Social network typologies and mortality risk among older people in China, India, and Latin America: A 10/66 Dementia Research Group population-based cohort study

Typologies of duocentric networks among low-income newlywed couples

The social networks surrounding intimate couples provide them with bonding and bridging social capital and have been theorized to be associated with their well-being and relationship quality. These networks are multidimensional, featuring compositional (e.g., the proportion of family members vs. friends) and structural characteristics (e.g., density, degree of overlap between spouses' networks). Most previous studies of couple networks are based on partners' global ratings of their network characteristics or network data collected from one member of the dyad. This study presents the analysis of "duocentric networks" or the combined personal networks of both members of a couple, collected from 207 mixed-sex newlywed couples living in low-income neighborhoods of Harris County, TX. We conducted a pattern-centric analysis of compositional and structural features to identify distinct types of couple networks. We identified five qualitatively distinct network types (wife family-focused, husband family-focused, shared friends, wife friend-focused, and extremely disconnected). Couples' network types were associated with the quality of the relationships between couples and their network contacts (e.g., emotional support) but not with the quality of the couples' relationship with each other. We argue that duocentric networks provide appropriate data for measuring bonding and bridging capital in couple networks.

Network Types and Functional Health in Old Age: It is Not Just the Size of the Network That Matters

OBJECTIVES

Findings on the effect of network size and support on functional health are mixed. We examine whether network types, that simultaneously incorporate multiple network characteristics, are associated with functional health in late life.

METHODS

Data are from the National Social Life, Health, and Aging Project (N = 3005). We estimated the longitudinal effect of membership in five multidimensional network types on disability in six activities of daily living using negative binomial regression, and on mobility (assessed using a timed walk test) using a generalized linear mixed model.

RESULTS

Compared to those in the large without strain network, older adults in the small, restricted, high contact network had fewer disabilities but worse mobility, while those in the large network with strain also had worse mobility.

DISCUSSION

Care plans focusing on function and mobility should consider multiple aspects of older adults' social networks including network size, diversity, and relationship strain.

Neighborhood socioeconomic position, living arrangements, and cardiometabolic disease among older Puerto Ricans: An examination using PREHCO 2002-2007

Cardiometabolic diseases are among the leading causes of mortality worldwide and are increasingly prevalent in rapidly aging populations. Neighborhood socioeconomic position (SEP) and living arrangements are increasingly recognized as important determinants of cardiometabolic health but have not been examined within Puerto Rico. This study examined the association between neighborhood SEP, living arrangements, and incidence of cardiometabolic conditions among island-dwelling older Puerto Ricans, using longitudinal data from the Puerto Rican Elderly Health Conditions Project (Waves I 2002/03 and II 2006/07) linked with 2000 Census data for neighborhood-level conditions. Our sample consists of non-institutionalized adults aged 60 and older who remained in the same residence over both waves of data collection (N = 2,769). We used multilevel multinomial logistic regression models to examine the relationship between neighborhood SEP and the prevalence and incidence of cardiometabolic disease. Findings show that residence in a socioeconomically advantaged neighborhood was positively associated with reporting having one cardiometabolic condition at baseline, but not associated with the incidence of cardiometabolic conditions at follow-up. Living without a partner was negatively associated with reporting having cardiometabolic conditions compared to living with a partner. Similar results were found for the incidence of cardiometabolic conditions. Living arrangements significantly modified the relationship between neighborhood SEP and cardiometabolic conditions. Compared to living with a partner, living alone in a socioeconomically advantaged neighborhood was associated with a reduced risk of reporting having one condition. Living with children in a socioeconomically advantaged neighborhood was associated with a reduced risk of developing one cardiometabolic condition than living with a partner. Living arrangements are more salient to cardiometabolic health than neighborhood SEP. Social programs and services focused on household composition and familial support are needed to identify older Puerto Ricans potentially at risk of underdiagnosed chronic conditions, especially as ongoing economic, demographic, environmental, and healthcare crises potentially exacerbate social inequalities.

A Home-Care Service for Frail Older Adults: Findings from a Quasi-Experiment in Milan

Population aging is particularly pronounced in Italy. Recently, home-care services emerged as one of the desirable strategy when dealing with such situations of fragility. In this framework, we present the evaluation of a home-care service which was experimentally implemented by Fondazione Sacra Famiglia and Casa di Cura Ambrosiana in the 2017-2018 biennium. The service consisted of a twice-weekly nursing visit intended to monitor patient health conditions and to gather data constantly supervised by a geriatrician. The eligible population consisted of the users of San Carlo Hospital Emergency Department (91 individuals). Twenty of these individuals had access to the experimental home-care service. The results show the smaller probability of mortality for the treatment group compared to the control group, but similar probabilities in admissions to ER and in hospitalizations. These findings suggest that health home-care policies could reduce mortality by lessening the negative effects of relational isolation.

Changes in Social Relationships and Physical Functions in Community-Dwelling Older Adults

BACKGROUND

Social relationships are associated with physical function. However, little scholarly attention has been focused on the effect of changing social factors on physical function.

PURPOSE

This study was designed to examine the effects on physical function of changes in social relationships in adults aged 65 years and older.

METHODS

This study is part of a longitudinal, prospective cohort study that was conducted on community-dwelling older adults in a suburban area of central Japan. Baseline self-report data were collected in 2011, and a follow-up survey was conducted in 2017. Social relationships were assessed using the Index of Social Interaction, and physical function was evaluated using a subscale of the Kihon Checklist. Chi-square tests, Mann-Whitney U tests, and multiple logistic regression analysis were used to analyze data from 442 older adults who were functionally independent at baseline.

RESULTS

After controlling for covariates in 2011, negative changes in social relationships (odds ratio [ OR ] = 3.20, 95% CI [1.18, 8.69]) were found to be associated with physical function decline. Moreover, 1-point increases in the different social-relationship values between baseline and follow-up were associated with protective effects against functional decline ( OR = 0.71, 95% CI [0.63, 0.80]). Furthermore, median trends between baseline and follow-up revealed associations between decreasing ( OR = 4.18, 95% CI [1.53, 11.39]) and continuously low ( OR = 2.98, 95% CI [1.42, 6.28]) social relationships and physical function decline.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings support a strong association between negative changes in social relationships and physical function decline and highlight the importance of promoting social relationships to delay physical function decline in older adults.

