience sample of 1146 Israeli participants, ranging in age from 45 to 65, filled out scales assessing SNtD, aging anxiety, dying anxiety, death anxiety, and ageism.

RESULTS

High levels of SNtD were positively associated with aging, dying, and death anxieties. Moreover, there was a positive association between ageism and the three end-of-life anxieties. Significant interactions demonstrated the moderating effect of ageism for the relationship between SNtD and both aging and dying anxieties, but not for death anxiety.

CONCLUSION

SNtD is an important construct, which is connected to various perceptions and anxieties concerning the aging and dying processes. Moreover, while high ageism mitigates the positive association between SNtD and certain anxieties, the role of ageism is more complicated, and its negative aspects are discussed.

The connection between subjective nearness-to-death and depressive symptoms: The mediating role of meaning in life

Depression is characterized by a wide range of emotional, cognitive, and physical symptoms. Two prominent features of depressive symptoms are a sense that life has no meaning on the one hand, and that life is not worth living on the other hand. In recent years, the subjective perception of how close one feels to his/her death has gained importance as a significant factor associated with various aspects of physical and psychological well-being. Thus, the current study examined the connection between subjective nearness-to-death, meaning in life, and depressive symptoms, and assessed whether meaning in life mediates the connection between subjective nearness-to-death and depressive symptoms. Data was collected from 268 participants between the ages of 28 and 74 (mean age = 46.75), who completed measures of subjective nearness-to-death, meaning in life, and depressive symptoms. Results yielded a significant positive connection between subjective nearness-to-death and depressive symptoms, as well as a negative connection between meaning in life and depressive symptoms. Moreover, meaning in life was found to mediate the connection between subjective nearness-to-death and depressive symptoms. Findings are discussed in light of the Terror Management Theory, and potential clinical implications are suggested.

Self-care agency, lifestyle, and physical condition predict future frailty in community-dwelling older people

The purpose of this 2 year longitudinal study was to identify the relationship between self-care agency, lifestyle, physical condition, and frailty among community-dwelling older people in a rural area of Japan. The participants were 133 older individuals aged 65 years or above. Data collection was conducted via face-to-face interviews using self-administered questionnaires. Background information, such as age, sex, current employment status, family structure, medication use, comorbidities, and knee and lower back pain, were assessed. The definition of frailty was based on the Frailty Checklist. Self-care agency, lifestyle habits, and locomotive syndrome were assessed using specific assessment scores. Logistic regression analysis showed that locomotive syndrome, knee and lower back pain, and stroke are risk factors for frailty. Among the factors associated with frailty, current employment, regular exercise, and self-care agency were recognized as preventive factors of depression, decreased cognitive function, and being housebound. Our findings suggest that enhancing self-care agency, regular exercise, and self-management skills for chronic illness and disability may decrease the progression of frailty among older people.

Factors Contributing to Unexpected Retirement and Unemployment in Adults Over 50 Years Old in Ireland

Older adults are increasingly important to maintaining stable workforces. As such, factors contributing to early workforce exit must be identified. This study aimed to identify predictors of unexpected retirement and unemployment at older age, with respect to psychological constructs, resulting adverse behaviors, and health-related factors reflecting functional status. Data were extracted from The Irish Longitudinal Study on Ageing (TILDA) to predict unexpected retirement and unemployment in older adults in Ireland. Increasing age, increasing number of impairments in activities of daily living, and frailty status of “pre-frail/frail” (relative to non-frail) increased the likelihood of unexpected retirement; while greater numbers of physical limitations and “pre-frail/frail” status significantly predicted unemployment at older age. Pre-frail/frail status or reduced physical capability for everyday tasks may adversely affect older individuals’ ability to obtain and/or maintain employment. These findings advance the current understanding of factors associated with unexpected retirement and unemployment at older ages. Findings may aid in identifying strategies to extend working life and to aid at-risk older adults, and may inform components of care on which to focus to minimize loss of function and mobility, and maintain independence, with aging.

Old man-young man: T.S. Eliot's Gerontion and the problem of identity

BACKGROUND

In his poem Gerontion (1920) Nobel laureate T.S. Eliot uses powerful language to give a fictional, highly condensed, first-person account of medical and psychological conditions that arise with old age: physical frailty, cognitive decline, sensory impairment, depressive symptoms with embitterment, social withdrawal and the psychological strain of having to face old age and make meaning of one's life. Surprisingly, he wrote the poem as a young man.

METHODS

In this qualitative study, we used a hermeneutic approach to interpret Gerontion from a psychiatric perspective. We considered how Gerontion could help us to further an empathic understanding of these mental states, why a young man expresses himself through the voice of an old man and how the depressed-aggressive tone of the poem with its contempt and anti-Semitism can be interpreted.

CONCLUSIONS

We concluded that Eliot was grappling with his identity as an American in England, as a sexually inhibited husband to a demanding wife, as a banker and poet and as someone who had witnessed the effects of WWI. Readers of the poem can simultaneously experience the suffering of an old man and the identity crisis of a young man. The poem can thus further insight into the development of contempt and promote empathy and professionalism in dealing with states such as late-life depression. Consequently it is well suited for use in medical classes on these issues, particularly because it is much shorter than a novel or film.