Social network type and subsequent cognitive health among older Europeans

Examining the Social Networks Types and Their Effects on Caregiving Experience of Family Caregivers for Individuals With Dementia: A Mixed-Methods Study

Background and Objectives

Social networks are crucial to personal health, particularly among caregivers of individuals with dementia; however, different types of social networks among caregivers of those with dementia and how these differences are associated with caregiver burden and positive appraisal, remain underexamined. This study aims to depict dementia caregivers' social network types, related factors, and impact on caregiving experiences.

Research Design and Methods

A questionnaire-based survey was conducted with a total of 237 family caregivers of individuals with dementia nested additional semistructured interviews conducted with 14 caregivers in Chongqing, China. A quantitative study was designed to collect data on personal and situational information, social networks, caregiver burden, and positive aspects of caregiving. Qualitative data were collected via semistructured interviews. Latent class analysis and multivariate regression analyses were applied to quantitative data, and inductive content analysis to qualitative data.

Results

The 3 social network types-family-limited (n = 39, 16.46%), family-dominant (n = 99, 41.77%), and diverse network (n = 99, 41.77%)-differed in age and sex of caregivers and individuals with dementia, stage of dementia, and caregiving intensity. Caregivers in family-dominant networks had a lower caregiver burden (β= -0.299, p = .003) and greater positive aspects of caregiving (β= 0.228, p = .021) than those in family-limited networks. Three themes-accessibility, reciprocity, and reliance-emerged as facilitators and barriers when asking for support. Caregivers frequently cited the perception of economic, practical, and emotional support, yet reported a lack of adequate formal support from healthcare providers.

Discussion and Implication

Family caregivers of individuals with dementia have different social network types that vary considerably among sociocultural contexts and perceive various types of support from social networks. Solid family networks and diverse social networks are contributors to long-term dementia care.

Is Formal Social Participation Associated with Cognitive Function in Middle-Aged and Older Adults? A Systematic Review with Meta-Analysis of Longitudinal Studies

This systematic review with meta-analysis aimed to explore the association between formal social participation and cognitive function in middle-aged and older adults using data from longitudinal studies. A comprehensive search was conducted in Scopus, PubMed, and Web of Science for longitudinal studies that assessed the association between formal social participation and cognitive function in middle-aged and older adults published between January 2010 to 19 August 2022. Risk of bias was judged using the RoBANS tool. Meta-analysis using a random-effects model was computed with odds ratio (OR) and 95% confidence interval (CI) for cognitive decline probability. Sensitivity analyses were made to explore any changes to the pooled statistical heterogeneity and pooled effect size. Certainty of evidence was judged using the GRADE framework. We included 15 studies comprising 136,397 participants from 5 countries. Meta-analyses showed that formal social participation was associated with reduced cognitive decline (OR = 0.78, 95% CI 0.75-0.82, p < 0.001), with very low certainty of evidence. Formal social participation appears to enhance cognition in middle-aged and older adults, but further high-quality research is needed given the very low certainty of evidence.

Self- and interviewer-reported cognitive problems in relation to cognitive decline and dementia: results from two prospective studies

BACKGROUND

Little is known regarding the association of interviewer-reported cognitive problems (ICP) with age-related cognitive decline. We aimed to investigate the independent associations of ICP and the combined associations of ICP and self-reported cognitive problems (SCP) with subsequent cognitive decline and dementia in two prospective cohort studies.

METHODS

We included 10,976 Chinese (age = 57.7 ± 8.7) and 40,499 European (age = 64.6 ± 9.4) adults without dementia from the China Health and Retirement Longitudinal Study (CHARLS) and the Survey of Health, Ageing, and Retirement in Europe (SHARE). Self-rated memory (5-point scale) and interviewer-rated frequencies of asking for clarification (6-point scale) were used to define SCP and ICP (dichotomized). Outcomes included objective cognitive test scores (z-score transformation) and incident dementia. Generalized estimating equation models were performed to evaluate mean differences in objective cognitive decline. Logistic and Cox regression models were used to estimate the relative risk of dementia. Results from two cohorts were pooled using the random-effects models.

RESULTS

ICP was associated with faster cognitive decline in CHARLS (βCHARLS = -0.025 [-0.044, -0.006] z-score/year). ICP and SCP were also independently associated with higher risk of dementia in two cohorts (pooled relative risk for SCP = 1.73 [1.30, 2.29]; pooled relative risk for ICP = 1.40 [1.10, 1.79]). In the joint analysis, participants with coexistence of SCP and ICP had the fastest cognitive decline (βCHARLS = -0.051 [-0.080, -0.021]; βSHARE = -0.024 [-0.043, -0.004]; pooled β = -0.035 [-0.061, -0.009] z-score/year) and highest risk of dementia (ORCHARLS = 1.77 [1.42, 2.20]; HRSHARE = 2.94 [2.42, 3.59]; pooled relative risk = 2.29 [1.38, 3.77]).