The Relationship Between Social Isolation and Mortality Among Adults Aged 50 and Older in a 12-year Follow-Up Analysis in Mexico

Social relationships have a complex nature shaped mainly by two dimensions: structure and function. Previous research raised the importance of considering both features simultaneously given that they may operate differently. However, research on social relationships and mortality mainly refers to European and U.S. populations. This study examines structural and functional features of social relationships to understand social isolation among adults aged 50 and older in Mexico. In addition, we analyze that association with mortality, using panel data from a 12-year follow-up from the Mexican Health and Aging Study (2003-2015). Results reveal that structural and functional features of social relationships are intertwined, and social isolation was shaped by two aspects that we label lack of socialization and being alone and feeling lonely. After controlling for a series of sociodemographic and health variables, Cox proportional hazard regression models indicate that both aspects significantly increase mortality among older adults in Mexico.

Coresidence increases the risk of testing positive for COVID-19 among older Brazilians

Background

Brazil is among the countries hit hardest by COVID-19, and older adults are among the vulnerable groups. Intergenerational coresidence and interdependence among family members, both prevalent in Brazil, likely increase social and physical contact and thus potential infection.

Methods

Using nationally representative data from the COVID-19 module of the Brazilian National Household Sample Survey (Pesquisa Nacional por Amostra de Domicílios), collected between July and November of 2020, we examined the association between living arrangements and exposure to and testing for COVID-19 among 63,816 Brazilians aged 60 years and older. We examine whether living arrangements influence self-reported COVID-19 symptoms as an indicator of subjective health assessment, testing as an indicator of health care service use, and a positive COVID-19 test result as an objective indicator of exposure to the disease.

Results

Living arrangements shape older adults’ vulnerabilities to COVID-19 exposure and testing. Specifically, those living alone were more likely to report having symptoms and having had a test for COVID-19. However, older adults in multigenerational and skipped generation households were more likely than solo-dwellers to test positive for COVID-19. Those with symptoms were more likely to test, regardless of their living arrangement. Among older adults without symptoms, those living alone had a higher probability of testing than those living in multigenerational or skipped-generation households.

Conclusions

Overall, our findings suggest that coresidence with younger family members puts older adults’ health at risk in the context of COVID-19. As younger Brazilians are increasingly vulnerable to COVID-19 and experiencing severe outcomes, policy makers need to be more attentive to the health needs of households that comprise older and younger cohorts, which are also more prevalent in poor and marginalized segments of the population.

Social network typology and health among parents of children with developmental disabilities: Results from a national study of midlife adults

OBJECTIVE

There is increasing interest in the role of contextual factors in promoting well-being among parents of children with developmental disabilities. This study aimed to examine whether social network types moderate the impacts of having a child with a developmental disability on parents' health.

METHODS

Using cross-sectional data from the Midlife in the United States survey (MIDUS 2 and Refresher cohorts), we analyzed a sample of 363 parents of children with developmental disabilities and 4,919 parents of children without developmental disabilities. K-means cluster analysis was implemented to identify a social network typology. Modified Poisson and negative binomial regression models estimated the effect of having a child with a developmental disability and the typology on parents' physical health (self-rated health, number of chronic conditions) and mental health (self-rated mental health, major depression).

RESULTS

The cluster analysis revealed two social network types. Parents of children with developmental disabilities were more likely to have "restricted/unsupported" networks, whereas parents in the comparison group were more likely to have "diverse/supported" networks. Social support was more important for differentiating the network types of parents of children with developmental disabilities, while social integration was more salient for the comparison group. Parents of children with developmental disabilities fared worse on all outcomes relative to parents of children without disabilities. However, the typology had a compensatory psychological effect; the diverse/supported network type conferred greater mental health benefits to parents of children with developmental disabilities than to those in the comparison group. The diverse/supported network type was also associated with better physical health, but the associations did not differ between the two parent groups.

CONCLUSIONS

The results of this study emphasize the importance of social determinants of well-being for those with exceptional parenting responsibilities. Strengthening social networks may have a particularly positive impact on such parents' mental health.

Three-year effects of neighborhood social network intervention on mental and physical health of older adults

OBJECTIVES

Although neighborhood is considered to be a crucial source of social network to promote health among older adults, current findings are mostly derived from observational study designs. This study examined whether participations in event-based community programs could increase neighborhood social network and whether such increase could lead to desirable changes in mental and physical health among older adults.

METHOD

This study employed quasi-experimental design. A baseline questionnaire survey was sent to residents of Tsurukabuto community aged 60 years or more (n = 1769); 1,068 responded. Community events were implemented approximately once a month for three years. Then, a three-year follow-up survey questionnaire was sent to the respondents of the baseline survey. The total number of respondents in the latter survey was 662; of the total, 173 participated in the intervention. Strong and weak ties with neighbors, mental well-being (Ikigai-9), health-related quality of life (HRQOL), and instrumental activity of daily living (IADL) were measured in the surveys.

RESULTS

The path analysis revealed that intervention participation was significantly associated with changes in strong ties (standardized path coefficient = 0.12) and changes in strong ties were associated with those in Ikigai-9 scores (standardized path coefficient = 0.15). The total and indirect effects of intervention participation on Ikigai-9 scores were significant. Significant intervention effects were not observed for HRQOL and IADL scores.

CONCLUSION

This study found that participation in our event-based intervention could indirectly and positively influence older adults' mental well-being through their strong ties with their neighbors.

Communication About Chronic Pain in Older Persons' Social Networks: Study Protocol of a Qualitative Approach

A lack of social relations appears to impact on health and life expectancy among the older persons. The quality and diversity of social relations are correlated with good health and well-being in later life. Chronic pain is a crucial issue in aging population. Effective communication between the older persons with chronic pain, their relatives and the actors of the healthcare system facilitates the management of this condition. Studies on communication in later life generally do not consider the older persons' social network as a whole, focusing only a specific segment (e.g., family or medical staff). This lack of scientific data prevents the actors of the healthcare system from offering solutions to bridge clinically relevant communication gaps. As a consequence, our study has three objectives: (1) to identify how the older persons perceive communication about chronic pain with their social network; (2) to identify their unmet communication needs; (3) to develop recommendations that improve communication about chronic pain in later life. The study will be divided into two phases. The first phase will meet objectives 1 and 2. It will involve individual interviews with about 50 people over 75 years old suffering from chronic pain and without major cognitive or auditory troubles. In this phase, we will apply a multi-layered analysis. We will map the older persons' personal network and identify their communication practices and needs, by combining content and discourse analysis with social network theories. The second phase of the study will aim at recommendations based on the results of the first phase (objective 3). It will require focus groups with different sets of stakeholders (older persons, relative caregivers, health professionals, decision-makers). In the second phase, we will use content analysis to pinpoint the concerns and suggestions for action. The results will be disseminated on three levels: (1) to the scientific world (specialists in the field of health and aging and health communication); (2) to health practitioners working with older persons; (3) to society at large, with a focus on institutions and groups directly concerned by the issue.

