Effects of selected leisure activities on preventing loneliness among older Chinese

Internet Use and Loneliness Among Urban and Non-Urban Chinese Older Adults: The Roles of Family Support, Friend Support, and Social Participation

OBJECTIVES

This study investigated the association between internet use and loneliness among older Chinese adults, and the mediating effects of family support, friend support, and social participation. These associations were evaluated in the context of urban and non-urban geographic settings.

METHODS

This study used data from the 2018 wave of the China Longitudinal Ageing Social Survey (N = 10,126), examining samples of urban (n = 3,917) and non-urban (n = 6,209) older adults separately. Linear regression and path analysis within a structural equation modeling framework were employed.

RESULTS

Internet use was negatively associated with loneliness for both urban and non-urban residing older adults. Family support and social participation mediated the association between internet use and loneliness for both urban and non-urban residing older Chinese adults, but friend support mediated this association only for urban older residents.

DISCUSSION

This study shed light on our understanding of the relationship between internet use and loneliness among older adults in the Chinese context. Also, these findings suggested that digital interventions for loneliness should pay special attention to the different characteristics of urban and non-urban dwelling older Chinese adults.

Symptom patterns of comorbid depression and anxiety among older adults in China and their predictors

Comorbid depression and anxiety causes serious psychological and physiological damage for older people. This study aimed to identify heterogeneous classes of comorbid depression and anxiety (CDA) among older people in China and to ascertain predictors of latent class membership. Cross-sectional data of 10,919 cases were extracted from the Chinese Longitudinal Healthy Longevity Survey. Latent profile analysis (LPA) was used to identify symptom patterns of comorbid depression (measured by the 10-item Center for Epidemiologic Studies Depression Scale) and anxiety (measured by the Generalized Anxiety Disorder 7-item Scale). Multinomial logistic regressions following bivariate analyses were used to explore the relationship between the derived classes and individual- and social-level factors. Four patterns of CDA were identified: low symptoms of depression and anxiety (30.52%; n = 3333), mild depression only (53.26%; n = 5815), moderate depression and anxiety (13.82%; n = 1509), and severe depression and anxiety (2.40%; n = 262). Older people who are male, suffer from multimorbidity, and lack a healthy lifestyle are more likely to have problematic symptom profiles. While intimate relationships with partners and children significantly predicted CDA patterns, the effects of sibling relationships, daily life, and emotional support from the community were insignificant. LPA identified four distinct CDA patterns among a representative sample of older Chinese people. While restless sleep, lack of positive emotions, uselessness, and weak concentration are salient across all profiles, "difficult to relax" is prominent in profiles high in anxiety. In addition to individual-level variables, social-level factors, especially intimate relationships with partners and children rather than general links to siblings or the community, have unneglectable impacts on whether and to what extent older Chinese adults suffer from CDA in the cultural context of relationism, patriarchy, and filial piety.

Internet use and loneliness among older Chinese adults

OBJECTIVES

This study examined the association between Internet use and loneliness among Chinese older adults (aged 60+) over a two-year period using nationally representative survey data from China.

METHODS

Using data from the 2016 and 2018 waves of the China Longitudinal Ageing Social Survey (N = 8,059), we estimated difference-in-differences regression models to assess the association between Internet use and levels of loneliness over time.

RESULTS

Compared to Internet non-users, Chinese older adults who were new Internet users, as well as those who were continuous Internet users, reported lower levels of loneliness over time (B = -0.21, p < 0.001 and B = -0.16, p < 0.001, respectively). Conversely, those Chinese older adults who used the Internet in wave 1 but then disengaged from using the Internet in wave 2 demonstrated an upward trend in loneliness over time, similar to Internet non-users (the estimate of difference-in-differences was non-significant for the comparison between disengaged-users and non-users: B = -0.03, p = 0.42).

CONCLUSION

This study provided new evidence to support the potential benefits of Internet use for reducing the risk of loneliness among Chinese older adults. The findings suggested that supporting current Internet users to remain digitally engaged is as important as encouraging Internet non-users to cross the digital divide.

Playing Kioku Reduces Loneliness in Older Adults: A Pilot Study

Introduction: Playing together increases social connectedness, and it may be a tool to reduce loneliness. Research into the mental health benefits of board games is underdeveloped. Objectives: The study aims to examine the effects of the Kioku board game on well-being outcomes. The Kioku board game was developed in order to enable small group interactions with a focus on encouraging participants to create stories through mutual attention and interaction. We hypothesized that following a weekly intervention for 12 weeks, players would report a decrease in loneliness and an increase in well-being, compared with nonplayers. Methods: During the summer of 2022, participants in groups of 4-5 players, chose a cube word and narrated a story. A sample of 151 older adults (Mean age = 75.05 ± 6.46 years) recruited from seven community activity centers in Israel was assigned by block randomization to an intervention (n = 72) or a control group (n = 79), awaiting 4-6 weeks for future participation. Loneliness (UCLA loneliness scale) and well-being (World Health Organization 5-item scale) were evaluated at baseline and at 12 weeks. Results: A two-way repeated measures analysis of covariance (ANCOVA) (Group × Time) controlling for age, country of origin, and marital status revealed significant interaction effects for loneliness [F(1, 146) = 178.04, n2 = 0.549, P < 0.001] and well-being [F(1, 146) = 69.14, n2 = 0.321, P < 0.001]. Loneliness decreased in the intervention group (mean difference: 0.62 points, P < 0.001), and increased in the control group (mean difference: 0.18 points, P = 0.001). Well-being increased in the intervention group (mean difference: 0.79 points, P < 0.001) and decreased in the control group (mean difference: 0.20 points, P < 0.001). Conclusions: Our findings support the effectiveness of the Kioku board game intervention for decreasing loneliness and promoting well-being in older adults, who might still be coping with the effects of the COVID-19 pandemic.