CONCLUSIONS

The study suggested that interviewer-reported cognitive problems may be early indicators of cognitive decline and dementia in middle-aged and older adults. A combination of self- and interviewer-reported cognitive problems showed the strongest associations with cognitive decline and dementia.

Practices of Self-Care in Healthy Old Age: A Field Study

Two competing psychological approaches for how to care for oneself to stay healthy in old age have coexisted and dominated the scientific literature.

OBJECTIVE

Identify the self-care practices of healthy older adults and establish the relationship between these practices and the cognitive processes involved.

METHOD

105 healthy older people (83.91% women) recorded their self-care practices using the Care Time Test and underwent a cognitive evaluation.

RESULTS

The frequency and variety of different activities that participants spent performing on a day of the week where they had the fewest obligations are as follows: nearly 7 h on seven survival activities, 4 h and 30 min on three maintenance of functional independence activities and 1 h on one activity that promoted personal development. Older people who carry out activities in a developmental approach showed better everyday memory (8.63 points) and attention levels (7.00 points) than older people who carry out activities using a conservative approach (memory: 7.43; attention level: 6.40).

CONCLUSION

The results evidenced that the frequency and variety of activities that promote personal development are associated with better attention and memory performance.

Nutrition risk varies according to social network type: data from the Canadian Longitudinal Study on Aging

OBJECTIVE

There were two primary objectives, namely: (1) to determine the social network types that Canadian adults aged 45 and older belong to and (2) to discover if social network type is associated with nutrition risk scores and the prevalence of high nutrition risk.

DESIGN

A retrospective cross-sectional study.

SETTING

Data from the Canadian Longitudinal Study on Aging (CLSA).

PARTICIPANTS

17 051 Canadians aged 45 years and older with data from baseline and first follow-up of the CLSA.

RESULTS

CLSA participants could be classified into one of seven different social network types that varied from restricted to diverse. We found a statistically significant association between social network type and nutrition risk scores and percentage of individuals at high nutrition risk at both time points. Individuals with restricted social networks had lower nutrition risk scores and are more likely to be at nutrition risk, whereas individuals with diverse social networks had higher nutrition risk scores and are less likely to be at nutrition risk.

CONCLUSIONS

Social network type was associated with nutrition risk in this representative sample of Canadian middle-aged and older adults. Providing adults with opportunities to deepen and diversify their social networks may decrease the prevalence of nutrition risk. Individuals with more restricted networks should be proactively screened for nutrition risk.

The Associations of Loneliness and Social Support with Cognitive Impairment among Middle-Aged and Older Individuals with Diabetes

Diabetes mellitus is a chronic disease with significant morbidity and mortality and it is associated with poor cognitive performance in later life. This study seeks to determine the relationship between social support and cognitive function among participants with type 2 diabetes mellitus (T2DM). We used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, including participants with T2DM aged 45 and older (n = 4821). We examined different aspects of perceived social support, measured as structural social support (e.g., marital status), functional social support (having a caregiver in case of sickness or disability), and loneliness. We examined cognitive functioning using a six-item screener. Our results indicate that adults who felt lonely for 5-7 days per week had almost double the odds of cognitive impairment compared to those who didn't feel lonely. These results suggest that among middle-aged and older individuals with T2DM, interventions targeting lonely adults and which aim to reduce loneliness may combat some of the risks of cognitive decline.

Association between walking and square dancing-oriented leisure-time physical activity and cognitive function among middle-aged and elderly people in Southwest China

BACKGROUND

Southwest China is facing a serious aging problem across the country, but the status of cognitive function in middle-aged and elderly people in this region is superior to the national average. This study intends to reveal the leisure-time physical activity (LTPA) pattern in this region and explore whether this pattern is beneficial for cognitive function.

METHODS

The data came from the 2019-2021 baseline survey on cognitive function of a natural population cohort conducted by West China Hospital of Sichuan University. A structured questionnaire was used to investigate the LTPA status of the participants, and the Mini-Mental State Examination was used to evaluate their cognitive function. Then, we used multiple linear regression to analyze the association between LTPA and cognitive level, and further subgroup analysis was carried out according to sex, age and waist-to-hip ratio.

RESULTS

A total of 2697 participants were enrolled, with an average age of 66.19 ± 6.68 years. The average cognitive function score was 27.23 ± 2.72, of which 8.60% indicated mild cognitive impairment. Their median LTPA level was 24.50 MET-hours per week, of which 70.37% reached the activity level recommended by WHO, with the main types being walking (1340 cases, 49.68%), square dancing (270 cases, 10.01%), or walking + square dancing (172 cases, 6.38%). Multiple linear regression showed that cognitive function increased with the amount of LTPA from 11.25 MET-hours/week to 36.40 MET-hours/week (β 0.09 for 11.25 ~ 24.50 MET-hours/week, β 0.38 for 24.50 ~ 36.40 MET-hours/week) but stabilized at more (β 0.39 for ≥36.40 MET-hours/week). The positive association persisted even for those who only walked (β 0.37 for 24.50 ~ 36.40 MET-hours/week, P = 0.008).