Admission to long-stay residential care and mortality among people with and without dementia living at home but on the boundary of residential care: a competing risks survival analysis

BACKGROUND

Health policy in many countries is underpinned by a commitment to support dependent older people to remain in their own home for as long as possible and practicable. This study explores factors affecting both admission to long-stay residential care (LSRC) and mortality among people with and without dementia who are currently living at home with intensive formal care support.

METHODS

This is a cross-sectional study based on administrative data collected on 429 dependent older people in Ireland, 269 of whom were people with dementia. A cause-specific hazard model was used to investigate the hazard of admission to LSRC, while accounting for mortality as a competing risk and vice versa.

RESULTS

Admission to LSRC was higher for people with dementia relative to people without and for those receiving lower amounts of informal care. The hazard of mortality was significantly higher for older people aged 85+, whereas it was lower for individuals with a medium level of dependency relative to those with high levels of dependency. The hazard of mortality was also influenced by the amount of informal care provision.

CONCLUSION

People with dementia are more likely to be admitted to LSRC than people without. Care for people with dementia needs to be more specialised and personal, and intensity of provision should not be equated to the number of care hours on offer. Informal care provision may help to prevent admission to LSRC. Advanced age, physical dependency and informal care provision affect mortality, raising interesting issues in relation to resource allocation.

The structure and functional correlates of social support networks of people in advanced old age living in chosen urban and rural areas in Poland: a cross-sectional study

The purpose of the study was to identify the different types of social support networks (SSNs) among community-dwelling people aged 75+ years in selected areas of Poland, and to evaluate any associations between the network type and demographic and health variables of the population studied. The two most prevalent SSN types identified using the Practitioner Assessment of Network Type were “family dependent” (35.8%) and “locally integrated” (32.2%). “Local self-contained” (6.4%), “wider community focused” (2.8%) and “private restricted” (5.6%) SSNs were observed less frequently. In 17.2% of cases, it was not possible to identify the type of network unequivocally. Older people with a locally integrated SSN, in contrast to the family dependent type, were generally younger, living alone, and less likely to be homebound, rate their health as poor, suffer from depression or dementia, and had lower levels of functional disability. Locally integrated SSNs are recognized in the literature as being the most robust in terms of facilitating well-being and providing sufficient support to help maintain the older person in the community. This may reflect the higher levels of independence of older people able to sustain these support networks, which are then transformed into family-dependent types as their health deteriorates, but confirmation of this would require prospective studies. An improved understanding of the prevalence of different types of social networks among older people in Poland would help to guide a systematic approach to recognizing unmet needs in this population and provide crucial information in the planning of formal services.

Association of Depression and Anxiety with Social Network Types: Results from a Community Cohort Study

Social networks protect individuals from mental health conditions of depression and anxiety. The association between each social network type and its mental health implications in the Indian population remains unclear. The study aims to determine the association of depression and anxiety with different social network types in the participants of a community cohort. We conducted a cross-sectional household survey among people aged ≥30 years in geographically defined catchment areas of Kerala, India. We used cross-culturally validated assessment tools to measure depression, anxiety and social networks. An educated male belonging to higher income quartiles, without any disability, within a family dependent network has lower odds of depression and anxiety. Furthermore, 28, 26.8, 25.7, 9.8 and 9.7% of participants belonged to private restricted, locally integrated, wider community-focused, family-dependent and locally self-contained networks, respectively. Close ties with family, neighbours, and community had significantly lower odds of anxiety and depression than private restricted networks. The clustering of people to each social network type and its associated mental health conditions can inform social network-based public health interventions to optimize positive health outcomes in the community cohort.

Loneliness Among Older Adults in Latin America, China, and India: Prevalence, Correlates and Association With Mortality

Objectives: This study was designed to explore prevalence and correlates of self-reported loneliness and to investigate whether loneliness predicts mortality among older adults (aged 65 or above) in Latin America, China and India. Methods: The study investigated population-based cross-sectional (2003-2007) and longitudinal surveys (follow-up 2007-2010) from the 10/66 Dementia Research Group project. Poisson regression and Cox regression analyses were conducted to analyse correlates of loneliness and its association with mortality. Results: The standardised prevalence of loneliness varied between 25.3 and 32.4% in Latin America and was 18.3% in India. China showed a low prevalence of loneliness (3.8%). In pooled meta-analyses, there was robust evidence to support an association between loneliness and mortality across Latin American countries (HR = 1.13, 95% CI 1.01-1.26, I2 = 10.1%) and China (HR = 1.58, 95% CI 1.03-2.41), but there were no associations in India. Conclusion: Our findings suggest potential cultural variances may exist in the concept of loneliness in older age. The effect of loneliness upon mortality is consistent across different cultural settings excluding India. Loneliness should therefore be considered as a potential dimension of public health among older populations.