Exploring the Relationship of Leisure Travel with Loneliness, Depression, and Cognitive Function in Older Adults

Loneliness, depression, and cognitive decline are pressing concerns among older adults. This study examines the association between leisure travel participation and these health outcomes in older adults, aiming to provide further evidence of the benefits of leisure travel. Using nationally representative historical data from the 2006 household survey of the Health and Retirement Study, this study conducted a series of regression analyses to investigate the relationship between traveling and the three health outcomes, adjusting for age, sex, race, marital status, education, total wealth, annual income, and difficulty with daily activities. The results reveal that travel patterns in terms of distance are significantly associated with loneliness, depression, and cognitive function. Long-distance travel is positively related to higher cognitive function and a reduction in depressive symptoms, along with lower levels of loneliness, reinforcing the notion that leisure travel can potentially act as a catalyst for improved cognitive and mental health by offering opportunities for enhancing social connections and forming new relationships. The findings on the relationships between participation in leisure travel and mental and cognitive health contribute to the body of evidence supporting the therapeutic value of leisure travel in promoting healthy aging and enhancing the overall well-being in older adults.

Moderating role of depression in the association between leisure activity and cognitive function among the disabled older people

Background

This study delves into the complex interaction between leisure activities and cognitive function in older people with disabilities, with a particular emphasis on the moderating influence of depression. Despite the well-documented cognitive benefits of leisure activities among the older people, the intricate relationship between depression and the association between leisure activities and cognitive function in this specific demographic has been rarely reported.

Methods

Drawing on data from the 2017-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), this study meticulously examined a cohort of 713 participants aged 65-89 years. We constructed a moderation model to examine the impact of leisure activity on cognitive function in older people with disabilities, with depression levels as a moderating variable.

Results

We found a positive association between engagement in leisure activities and cognitive function, highlighting the potential cognitive advantages associated with leisure engagement among disabled older people. However, the present analysis also reveals a significant moderation effect of depression on this relationship, shedding light on the nuanced nature of this association. Specifically, elevated levels of depression emerge as a critical moderator, attenuating the otherwise favorable impact of leisure activities on cognitive function among older people contending with disabilities.

Conclusion

In conclusion, the findings provide a compelling rationale for tailored interventions that comprehensively target both leisure activity engagement and concurrent depression management, effectively fostering improvements in cognitive function among the cohort of disabled older people.

Self-reported mid- to late-life physical and recreational activities: Associations with late-life cognition

OBJECTIVE

Physical and recreational activities are behaviors that may modify risk of late-life cognitive decline. We sought to examine the role of retrospectively self-reported midlife (age 40) physical and recreational activity engagement - and self-reported change in these activities from age 40 to initial study visit - in predicting late-life cognition.

METHOD

Data were obtained from 898 participants in a longitudinal study of cognitive aging in demographically and cognitively diverse older adults (Age: range = 49-93 years, M = 75, SD = 7.19). Self-reported physical and recreational activity participation at age 40 and at the initial study visit were quantified using the Life Experiences Assessment Form. Change in activities was modeled using latent change scores. Cognitive outcomes were obtained annually (range = 2-17 years) using the Spanish and English Neuropsychological Assessment Scales, which measure verbal episodic memory, semantic memory, visuospatial processing, and executive functioning.

RESULTS

Physical activity engagement at age 40 was strongly associated with cognitive performance in all four domains at the initial visit and with global cognitive slope. However, change in physical activities after age 40 was not associated with cognitive outcomes. In contrast, recreational activity engagement - both at age 40 and change after 40 - was predictive of cognitive intercepts and slope.

CONCLUSIONS

Retrospectively self-reported midlife physical and recreational activity engagement were strongly associated with late-life cognition - both level of performance and rate of future decline. However, the data suggest that maintenance of recreational activity engagement (e.g., writing, taking classes, reading) after age 40 is more strongly associated with late-life cognition than continued maintenance of physical activity levels.

Leisure, Recreation, and Life Satisfaction: A Longitudinal Study for People With Spinal Cord Injury

Background

Leisure and recreation (LR) are positively associated with social integration and life satisfaction in people with spinal cord injury (SCI). However, few studies have longitudinally observed long-term changes in LR participation among people with SCI and discussed the association of these activities with social integration and life satisfaction.

Objectives

This study aims to determine for people with SCI, within a 45-year period, the association between mobility and LR participation; the associations between LR participation and social integration and life satisfaction, respectively; and whether the association between LR participation and life satisfaction is mediated by social integration.

Methods

Growth modeling and linear mixed modeling were employed as the primary data analysis tools to explore longitudinal changes in LR participation, social integration, and life satisfaction. A mediation test was conducted to examine the potential mediation effect of social integration on the relationship between LR participation and life satisfaction.

Results

The mobility level, LR participation hours, and social integration of people with SCI decreased gradually during the 45-year period, whereas life satisfaction increased as they lived longer with the injury. LR participation was consistently and positively associated with social integration and life satisfaction of people with SCI. A mediation effect by social integration was observed between LR and life satisfaction.