Transcranial Photobiomodulation of Clearance of Beta-Amyloid from the Mouse Brain: Effects on the Meningeal Lymphatic Drainage and Blood Oxygen Saturation of the Brain

Here, we demonstrate the therapeutic effects of transcranial photobiomodulation (tPBM, 1267 nm, 32 J/cm2, a 9-day course) in mice with the injected model of Alzheimer's disease (AD) associated with accumulation of beta-amyloid (Aβ) in the brain resulting in neurocognitive deficit vs. the control group (CG) (the neurological severity score (NNS), AD 3.67 ± 0.58 vs. CG 1.00 ± 0.26%, p < 0.05) and mild cerebral hypoxia (AD 72 ± 6% vs. CG 97 ± 2%, p < 0.001). The course of tPBM improved neurocognitive status of mice with AD (NNS, AD 2.03 ± 0.14 vs. CG 1.00 ± 0.26, vs. 2.03 ± 0.14, p < 0.05) due to stimulation of clearance of Aβ from the brain via the meningeal lymphatic vessels (the immunohistochemical and confocal data) and an increase in blood oxygen saturation of the brain tissues (the pulse oximetry data) till 85 ± 2%, p < 0.05. These results open breakthrough strategies for non-pharmacological therapy of AD and clearly demonstrate that tPBM might be a promising therapeutic target for preventing or delaying AD based on stimulation of oxygenation of the brain tissues and activation of clearance of toxic molecules via the cerebral lymphatics.

The Prevalence of Vascular Dementia in China: A Systematic Review and Meta-Analysis from 2009-2019

BACKGROUND

Vascular dementia (VD), as the second-largest type of dementia, is a serious stage of vascular cognitive impairment. It is significant to conduct retrospective epidemiological studies to characterize further the disease for public health. This study estimated the prevalence of VD among the population aged 18 yr and older in China.

METHODS

Epidemiological investigations on VD published in journals and covering the period from 1999 to 2019 were identified manually and online by using Chinese databases (such as Chinese BioMedical Literature Database, Chinese National Knowledge Infrastructure database, Chinese science-technology databases, and the Chinese Wan-fang and Chongqing VIP database) and English databases (such as PubMed, Elsevier Science Bibliographic Databases and Cochrane library). Studies were included if the diagnostic criteria for VD are clear and the quality of the included literature was evaluated using the quality evaluation criteria of epidemiological research methods. A random-effects model was employed according to the statistical test of homogeneity.

RESULTS

Twenty-six studies met the inclusion criteria, including 100,923 subjects and 977 VD patients. The pooled prevalence of VD was 0.96% (95% [confidence interval, CI] 0.63%∼2.1%). The prevalence of VD increased with increasing age. There was a higher prevalence of VD in the northeast China population, in urban areas and males.

CONCLUSION

We stratified the included studies based on age, location, gender, and geographical distribution for prevalence. The prevalence of VD has slowly risen since 1999. It is obviously different between the North & South and urban &rural districts. While there are many benefits of systematic reviews, the methods presented have inherent limitations.

Is having an educationally diverse social network good for health?

While network research often focuses on social integration as a predictor of health, a less-explored idea is that connections to dissimilar others may benefit well-being. As such, this study investigates whether network diversity is associated with changes in four health outcomes over a 3-year period of time in the U.S.A. Specifically, we focus on how an underexplored measure of network diversity-educational attainment assortativity-is associated with common self-reported outcomes: propensity to exercise, body-mass index, mental health, and physical health. We extend prior research by conducting multilevel analyses using this measure of diversity while adjusting for a range of socio-demographic and network confounders. Data are drawn from a longitudinal probability sample of U.S. adults (n = 10, 679) in which respondents reported information about themselves and eight possible alters during three yearly surveys (2013-2015). We find, first, that higher educational attainment is associated with more educationally insular networks, while less-educated adults have more educationally diverse networks. Results further suggest that having educationally similar networks is associated with higher body-mass index among the less educated. Further exploration of the relationship between ego network diversity, tie strength, and health is warranted.

Older adults with physical disabilities: vulnerabilities relative to the body, the physical and social environment

OBJECTIVE

to understand the vulnerabilities of older adults with physical disabilities regarding their body, physical and social environments.

METHOD

this was a qualitative study based on Alfred Schütz' social phenomenology, with 15 older adults with physical disability from Cuiabá, state of Mato Grosso, Brazil. Open-ended questionnaires were administered to the participants in 2017. The units of meaning that emerged were organized into thematic categories.

RESULTS

physical decline, associated with the permanence of environmental and social barriers intensified the vulnerabilities of older adults. Gaps in health services are mitigated by informal social support networks and access to work was a form of social inclusion.

FINAL CONSIDERATIONS

vulnerabilities in the old age of persons with physical disabilities did not reside only in the body dimension, but also the physical and social environment, countering healthcare models based on the logic of reverting their dysfunctional body.

Social networks and their influences on nutrient intake, nutritional status and physical function in community-dwelling ethnically diverse older adults: a mixed-methods longitudinal study

Background

The United Kingdom population is ageing and becoming increasingly diverse; thus, it is vital to develop and implement interventions supporting this population shift. Social networks (SN) significantly impact health outcomes in later life, however relatively little is known about SN of community-dwelling ethnically diverse older adults. This study aimed to: 1) profile SN and changes in SN in this population over 8 months; 2) examine associations between SN, dietary intake, nutritional status, and physical function.

Methods

SN were assessed using the Wenger Practitioner Assessment of Network Type. Energy and nutrient intakes were measured using multiple-pass 24-h recalls. The Mini Nutritional Assessment-Short Form (MNA-SF) assessed nutritional status. Physical function was measured using the Short Physical Performance Battery (SPPB) and handgrip strength. Data were collected at baseline and 8-months. Correlation and regression analyses examined relationships between SN, physical function, nutrient intake and nutritional status. Semi-structured interviews were conducted at baseline (n = 92) and follow-up (n = 81) to identify potential influences of SN. Interviews were transcribed verbatim and analysed using directed content analysis.

Results

Quantitative data were obtained from 100 participants at baseline and 81 at follow-up. Mean (SD) age was 70.8 (8.1) years (59% male), comprising African/Caribbean (60%), South Asian (34%), and other ethnicities (6%). Five SN typologies were identified under two broad areas: integrated-SN consisting of locally integrated (44%) and wider community (8%); and non-integrated-SN consisting of family dependent (25%), local self-contained (17%), and private restricted (6%). At follow-up, 37% remained in non-integrated networks, 19% transitioned to non-integrated networks, 11% transitioned to, and 33% remained in, integrated networks. Participants within integrated networks at baseline had higher SPPB scores at follow-up. Compared to the private restricted, local self-contained SN significantly predicted zinc, riboflavin and vitamin B6 intakes. Participants remaining in, or transitioning to, non-integrated networks had low MNA-SF scores. Qualitative findings indicate that participants with reductions in SN perceived it as causing poorer physical function and eating behaviours.

Conclusion

In the present study, integrated SN were associated with higher physical function and nutritional status at 8-month’s follow-up. These results can inform the design of interventions to improve social networks, physical function and healthy nutrition within this population.

Improvement of social support in empty-nest elderly: results from an intervention study based on the Self-Mutual-Group model

BACKGROUND

China has the world's largest elderly population and an increasing number of empty-nest elderly. The purpose of this study is to evaluate the effectiveness of the Self-Mutual-Group model on social support of the empty-nest elderly, thus providing reference for improving their quality of life.

METHODS

A intervention study was conducted between October 2016 and May 2017 at six communities in Taiyuan, Shanxi Province, China. A total of 350 empty-nest elderly aged 60-88 years were randomly assigned in the intervention group (n = 167) with a 7-month SMG-based intervention or to a control group (n = 183) with no intervention. The social support of the participating elderly (n = 350) was assessed by the Social Support Rating Scale (SSRS) at the baseline and 7 months later, respectively.

RESULTS

A 7-month follow-up showed an increasing mean scores of SSRS, objective support, subjective support and support utilization of the intervention group, and reached statistical significance (P < 0.05).

CONCLUSIONS

The Self-Mutual-Group model was considered to be a positive intervention and was effective in increasing social support among the empty-nest elderly. Furthermore, future research should extend the intervention period and introduce multi-point measurement to better evaluate the intervention process and outcomes.

TRIAL REGISTRATION

Study on the 'SMG' Health Management Model Based on Community Organization Theory among empty-nest elderly (ChiCTR1800015884).

'Ingredients' of a supportive web of caring relationships at the end of life: findings from a community research project in Austria

In accordance with the pluralisation of life plans in late modernity, the societal organisation of care at the end of life is diverse. Although the public discourse in western societies is dominated by questions about optimising specialised palliative care services, public health approaches, which take into account the social determinants and inequalities in end-of-life care, have gained in importance over the last decade. Conceptual aspects, dimensions of impact and benefit for the dying and their communities are well discussed in the public health end-of-life care research literature. Our research focuses on the preconditions of a supportive caring web in order to understand how communities can build on their social capital to deal with existential uncertainty. As part of a large-scale community research project, we carried out focus groups and interviews with community members. Through dispositive analysis, we generated a set of care-web 'ingredients', which constitute and foster a caring community. These 'ingredients' need to be cultivated through an ongoing process of co-creation. This requires: (i) a focus on relationships and social systems; (ii) the creation of reflective spaces; and (iii) the strengthening of social capital, and d) the addressing of inequalities in care.

Association of Formal and Informal Social Support With Health-Related Quality of Life Among Chinese Rural Elders

Objectives: To explore the association of formal and informal social support with health-related quality of life (HRQOL) among Chinese rural elders and further investigate the influence of quantity and quality of social support on their HRQOL. Methods: The sample of 4189 Chinese rural elders over 60 years old was acquired from the 2015 China Health and Retirement Longitudinal Study (CHARLS). The HRQOL was evaluated by EQ-5D-3L questionnaire. The social support assessment was mainly based on the social support rating scale (SSRS), and Tobit regression analysis was used to explore the impact of social support on HRQOL. Results: The average EQ-5D index score (0 to 1) of the Chinese rural elders was 0.78 ± 0.16. Participants who were male or with better education were found to have higher scores. Those elders living alone, suffering from chronic diseases or disabled acquired lower scores. As for formal social support, higher medical or pension insurance and more social activities statistically significantly possessed higher scores. As for informal social support, higher number of offspring had a significant association with lower scores, while more contact with children and financial support from family were shown to be statistically significantly associated with higher scores after controlling for sociodemographic characteristics. The quality of social support is more important than its quantity. An interesting finding was that the EQ-5D index scores did not support the Chinese traditional belief that ‘the more children, the more blessings’. Conclusions: The EQ-5D index scores of the rural elders in China is above the median level based on the scores of EQ-5D. Social support is significantly associated with elderly peoples’ quality of life. The results would be significant for accurately improving the life quality of Chinese rural elders from the perspective of social support.

Number of Children, Partnership Status, and Later-life Depression in Eastern and Western Europe

Objectives

To investigate associations between number of children and partnership with depressive symptoms among older Europeans and assess whether associations are greater in Eastern than Western countries. We further analyze whether associations are mediated by provision and receipt of emotional and financial support.

Methods

Using cross-sectional data for five Eastern (Bulgaria, Czech Republic, Georgia, Romania, and Russia) and four Western European countries (Belgium, France, Norway, and Sweden) (n = 15,352), we investigated variation in depressive symptoms using linear regression. We fitted conditional change score models for depressive symptoms using longitudinal data for four countries (Bulgaria, Czech Republic, Georgia, and France) (n = 3,978).

Results

Unpartnered women and men had more depressive symptoms than the partnered. In Eastern, but not Western, European countries childlessness and having one compared with two children were associated with more depressive symptoms. Formal tests indicated that partnership and number of children were more strongly associated with depressive symptoms in Eastern than Western Europe.

Discussion

Availability of close family is more strongly associated with older people’s depressive symptoms in Eastern than Western Europe. The collapse of previous state supports and greater economic stress in Eastern Europe may mean that having a partner and children has a greater psychological impact than in Western countries.

Social network types, health, and well-being of older Asian Americans

Objectives: The purposes of this study were to: (1) develop an empirical typology of the social networks in diverse groups of older Asian Americans using both structural and subjective criterion variables; and (2) examine the relationship of the social network types to the measures of the health and well-being (self-rating of health, mental distress, and life satisfaction). Method: The participants included 533 older Asian Americans (Chinese, Asian Indian, Korean, Vietnamese, and other Asians) who participated in the 2015 Asian American Quality of Life Survey in Central Texas. Latent profile analysis (LPA) was conducted using seven social network-related variables. The identified typologies were then regressed on the indicators of health and well-being (poor rating of health, probable mental distress, and dissatisfaction with life). Results: The LPA identified the model with four network types as being most optimal. The groups were named "diverse-integrated" (37.5%), "moderately diverse-integrated" (21.2%), "marginally restricted-noncongregant" (22.1%), and "restricted-congregant" (19.1%). The results suggested that compared to the "diverse-integrated" group, the "marginally restricted-noncongregant type" fared worse than "the restricted-congregant group" in that the former had greater odds of both mental distress and dissatisfaction with life while the latter had higher odds only for dissatisfaction with life. Conclusion: Unlike previous network studies, network types were shaped in the continuum of different social ties and subjective evaluation on strength of social ties. Certain ethnic groups were over-represented in specific network types. Such findings suggest the importance of understanding ethnic group variations in network vulnerabilities when considering interventions.