Conclusion

A decline in mobility level was associated with a decrease in LR participation over time for people with SCI. Engaging in LR activities regularly and maintaining a certain level of social interaction are consistently and positively associated with long-term life satisfaction.

Free Time in Old Age: Does Health Status Determine the Choice of Leisure Activities in Indonesia?

This paper examines which leisure activities appear more attractive to older people, considering health status, disability and demographic-socio-economic and environmental variables. It employed data from Survei Penduduk Antar Sensus (SUPAS), the nationwide survey, conducted in 2015 by Indonesia's national statistical office. The sample selected 228,718 individuals aged 60 years old and above. Leisure activities were differentiated between active, sedentary, and no leisure activities. Health is measured with both health status and disability. Disability measures were adopted from Washington Group Short Set on Functioning-Enhanced (WG-SS Enhanced). Our multinomial regression models confirmed that health status was correlated with the choice of leisure activities in old age. Compared to older persons in good health, those reported in poor health without disruption to daily life were more likely to participate in sedentary or active leisure, but those with disruption to daily life were less likely to do so. Older persons with disability were disadvantaged in participating in either passive or active leisure. However, among all selected variables, employment and source of finance had the highest odds ratios and confounded the relationship between health and leisure activity.

Household Polluting Fuel Use and Frailty among Older Adults in Rural China: The Moderating Role of Healthy Lifestyle Behaviors

This study worked to investigate the effect of household polluting fuel use (HPFU), as an indicator of household air pollution exposure, on frailty among older adults in rural China. Additionally, this study aimed to examine the moderating effect of healthy lifestyle behaviors on the aforementioned association. This study employed cross-sectional data from the 2018 Chinese Longitudinal Healthy Longevity Survey, which conducted nationally representative sampling of older adults from 23 provinces in mainland China. The frailty index was calculated using 38 baseline variables that assessed health deficits through questionnaire surveys and health examinations. A total of 4535 older adults aged 65 years and above were included in our study, among whom, 1780 reported using polluting fuels as their primary household cooking fuel. The results of regression analyses and multiple robustness checks indicated a significant increase in the frailty index due to HPFU. This environmental health threat was more profound among women, illiterate individuals, and low-economic-status groups. Moreover, healthy dietary and social activities had significant moderating effects on the association between HPFU and frailty. HPFU can be regarded as a risk factor for frailty among older adults in rural China, with its effects exhibiting socio-economic disparities. The adoption of healthy lifestyle behaviors can alleviate the frailty associated with HPFU. Our findings underscore the significance of using clean fuels and improving household air quality for healthy aging in rural China.

Associations between Sedentary Duration and Cognitive Function in Older Adults: A Longitudinal Study with 2-Year Follow-Up

OBJECTIVES

This study aimed to investigate the association between different forms of sedentary behavior and cognitive function in Chinese community-dwelling older adults.

DESIGN

A longitudinal study with a 2-year follow-up.

SETTING AND PARTICIPANTS

Data from 5356 participants at baseline and 956 participants at the follow-up of the Anhui Healthy Longevity Survey (AHLS) were analysed.

MEASUREMENTS

Cognitive function was evaluated by the Mini-Mental State Examination (MMSE), and mild cognitive impairment (MCI) was classified according to education-specific criteria. Self-report questionnaires were used to assess the sedentary behavior of the participants.

RESULTS

The participants who reported longer screen-watching sedentary duration had higher MMSE scores (1-2 hours: β=0.758, 95% CI: 0.450, 1.066; > 2 hours: β=1.240, 95% CI: 0.917, 1.562) and lower likelihoods of MCI (1-2 hours: OR= 0.787, 95% CI: 0.677, 0.914; >2 hours: OR=0.617, 95% CI: 0.524, 0.726). The participants who had played cards (or mahjong) sedentary had higher MMSE scores (β= 1.132, 95% CI: 0.788, 1.476) and lower likelihoods of MCI (OR=0.572, 95% CI: 0.476, 0.687). However, the participants who reported longer other forms of sedentary duration had lower MMSE scores (1-2 hours: β=-0.409, 95% CI: -0.735, -0.082; > 2 hours: β=-1.391, 95% CI: -1.696, -1.087) and higher likelihoods of MCI (1-2 hours: OR=1.271, 95% CI: 1.081, 1.496; > 2 hours: OR=1.632, 95% CI: 1.409, 1.889). No significant association was detected between sedentary duration and MCI incidence.

CONCLUSION

Variations in the impact of diverse sedentary behaviors on the cognitive function were detected in Chinese older adults. However, such associations were cross-sectional and longitudinal associations were not found in the current study.

Comparing the Effects of Virtual Reality and Home Chair-Based Exercises on Balance, Daily Living Activities, and Loneliness Among Older Adults With Balance Disorders

The current quasi-experimental study aimed to compare the effects of virtual reality (VR) and home chair-based (HCB) exercises on balance, daily living activities, and loneliness among older adults (N = 90) with balance disorders living in nursing homes. Participants were assigned to three groups: (a) VR exercises, (b) HCB exercises, and (c) routine nursing home programs. Findings indicated that VR and HCB exercises significantly increased participants' balance and daily living activities compared to routine programs (p < 0.001). However, there was no clinical difference among groups regarding Berg Balance Scale and Barthel Index scores. Main effect of time regarding loneliness mean score (p = 0.991) was not significant among groups. The minimal detectable change pre-set standard for loneliness also showed no significant clinical difference. Exercise had no significant impact on loneliness; however, it had a positive role in improving balance and daily living activities, with no significant difference between VR and HCB exercises. Further studies are recommended to evaluate adherence to such exercises. [Research in Gerontological Nursing, 16(1), 33-42.].