Social support networks in Chinese older adults: health outcomes and health related behaviors: a path analysis

Background: Population aging is a social and economic concern for China. It is essential to understand types of social support networks available to elderly people living in China. Objectives: The aim of this research was to identify network types among Chinese older adults and to examine the differential relationship of the network types, health outcomes and health-related behaviors. Methods: Secondary analysis of data compiled by the Chinese Longitudinal Healthy Longevity Survey (n = 9749) was extracted. Network types were derived through latent class analysis with Mplus 6.12 software. Statistical analysis included descriptive statistics, one-way ANOVA, multiple logistic regression and path analysis. Results: Four types of social networks were identified, these included private (16%), non-couple-focused (15%), couple-focused (47%) and diverse (22%). Compared with elders belonging to other networks, elders in diverse network possessed the healthiest status and the highest health-related behaviors score. Health-related behaviors played a role in mediating social network types to health outcomes was identified. Findings were aligned to the conceptual model pathway proposed by Berkman ( 2000 ). Conclusion: The findings demonstrate that types of social networks for elders are significantly correlated to health-related behaviors and health outcomes. Detail and understanding of the correlations are useful to inform healthcare practice and policy and to assist the development of appropriate interpersonal interventions.

Pilot study of transcranial photobiomodulation of lymphatic clearance of beta-amyloid from the mouse brain: breakthrough strategies for non-pharmacologic therapy of Alzheimer's disease

In this pilot study, we analyzed effects of transcranial photobiomodulation (tPBM, 1267 nm, 32 J/cm²) on clearance of beta-amyloid (Aβ) from the mouse brain. The immunohistochemical and confocal data clearly demonstrate the significant reduction of deposition of Aβ plaques in mice after tPBM vs. untreated animals. The behavior tests showed that tPBM improved the cognitive, memory and neurological status of mice with Alzheimer's disease (AD). Using of our original method based on optical coherence tomography (OCT) analysis of clearance of gold nanorods (GNRs) from the brain, we proposed possible mechanism underlying tPBM-stimulating effects on clearance of Aβ via the lymphatic system of the brain and the neck. These results open breakthrough strategies for a non-pharmacological therapy of Alzheimer's disease and clearly demonstrate that tPBM might be a promising therapeutic target for preventing or delaying Alzheimer's disease.

Social support network typologies and their association with dementia and depression among older adults in Singapore: a cross-sectional analysis

OBJECTIVES

To examine the social support network type and its associations with depression and dementia among older adults in Singapore.

DESIGN

This study is a cross-sectional analysis of data from the Well-being of the Singapore Elderly study. The Practitioner Assessment of Network Type was used to identify five social support network types. Odds Ratios (OR) of dementia and depression were estimated with logistic regression and multinomial logistic regression, respectively, adjusted for sociodemographic variables.

SETTING

Singapore.

OUTCOME MEASURES

10/66 criteria and Automated Geriatric Examination for Computer Assisted Taxonomy computer algorithm.

PARTICIPANTS

2421 older adults aged 60 years and above, and their informants.

RESULTS

Logistic regression revealed that as compared with participants in the family dependent social support network type, those in the locally integrated social support network type were negatively associated with dementia. It was observed that it is the older adults' perception of the quality of social interaction that influences the likelihood of depression.

CONCLUSION

The social support network typology presents knowledge about the older adults' social network profile and their cognitive functioning-ability which would help stakeholders better identify older adults who might be at risk of cognitive decline or experiencing delay in diagnosis of dementia.

Physical Activity Attenuates Total and Cardiovascular Mortality Associated With Physical Disability: A National Cohort of Older Adults

Background

Regular physical activity (PA) has been shown to protect against disability onset but, once the disability is present, it is unclear if PA might attenuate its harmful health consequences. Thus, we examined if mortality risk associated with physical disability can be offset by PA among older adults.

Methods

We used data from a cohort of 3,752 individuals representative of the noninstitutionalized population aged 60 years and older in Spain. In 2000-2001, participants self-reported both PA levels (inactive, occasionally, monthly, weekly) and five physical disabilities (agility, mobility, global daily activities, instrumental activities of daily living, and self-care). Individuals were prospectively followed through 2014 to assess incident deaths.

Results

The mean follow-up was 10.8 years, with a total of 1,727 deaths, 638 of them due to cardiovascular disease (CVD). All disability types were associated with higher total and CVD mortality. Being physically active (ie, doing any PA) was associated with a statistically significant 26%-37% and 35%-50% lower risk of total and CVD death, respectively, across types of disability. As compared with those being physically active and without disability, those who were inactive and had a disability showed the highest mortality risk from total (hazard ratios from 1.52 to 1.90 across disabilities, all p < .05) and from CVD (hazard ratios from 1.99 to 2.24 across disabilities, all p < .05). Total and CVD mortality risk was similar in physically active participants with disabilities and in inactive individuals without disability.

Conclusions

In older adults, PA could attenuate the increased risk of mortality associated with physical disability.

A review of the 10/66 dementia research group

BACKGROUND

In this review we discuss how the study of dementia epidemiology in Low- and Middle-Income Countries (LMICs) has changed in the last 20 years, and specifically to review the evidence created by the 10/66 Dementia Research Group (DRG) and discuss future directions for research.

METHODS

We identified and collated all the papers related to the 10/66 Dementia Research Group, including papers from groups who adopted the 10/66 methodology, that have been published in peer-reviewed journals.

RESULTS

Over 200 papers including data from Africa, Asia, Europe and Latin America and the Caribbean were identified by this review. Many of the findings revolved around the epidemiology of dementia, mental health and non-communicable diseases, including the cross-cultural development and validation of measurement tools of cognition and functioning, need for care, care arrangements and mental health. Social ageing, care dependence and caregiver interventions were also topics that the group had published on.

DISCUSSION

A body of evidence has been generated that has challenged the view, prevalent when the group started, that dementia is comparatively rare in LMICs. The experience of the 10/66 DRG has shown that descriptive epidemiological research can be important and impactful, where few data exist. Monitoring population trends in the prevalence and incidence of dementia may be our best chance to confirm hypotheses regarding modifiable risk factors of dementia.

Weighted Symbolic Dependence Metric (wSDM) for fMRI resting-state connectivity: A multicentric validation for frontotemporal dementia

The search for biomarkers of neurodegenerative diseases via fMRI functional connectivity (FC) research has yielded inconsistent results. Yet, most FC studies are blind to non-linear brain dynamics. To circumvent this limitation, we developed a “weighted Symbolic Dependence Metric” (wSDM) measure. Using symbolic transforms, we factor in local and global temporal features of the BOLD signal to weigh a robust copula-based dependence measure by symbolic similarity, capturing both linear and non-linear associations. We compared this measure with a linear connectivity metric (Pearson’s R) in its capacity to identify patients with behavioral variant frontotemporal dementia (bvFTD) and controls based on resting-state data. We recruited participants from two international centers with different MRI recordings to assess the consistency of our measure across heterogeneous conditions. First, a seed-analysis comparison of the salience network (a specific target of bvFTD) and the default-mode network (as a complementary control) between patients and controls showed that wSDM yields better identification of resting-state networks. Moreover, machine learning analysis revealed that wSDM yielded higher classification accuracy. These results were consistent across centers, highlighting their robustness despite heterogeneous conditions. Our findings underscore the potential of wSDM to assess fMRI-derived FC data, and to identify sensitive biomarkers in bvFTD.

Social Network Types in Old Age and Incident Dementia

Lack of social support has shown to be a major risk factor for poor health, mortality, and dementia. We analyzed what factors drive the likelihood of having restricted social networks and to what extent those factors then influence the risk of developing dementia. Our results from the Leipzig Longitudinal Study of the Aged (LEILA75+) indicate that older age (odds ratio [OR]: 1.04) and living with other people (OR: 2.12) was associated with a greater likelihood of having a restricted social network. A better cognitive status (OR: 0.84) was associated with a smaller likelihood of having a restricted social network. The risk of developing dementia over the follow-up period was significantly higher among individuals with restricted (hazard ratio: 2.11) than with integrated social networks. Our findings suggest that integrating elderly individuals in the wider community is a crucial indicator for dementia risk.

The support needs of family caregivers of persons with dementia in India: Implications for health services

The World Alzheimer’s Report estimates that 4.1 million people in India have dementia. Caregivers of persons with dementia face physical, psychological, social and financial problems related to caring for a person with dementia. Literature on the caregiving experience however is highly specific to the sociocultural context and cannot be generalized. In low and middle income countries much of the caregiving takes place in people’s homes and is provided by family caregivers.

Aim

This study aims to explore the needs and challenges of family caregivers in Chennai, India.

Method

Focus group discussions and in-depth interviews were conducted using a topic guide. Participants were divided based on socio-economic status to ensure homogeneity. An inductive thematic approach was used to analyse and code the data. A total of 19 participants took part in the study.

Results

The results capture the experience of caregivers of persons with dementia in seeking help and accessing treatment. Priority caregiver needs were identified, including the need for sensitised, skilled health workers, information on dementia and advanced care needs and cost effective services.

Conclusion

The findings of this study strongly support the need to strengthen health systems capacity, make the health care services dementia friendly and cost effective. The influence of culture in shaping help seeking was evident in our findings. Interventions for caregivers and persons with dementia need to be developed and tested so they might be made fit for purpose and scaled up. It will be important to identify how these services can be adapted for use in low and middle income country resource setting like India.

Social networks, health promoting-behavior, and health-related quality of life in older Korean adults

In this cross-sectional, descriptive study, we compared the sociodemographic characteristics, social networks, health-promoting behavior, and the health-related quality of life of older Korean adults living in South Korea to those of older Korean adult immigrants living in the USA. A total of 354 older adults, aged 65 years or older, participated. Data were collected through self-directed questionnaires, and analyzed using a two way analysis of variance, t-tests, χ² -tests, and Pearson's correlation coefficient. The association between four sociodemographic characteristics and health-related quality of life was significantly different between the two groups. For the older Korean adults living in South Korea, positive correlations existed between a measure of their social networks and both health-promoting behavior and health-related quality of life. For the older Korean immigrants, the findings revealed a positive correlation only between social networks and health-promoting behavior. The study findings support the important association social networks can have with health-related quality of life, and their possible relationship to health-promoting behaviors of older Korean adults. We suggest that health policy-makers and healthcare providers develop comprehensive programs that are designed to improve older adults' social networks.

Self-rated health and its association with mortality in older adults in China, India and Latin America-a 10/66 Dementia Research Group study

Background

empirical evidence from high-income countries suggests that self-rated health (SRH) is useful as a brief and simple outcome measure in public health research. However, in many low- and middle-income countries (LMIC) there is a lack of evaluation and the cross-cultural validity of SRH remains largely untested. This study aims to explore the prevalence of SRH and its association with mortality in older adults in LMIC in order to cross-culturally validate the construct of SRH.

Methods

population-based cohort studies including 16,940 persons aged ≥65 years in China, India, Cuba, Dominican Republic, Peru, Venezuela, Mexico and Puerto Rico in 2003. SRH was assessed by asking 'how do you rate your overall health in the past 30 days' with responses ranging from excellent to poor. Covariates included socio-demographic characteristics, use of health services and health factors. Mortality was ascertained through a screening of all respondents until 2007.

Results

the prevalence of good SRH was higher in urban compared to rural sites, except in China. Men reported higher SRH than women, and depression had the largest negative impact on SRH in all sites. Without adjustment, those with poor SRH showed a 142% increase risk of dying within 4 years compared to those with moderate SRH. After adjusting for all covariates, those with poor SRH still showed a 43% increased risk.

Conclusion

our findings support the use of SRH as a simple measure in survey settings to identify vulnerable groups and evaluate health interventions in resource-scares settings.