Relationship between specific leisure activities and successful aging among older adults

Background/Objectives

This study was designed to investigate the association between specific leisure activities and successful aging among older adults, using data from the Chinese Longitudinal Healthy Longevity Survey.

Methods

A total of 7689 older adults were involved in this study and categorized as successful aging group (n = 3989; 51.8%) or non-successful aging group (n = 3703; 48.2%). Participants were identified as successful aging if they had a score of more than 3 points, or as non-successful aging. The points were based on the following five items and each item was assigned 1 point: self-rated health, self-rated psychological status or mood, cognitive function, activities of daily life, and physical activity. Six activities including gardening work, reading newspapers or books, raising domestic animals or pets, playing cards or mahjong, watching TV or listening to radio, and participating in social activities were collected to reflect leisure activities. Chi-square tests, independent sample t-test, and logistic regression analyses were employed to explore the association between specific leisure activities and successful aging.

Results

The prevalence of successful aging was 51.8% among Chinese older adults. A significant positive relationship was found between the frequency of participation in specific leisure activities and successful aging (p < 0.05). Older adults who usually participated in leisure activities had greater odds for successful aging compared to those who never participated in leisure activities (adjusted odds ratio (OR): 1.31 (95% CI: 1.15-1.49) to 1.88 (95% CI: 1.62-2.19)). Older adults participating in one or more leisure activities had greater odds for successful aging compared to those who did not participate in leisure activities (adjusted OR: 1.51 (95% CI: 1.30-1.76) to 4.10 (95% CI: 2.44-6.89)).

Conclusions

The findings provide evidence that participating more frequently and in more leisure activities was associated with a greater probability of successful aging among Chinese older adults. Encouraging older people to participate frequently in a larger number of leisure activities may be a key to promote successful aging. Therefore, the frequency and number of participation in leisure activities should be highlighted and targeted for promoting successful aging.

The mediating role of psychological resilience between social participation and life satisfaction among older adults in China

BACKGROUND

A significant correlation has been discovered between social participation and older adults' life satisfaction, but the relationships among social participation, psychological resilience, and life satisfaction remain to be confirmed. Therefore, this study aims to identify the relationship between social participation and life satisfaction for Chinese older adults and to analyse the possible mediating role of psychological resilience between these two aspects.

METHODS

Data on 15,779 people aged 65 years and above were extracted from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Social participation was classified into two levels: low-level involvement activities and high-level involvement activities. Hierarchical regression analysis was applied to analyse the correlations between the two levels of social participation and older adults' life satisfaction as well as the mediating effects of psychological resilience on this association.

RESULTS

The results indicate that two levels of social participation were each positively correlated with life satisfaction. Specifically, high-level involvement activities (β = 0.070, P < 0.001) were more strongly associated with life satisfaction than low-level involvement activities (β = 0.051, P < 0.001). Moreover, psychological resilience was found to partially mediate the association between low-level involvement activities and high-level involvement activities and life satisfaction.

CONCLUSION

A higher level of life satisfaction for older adults is related to participation in high-level involvement activities. Psychological resilience has a mediating effect on the association between two levels of older adults' social participation and life satisfaction. These findings suggest that the government and society should establish a more concrete understanding of the psychological resilience of older adults.

The changes in feeling of loneliness after retirement among baby boomers and pre-boomers in Taiwan: Do work-family conflict before retirement and social engagement after retirement matter?

Significance

Few studies have analyzed how loneliness-related factors differ across generations for older adults in non-Western societies. Building upon the stress process model, this study aimed to explore the relationships between work-family conflict before retirement, social engagement after retirement and changes in loneliness after retirement among retirees across two birth cohorts (Baby Boomers and pre-Boomers) in Taiwan.

Methods

Data from the Taiwan Health and Retirement Study, a nationwide retired cohort sample collected from two waves between 2015/2016 and 2018/2019, was analyzed. A total of 2370 retirees aged 50–74 years were included in the analysis after excluding those who died or were lost to follow-up. Multivariate multinomial logistic models were used to estimate four types of changes in loneliness: (1) remaining not lonely, (2) becoming not lonely, (3) becoming lonely, and (4) remaining lonely.

Results

About two-thirds of the retirees remained not lonely, and less than 10% maintained their feelings of loneliness across two waves. Multinomial logit models showed that both cohorts who experienced work-family conflict before retirement and stressful life events after retirement had higher odds of remaining lonely than those who remained not lonely. However, an increase in social engagement, especially social contact, appeared to be a protective factor against becoming and remaining lonely for both cohorts. Yet, work-related characteristics before retirement were significantly related to the changes in loneliness among pre-Boomers rather than Baby Boomers.

Conclusions

The results suggest that work-family conflict before retirement produces an exacerbating effect; in contrast, social engagement after retirement is beneficial to not feeling lonely across two birth cohorts in Taiwan. This investigation highlights the importance of social stressors occurring before retirement because these have an effect on retirees’ feelings of loneliness beyond individual socioeconomic status.