Mediterranean lifestyle and cardiovascular disease prevention

BACKGROUND

Adherence to a Mediterranean dietary pattern is a well-established protective factor against cardiovascular disease (CVD). However, diet quality is only one aspect of the overall healthy lifestyle adopted by Mediterranean populations. The latter has never been evaluated as a multi-factorial composite lifestyle. Thus, the aim of the present study was to provide a broader picture of the Mediterranean lifestyle and its effects on CVD risk, among elderly individuals.

METHODS

During 2005-2015, 2,749 older (aged 65-100 years) from 21 Mediterranean islands (MEDIS) and the rural Mani region (Peloponnesus) of Greece were voluntarily enrolled onto the study. Dietary habits, physical activity status, socio-demographic characteristics, lifestyle parameters (sleep, smoking habits, social life and educational status) and clinical profile aspects were derived through standard procedures.

RESULTS

The overall prevalence of the traditional CVD risk factors were 62.3% for hypertension, 22.3% for diabetes mellitus (type 2) and 47.7% for hypercholesterolemia. The presence of diabetes mellitus was positively predicted by the geriatric depression scale (GDS) [odds ratio (OR) =1.13, 95% confidence interval (CI): 1.02-1.25] and by an urban residential environment (OR =2.57, 95% CI: 1.10-6.06) after adjusting for several confounders. Presence of hypertension was predicted by increasing age (OR =1.07, 95% CI: 1.02-1.12), increasing body mass index (BMI) (OR =1.12, 95% CI: 1.04-1.21), the habit of midday sleep (OR =2.07, 95% CI: 1.07-4.02) and inversely predicted by the frequency of socializing with friends (OR =0.767, 95% CI: 0.616-0.955). The estimated score in the GDS was the only independent positive predictor for the presence of hypercholesterolemia (OR =1.10, 95% CI: 1.01-1.21).

CONCLUSIONS

Lifestyle parameters such as social life, midday sleep (siesta) and residential environment are strongly associated with the presence of CVD risk factors in elderly and should be part of broader CVD prevention strategies to reduce the burden of the disease.

Understanding the value of social networks in life satisfaction of elderly people: a comparative study of 16 European countries using SHARE data

Background

Networks of family and friends are a source of support and are generally associated with higher life satisfaction values among older adults. On the other hand, older adults who are satisfied with their life may be more able to develop and maintain a wider social network. For this reason, the causal link between size and composition of the social networks and satisfaction with life is yet to be explored. This paper investigates the effect of the ‘size’, (number of family and friends, and network) and the ‘composition’ (the proportion of friends over total number of persons) of the social network on life satisfaction among older adults (50+). Moreover, we also investigate the patterns of this relation between different European countries.

Method

Data from the 4^th wave of Survey of Health, Ageing and Retirement in Europe and an instrumental variable approach are used to estimate the extent of the relation between life satisfaction and size and composition of social networks.

Results

Respondents in Western and Northern European (WNE) countries report larger networks than respondents in Eastern and Southern European (ESE) countries. However, the positive relationship between network size and life satisfaction is consistent across countries. On the other hand, the share of friends in the network appears to be generally negatively related to satisfaction with life, though results are not statistically significant for all countries.

Conclusions

Apparently, a larger personal network is important for older adults (50+) to be more satisfied with life. Our results suggest that this relation is particularly positive if the network is comprised of family members.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0362-7) contains supplementary material, which is available to authorized users.

World Health Organization disability assessment schedule 2.0: An international systematic review

PURPOSE

This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument.

METHOD

Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases.

RESULTS

We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry).

CONCLUSIONS

The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.

Assessment of Continuity of Care among Patients with Multiple Chronic Conditions in Italy

The aims of the present study were to evaluate the extent of continuity of care and to investigate its association with several factors among a sample of outpatients with chronic diseases in Italy. The survey was conducted, using face to face interview, from March to December 2014 in a random sample of 633 outpatients with chronic conditions who were going in cardiology, metabolic disorders, and respiratory ambulatory center of four hospitals. A multivariate ordered logistic regression model was used to identify factors associated with the outpatients continuity of care. The mean of the Bice-Boxerman continuity of care (COC) index related to the entire sample was 0.44, and 27.9%, 58.4%, 13.7% had a low, intermediate, and high value of the index based on the tertiles of the distribution. The results of the ordered logistic regression analysis showed that female patients, those older, those who had a lower score of Katz Index of independence in activities of daily living, those who had a lower Charlson et al. comorbidity score, and those who had no hospitalization in the last year, were significantly more likely to have a higher value of the COC index. Patients who had completed a secondary school education had significantly lower odds of having a high value of COC index in comparison to patients with a college degree educational level. Policy makers and clinicians involved in the care of patients should implement comprehensively and efficiently efforts in order to improve the continuity of care in patients with chronic diseases.

An interpretative phenomenological analysis (IPA) of coercion towards community dwelling older adults with dementia: findings from Mysore studies of natal effects on ageing and health (MYNAH)

PURPOSE

Limited availability of specialist services places a considerable burden on caregivers of Persons with Dementia (PwD) in Low- and Middle-Income Countries (LMICs). There are limited qualitative data on coercive behavior towards PwD in an LMIC setting.

AIM

The aim of this study was to find relevant themes of the lived experience of relatives as caregivers for PwD in view of their use of coercive measures in community setting in South India.

METHOD

Primary caregivers (n = 13) of PwDs from the Mysore study of Natal effects on Ageing and Health (MYNAH) in South India were interviewed to explore the nature and impact of coercion towards community dwelling older adults with dementia. The narrative data were coded using an Interpretative Phenomenological Analysis (IPA) approach for thematic analysis and theory formation.

RESULTS

Caregivers reported feeling physical and emotional burn-out, a lack of respite care, an absence of shared caregiving arrangements, limited knowledge of dementia, and a complete lack of community support services. They reported restrictions on their lives through not being able take employment, a poor social life, reduced income and job opportunities, and restricted movement that impacted on their physical and emotional well-being. Inappropriate use of sedatives, seclusion and environmental restraint, and restricted dietary intake, access to finances and participation in social events, was commonly reported methods of coercion used by caregivers towards PwD. Reasons given by caregivers for employing these coercive measures included safeguarding of the PwD and for the management of behavioral problems and physical health.

CONCLUSION

There is an urgent need for training health and social care professionals to better understand the use of coercive measures and their impact on persons with dementia in India. It is feasible to conduct qualitative research using IPA in South India.