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No relevant research has explored factors associated with the loneliness of retirees across generations in non-Western societies.

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Retirees who experienced work-family conflict before retirement were more likely to be in the group of remaining lonely after retirement.

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Social contact is a protective factor from being in the groups of becoming and remining lonely for borth cohorts.

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Work-related characteristics before retirement were significantly related to changes in loneliness among pre-Boomers only.

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The findings are timely because older people are dramatically increasing and becoming burdened with psychological problems.

Examining Differences, Relationships, and Predictors for Loneliness in an Adult Population: The Roles of Personal Characteristics, Place of Residence, Leisure Activities, Mental Health, and Social Outcomes

Loneliness is associated with poor mental and social outcomes globally. The literature suggests an association between loneliness and personal characteristics, place of residence, and leisure activities. However, the current literature has produced inconsistent findings and has focused largely on older adults. This study is one of the first to examine the differences, relationships, and predictors of loneliness in an adult population, and the roles of personal characteristics, place of residence, leisure activities, mental health, and social outcomes. A cross-sectional online survey was undertaken. A sample of 155 adults responded, with a mean age of 34.5 years (SD = 13.2), and with 54.1% identifying as female. An analysis revealed experiences of loneliness across the sample. In addition, age was moderately associated with loneliness, while psychological distress, depressive symptoms, and social networks were significantly associated with loneliness. Depressive symptoms were a positive predictor for loneliness, and social networks were a negative predictor for loneliness. This study has confirmed findings from previous research and provided new information on loneliness, which can guide future research and interventions to prevent or support people who suffer from loneliness.

Using machine learning algorithms for predicting cognitive impairment and identifying modifiable factors among Chinese elderly people

Objectives: This study firstly aimed to explore predicting cognitive impairment at an early stage using a large population-based longitudinal survey of elderly Chinese people. The second aim was to identify reversible factors which may help slow the rate of decline in cognitive function over 3 years in the community. Methods: We included 12,280 elderly people from four waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), followed from 2002 to 2014. The Chinese version of the Mini-Mental State Examination (MMSE) was used to examine cognitive function. Six machine learning algorithms (including a neural network model) and an ensemble method were trained on data split 2/3 for training and 1/3 testing. Parameters were explored in training data using 3-fold cross-validation and models were evaluated in test data. The model performance was measured by area-under-curve (AUC), sensitivity, and specificity. In addition, due to its better interpretability, logistic regression (LR) was used to assess the association of life behavior and its change with cognitive impairment after 3 years. Results: Support vector machine and multi-layer perceptron were found to be the best performing algorithms with AUC of 0.8267 and 0.8256, respectively. Fusing the results of all six single models further improves the AUC to 0.8269. Playing more Mahjong or cards (OR = 0.49,95% CI: 0.38-0.64), doing more garden works (OR = 0.54,95% CI: 0.43-0.68), watching TV or listening to the radio more (OR = 0.67,95% CI: 0.59-0.77) were associated with decreased risk of cognitive impairment after 3 years. Conclusions: Machine learning algorithms especially the SVM, and the ensemble model can be leveraged to identify the elderly at risk of cognitive impairment. Doing more leisure activities, doing more gardening work, and engaging in more activities combined were associated with decreased risk of cognitive impairment.

A Quasi-Experimental Study on the Effect of an Outdoor Physical Activity Program on the Well-Being of Older Chinese People in Hong Kong

Active participation in physical activity by older people is effective in improving their health. This research aims to examine the positive effects of participation in vigorous outdoor physical activities by older Chinese people in Hong Kong, and whether such effects would vary with socioeconomic background. A quasi-experimental, nonequivalent group design was used. A total of 22 participants were randomly assigned to participate in an outdoor physical activity program. Another 14 participants took part as a control group. The 14-item Self-Image of Aging Scale for Chinese Elders and the four-item self-report Subjective Happiness Scale were used to measure participants’ self-image and overall happiness level. All participants completed the assessment before and after the program. Happiness level was enhanced in participants in the experimental group (p = 0.037) and their level of overall mental health also improved (p = 0.031, η²p = 0.129). Demographics did not have any significant effect on well-being outcomes. A structured outdoor physical activity program could be a viable choice for future practice to enhance the mental well-being of older Chinese people.

Mobile Application Use and Loneliness among Older Adults in the Digital Age: Insights from a Survey in Hong Kong during the COVID-19 Pandemic

Existing literature on the associations between use of mobile applications (i.e., mobile apps) and loneliness among older adults (OAs) has been mainly conducted before the outbreak of the COVID-19 pandemic. Since mobile apps have been increasingly used by OAs during the pandemic, subsequent effects on social and emotional loneliness need updated investigation. This paper examines the relationship between mobile app use and loneliness among Hong Kong’s OAs during the pandemic. In our research, 364 OAs with current use experience of mobile apps were interviewed through a questionnaire survey conducted during July and August 2021, which assessed the use frequency and duration of 14 mobile app types and levels of emotional and social loneliness. The survey illustrated communication (e.g., WhatsApp) and information apps were the most commonly used. Emotional loneliness was associated with the use of video entertainment (frequency and duration), instant communication (duration), and information apps (duration). Association between video entertainment apps’ use and emotional loneliness was stronger among older and less educated OAs. Our findings highlight the distinctive relationships between different types of apps and loneliness among Hong Kong’s OAs during the pandemic, which warrant further exploration via research into post-pandemic patterns and comparative studies in other regions.

Effects of Tabletop Games on Cognition in Older Adults: A Systematic Review and Meta-Analysis

Studies have shown that leisure activities, such as tabletop games, not only increase social interactions and reduce depression among older adults, but also help improve their cognitive function. However, the effects of tabletop games on cognition in older adults are yet to be comprehensively analyzed. The purpose of this study was to review and examine the effects of tabletop games on cognition in older adults. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were searched in seven electronic databases from their inception to December 2020. A total of 3946 studies were retrieved, among which 11 studies were systematically reviewed and 10 were meta-analyzed. In older adults with intact cognition, tabletop games had positive effects on their global cognition (standardized mean differences [SMD] = 1.36, 95% confidence intervals [CI]: 0.37-2.34, P < 0.001) and executive function (SMD = 0.47, 95% CI: 0.12-0.83, P < 0.001). In older adults with cognitive impairment, significant differences were found in global cognition (SMD = 0.53, 95% CI: 0.09-0.98, P = 0.02). Tabletop games had the characteristics of cognitive training and interpersonal interactions. After receiving tabletop game interventions, the cognitive functioning in older adults with intact cognition and those with mild cognitive impairment or dementia was improved. For older adults, in addition to improving cognitive functioning, tabletop games also increased their social participation and interactions. Systematic Review Registration: This review has been registered in the PROSPERO (CRD42021254085).

Prevalence of Loneliness and Associated Factors among Community-Dwelling Older Adults in Indonesia: A Cross-Sectional Study

Loneliness has become one of the most common psychological problems experienced by older adults. Previous studies have indicated that loneliness is correlated with poor physical and psychological health outcomes; therefore, it is important to pay attention to people experiencing loneliness. However, there is a lack of information regarding the prevalence of loneliness, and its associated factors, among community-dwelling older adults in Indonesia, which this study aimed to understand. This study used a cross-sectional, descriptive, and correlational research design. Stratified random sampling was applied to 1360 participants, aged ≥ 60 years, in 15 community health centers in Kendari City, Indonesia. The following questionnaires were used to collect data, including demographic and characteristic information, Short Portable Mental Status Questionnaire, Multidimensional Scale of Perceived Social Support, Geriatric Depression Scale Short Form, and a single-item loneliness question. The prevalence of loneliness among older adults was 64.0%. The multivariate logistic regression showed that older adults who were female, lived with family, had fewer children, had a poor health status, had a poor oral status, had more chronic diseases, had no hearing problems, had poor cognitive function, and had depression had a higher chance of feeling lonely. Loneliness is a serious health issue among the older population in Indonesia. The government, social workers, and healthcare professionals should pay immediate attention to this psychological problem. The study also suggests that appropriate strategies for the prevention of loneliness should be developed in the near future.

The Association between Social Participation and Loneliness of the Chinese Older Adults over Time-The Mediating Effect of Social Support

Based on activity theory, this paper employed data from the 2013, 2015, and 2018 waves of the China Health and Retirement Longitudinal Survey, and adopted Hierarchical Linear Modeling and longitudinal mediation analysis to explore the temporal variation characteristics of loneliness and the influence of social participation on loneliness in Chinese Older Adults, as well as the mechanism of them. The study found that loneliness among older adults overall was at a moderate level from 2013 to 2018 and increased over time, which may be related to decreasing social participation from year to year. Decreased social participation was associated with increased loneliness over time (β = -0.060, p < 0.001) and lower social support (β = 0.109, p < 0.001), which was associated with more loneliness (β = -0.098, p < 0.001). In addition, social support played a significant mediating role in the realization of social participation in alleviating loneliness. Social participation can not only directly reduce loneliness, but also reduce loneliness by increasing social support.

Implications of COVID-19 on the Loneliness of Older Adults in Residential Care Homes

With little understandings on the loneliness of older adults in residential care homes structured by social contact restrictions, the provision of person-centered care was jeopardized during the pandemic. This study employed hermeneutic phenomenology to explore the lived experiences of loneliness of this population during a 5-month period of the COVID-19 pandemic. We conducted unstructured face-to-face interviews with 15 older adults living in seven residential care homes. Thematic analysis was guided by Van Manen's approach. The essence of loneliness was uncovered as "A deprived sense of self-significance in a familiar world contributes to older adult's disconnection with prior commitments." A sub-theme "From collapse to dissolution of self-understanding" revealed how COVID-19 structured their loneliness. Another sub-theme, "Restoring meanings by establishing connections with entities" illustrated the ways to mitigate loneliness during the pandemic. Activities fostering alternative self-interpretation are important to protect older adults against loneliness.

The efficacy of a transdiagnostic group cognitive behavioral intervention for Chinese elderly with emotional disorders: A one-year follow-up randomized clinical trial

BACKGROUND

With the global aging, geriatric emotional disorders have received more and more attention. Psychotherapy is an effective approach for alleviating the symptoms associated with emotional disorder, but the number of experienced therapists is low. Studies should be conducted to explore a low-cost and efficient treatment method. Previous findings indicate that transdiagnostic cognitive behavior therapy is an effective approach for treatment of emotional disorders. Group therapy is appropriate for the elderly as they are characterized by high levels of loneliness. In this study, we compared and explored the effects of a transdiagnostic group cognitive behavioral intervention (TD-GCBT), a transdiagnostic individual cognitive behavioral intervention (TD-CBT), and treatment as usual (TAU) on treatment of emotional disorders among the elderly.

METHOD

A total of 120 elderly patients diagnosed with emotional disorders were randomly assigned to the TD-GCBT group (40), TD-CBT group (40), and TAU group (40). Changes in symptoms were assessed using HAMD, PHQ-9, HAMA, and GAD-7 scales at baseline, post-treatment (three months), six-month and twelve-months follow-up. The efficacies of the three intervention strategies were compared using linear mixed-effects models. Post-hoc and simple effect analyses were conducted to determine the differences among the three groups.

RESULTS

The HAMD, PHQ-9, HAMA, and GAD-7 scores revealed a significant effect from baseline to 12 months for time (p < 0.001), group (p < 0.001) and time × group interaction (p < 0.001) in TD-GCBT group compared with the TD-CBT group and TAU group. The effect of TD-GCBT (HAMD: Cohen's d (3th month, 6th month, 12th month) = 2.69, 3.98, 4.51; HAMA: Cohen's d = 2.84, 4.13, 5.20) and TD-CBT (HAMD: Cohen's d = 2.55, 2.87, 2.63; HAMA: Cohen's d = 2.43, 2.83, 2.78) group was better relative to that of the TAU group (HAMD: Cohen's d = 0.41, 1.13, 1.46; HAMA: Cohen's d = 0.64, 1.22, 1.57) (p < 0.001). The scores of the TD-GCBT group showed the most significant decrease compared with the other two groups.

CONCLUSION

The findings indicate that TD-GCBT method is effective for treatment of emotional disorders among the elderly. TD-GCBT is effective for alleviating depression and anxiety symptoms up to at least nine months after treatment. The results indicate that TD-GCBT is a cost-effective and resource-effective strategy and can be used an alternative therapy for treatment of mental disorders.

CLINICAL TRIAL REGISTRATION

[https://www.chictr.org.cn], identifier [ChiCTR1900021806].

Urban-rural differences in the association between social activities and depressive symptoms among older adults in China: a cross-sectional study

BACKGROUND

Participation in social activities has positive health effects among older adults; however, few studies have investigated the association between social activity and depressive symptoms among Chinese older adults. This study aimed to examine the association between social activities and depressive symptoms among older adults in China regarding urban-rural differences.

METHODS

Data were collected from 8255 respondents from the 2015 China Health and Retirement Longitudinal Study. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale. Type and frequency of social activities were collected via a questionnaire. Multivariate logistic regression analysis was used to explore the relationship between social activities and depressive symptoms.

RESULTS

In our study, the prevalence of depressive symptoms was lower in urban older adults compared with rural older adults (25.2% vs. 40.7%). After adjustment for all covariates, our results indicated that interacting with friends almost weekly or almost daily (almost weekly: OR = 0.568, 95%CI: 0.337-0.955; almost daily: OR = 0.664, 95%CI: 0.453-0.973) and participating in community organizations almost daily were inversely associated with depressive symptoms among urban older adults (OR = 0.107, 95%CI: 0.012-0.952). Interacting with friends almost daily (OR = 0.847, 95% CI: 0.720-0.996) and participation in hobby groups either almost every week or almost daily were both inversely associated with depressive symptoms among rural older adults (almost weekly: OR = 0.683, 95%CI: 0.518-0.902; almost daily: OR = 0.567, 95%CI: 0.440-0.731). Participating in sports groups almost daily was inversely associated with depressive symptoms among both urban and rural older adults (urban: OR = 0.664, 95%CI: 0.445-0.991; rural: OR = 0.506, 95%CI: 0.366-0.700).

CONCLUSIONS

Our findings indicated that there is a cross-sectional association between participation in social activities and depressive symptoms among Chinese older adults, and the association differed between urban and rural older adults. This implies that participation in social activities may be significant for alleviating depressive symptoms of older adults. When encouraging older adults to participate in social activities, the government should consider urban-rural differences and take effective measures accordingly. Longitudinal studies are needed to examine the causal relationships between social activities and depressive symptoms among older adults.

Prevalence of Loneliness and Related Factors Among Older Adults in Taiwan: Evidence From a Nationally Representative Survey

BACKGROUND

Loneliness is a common problem among older populations, and very few studies have examined loneliness among older adults in Taiwan.

AIM

This study aimed to understand the prevalence of loneliness and factors associated with it among older adults in Taiwan.

METHODS

Data from the Taiwan Longitudinal Study of Aging collected in 2015 were analyzed and involved 4588 participants aged ≥65 years. The outcome variable was a self-reported loneliness question, and independent variables included demographic characteristics, a self-reported health status, physical function, number of comorbidities, cognitive function, and social support. A multivariate logistic regression was used to identify predictors of loneliness.

RESULTS

The prevalence of loneliness among older adults in Taiwan was 10.5%. The multivariate logistic regression showed that old persons who were male, lived alone, perceived that they had a poor health condition, had no spouse, had no job, and had poor emotional support had higher likelihood of feeling lonely.

CONCLUSIONS

This study investigated loneliness in a nationally representative sample of older adults and revealed that one-tenth of this older population might experience loneliness which requires immediate action. Special attention should be given to the aforesaid factors in older adults to identify problems and provide interventions as early as possible in order to prevent loneliness and thus reduce the resultant negative effects on physical and mental conditions. Appropriate interventions should be developed to prevent or ameliorate feelings of loneliness among older populations using rigorous research designs such as randomized controlled trials.

Mahjong Playing and Leisure Physical Activity Alleviate Cognitive Symptoms in Older Community Residents

Leisure activities, particularly physically and cognitively stimulating leisure activities, mitigate cognitive decline. The present study aimed to examine the relationship between mahjong playing, leisure physical activity, and mild cognitive impairment (MCI). Older adults with and without MCI were recruited (n = 489, healthy group; and n = 187, MCI group). The regression results showed that years of mahjong playing (odds ratio = 0.595, 95% confidence interval [0.376, 0.961], p = .032) and physical activity (odds ratio = 0.572, 95% confidence interval [0.381, 0.849], p = .012) were associated with reduced odds of having MCI after adjusting for a series of covariates. Leisure physical activity and mahjong playing interacted with each other and produced combined effects on the odds of having MCI. Combined cognitive and physical interventions may produce larger benefits on cognition than either intervention alone.

Art Attendance and Change in Cognitive Function Among U.S. Community-Dwelling Chinese Older Adults

Engaging in leisure activities that are cognitively simulating and enjoyable may be protective against cognitive decline in older adults; yet, few studies have examined this topic. We used two waves of data from the Population Study of Chinese Elderly and ran mixed-effects regression models to examine the relationship between baseline art activity attendance (including attending museum, musical arts, or both) and change in cognitive function (global, episodic memory, working memory, and executive function) among 2,703 older U.S. Chinese adults. We found that compared with older adults who did not attend any art activities, those who reported attending both art activities experienced a slower rate of change in episodic memory (estimate = -0.07; SE = 0.03; p = .01) and executive function (estimate = -0.06; SE = .03; p = .04). Our study findings point to the importance of attending art-based culture events among U.S. Chinese older adults.

Life satisfaction, life quality, and leisure satisfaction in health professionals

PURPOSE

This study was aimed to determine the relationships between life satisfaction, life quality, and leisure satisfaction in health professionals.

DESIGN AND METHODS

The study was conducted with 498 health professionals working in a city of the Central Anatolia Region, Turkey. Data were collected using Socio-Demographic Form, the Satisfaction with Life Scale, the Short Form of World Health Organization Quality of Life Questionnaire, and the Leisure Satisfaction Scale.

FINDINGS

There was a positive significant relationship between life satisfaction, life quality, and leisure satisfaction. As the level of leisure satisfaction of health professionals increases, the life satisfaction, and life quality also increase.

PRACTICE IMPLICATIONS

Rise in the level of leisure satisfaction is important to increase life satisfaction and improve life quality of health professionals. Therefore, leisure patterns and behaviors that increase leisure satisfaction should be integrated into daily lives of these professionals.

Gender and Age Differences in Loneliness: Evidence for People without and with Disabilities

This study examines the relationships between loneliness, gender, and age for people without and with disabilities (moderate versus severe) in Germany. Using data taken from the German Socio-Economic Panel (SOEP) for the years 2013 and 2017 and using the UCLA (University of California, Los Angeles) Loneliness Scale, in general we found that males report lower loneliness scores as compared to those for females. Furthermore, we found a strong association between loneliness and the individual's age, but with differences according to gender and disability status. For example, for males with severe disabilities levels of loneliness decrease with age, whereas for females with severe disabilities the opposite result is found. In addition, we found that participation in leisure activities and having a higher frequency of contacts with family, friends, and social online networks (measured by the relational time index) contribute to reducing loneliness for all individuals. From a public policy perspective, it is necessary to undertake the design, promotion, and implementation of instrumental, emotional, and social support measures for people with disabilities (in particular for females that are severely limited in their daily activities), which can contribute to reducing their loneliness scores and increasing their levels of life satisfaction.

Playing Mahjong for 12 Weeks Improved Executive Function in Elderly People With Mild Cognitive Impairment: A Study of Implications for TBI-Induced Cognitive Deficits

Background: Mild cognitive impairment (MCI) is common among elderly people. So far, effective treatment that can stabilize or reverse the cognitive decline associated with MCI is lacking. Recent studies suggest that playing mahjong may improve attention and memory in elderly people. However, its effect on executive function remains unknown.

Methods: 56 elderly people (74.3 ± 4.3 years of age) with MCI from the First Social Welfare the First Nursing Home of Nanchong were randomized into mahjong and control groups (N = 28, each group). Subjects in the mahjong group played mahjong three times a week for 12 weeks, while people in the control group assumed normal daily activity. Executive function was evaluated using the Montreal Cognitive Assessment—Beijing (MoCA-B), the Shape Trail Test (STT), and the Functional Activities Questionnaire (FAQ) before the study and then at 6 and 12 weeks after mahjong administration.

Results: There were no baseline differences in MoCA-B, STT, and FAQ scoring between the two groups. The MoCA-B, STT, and FAQ scores, however, improved significantly in the mahjong group but not in the control group after the 12-week mahjong administration. Significant correlations were also found between STT and FAQ scores.

Conclusions: Playing Mahjong for 12 weeks improved the executive function of elderly people with MCI. Because Mahjong is a simple, low-cost entertainment activity, it could be widely applied to slow down or reverse the progression of cognitive decline in people with MCI, including those with traumatic brain injury.