CONCLUSIONS

Middle-aged and elderly people in Southwest China hold a relatively high level of LTPA status, and walking and square dancing-oriented LTPA are positively correlated with cognitive function.

Olfaction in (Social) Context: The Role of Social Complexity in Trajectories of Older Adults' Olfactory Abilities

Objectives: Olfaction is an important correlate of later-life health, including cognition and mortality risk. Environmental enrichment protects against olfactory decline, yet little research considers the social context as a source of sensory enrichment or stimulation. This study examines how exposure to social complexity (i.e., diversity or novelty in social networks and activities) shapes later-life olfaction. Methods: Cross-sectional and longitudinal ordered logit models analyze data from 1,447 older adults interviewed at Rounds 1 and 2 of the National Social Life, Health, and Aging Project. Results: Exposure to greater social complexity (larger social networks, greater network diversity) is associated with significantly better olfaction at baseline. Increases in network diversity and fewer network losses significantly protect against olfactory decline over time. Discussion: Findings highlight the social context as an important, yet relatively overlooked source of sensory enrichment, and underscore the need for biological applications to integrate social life dynamics into studies of health trajectories.

The role of social networks in the self-management support for young women recently diagnosed with breast cancer

It is widely acknowledged that social network support plays an important role in the quality of life and illness management of breast cancer survivors. However, the factors and processes that enable and sustain such support are less well understood. This paper reports baseline findings from a prospective UK national cohort of 1,202 women with breast cancer (aged <50 years at diagnosis), recruited before starting treatment, conducted in 2016-2019. Descriptive, univariate and multivariate regression analyses explored associations between the individual, and network member characteristics, and the type of support provided. Social network members provided a substantial level of illness-related, practical and emotional support. Highest contribution was provided by friends, followed by close family members. The social network members of women who did not have a partner provided a higher level of support than those in networks with a partner. Women without higher education were more reliant on close family members than those with higher education, and this was more so for women without a partner. Women with higher education without a partner were more reliant on friends and were overall best supported. Women without higher education who did not have a partner were overall least well supported. They had much smaller networks, were highly reliant on close family members, and on high level contributions from all network members. There is a need to develop network-based interventions to support people with a cancer diagnosis, prioritising support for the groups identified as most at risk. Interventions that support engagement with existing network members during treatment, and those that help extend such networks after treatment, are likely to be of benefit. A network perspective can help to develop tailored support and interventions by recognising the interactions between network and individual level processes.

Mapping Protective Performance of Social Network Types on Health and Quality of Life in Older People in European Regions

Objectives: To identify social network profiles using Latent Profile Analysis (LPA), to study the relationships of these profiles with health markers, mental health, quality of life, and cognitive functioning, and to compare profiles across European regions. Methods: 27,272 participants from the Wave 8 of the SHARE project, aged 65 or older (M = 74.95, SD = 7.17) from Europe. Statistical analyses included LPAs followed by MANOVAs to compare the profiles and the health markers. Results: Five profiles were identified: family, friends, spouse, diverse, and others. A no network group was also added. The prevalence of the specific profiles differed across European regions. Individuals with no network and those categorized into the others profile presented the worst health outcomes. Discussion: The “friends” network is more protective toward cognitive functioning and physical health and the “spouse” and “family” ones are more protective toward mental health. The variability according to European regions is discussed.

By Internal Network or by External Network?-Study on the Social Network Mechanism of Reducing the Perception of Old-Age Support Risks of Rural Elders in China

Nowadays, it is a general trend for China to enter a deep aging society, and the aging situation of the rural population is particularly severe. As informal endogenous resources in rural areas, social networks play an essential role in ensuring elders' later life. Data were drawn from a questionnaire survey of 1126 rural elders in 11 provinces of China. Descriptive statistics and an ordinary least square regression model were conducted to explore the impact of social networks on the perception of old-age support risks of rural elders. There was a significant positive association between the social network size and the reduction in perception of old-age support risks of rural elders. The reduction effect was mainly reflected in the internal network size, whereas it was not evident in the external network size. There was a significant positive association between the heterogeneity of the network and the perceived level of old-age support risks of rural elders. There was a significant positive association between the communication frequency of external network relationships and the perceived level of old-age support risks of rural elders. We found a significant negative association between the ratio of communication frequency between the internal and external network relationships and the perception of old-age support risks of rural elders. Compared with the external network, the internal network had a more evident reduction effect on the social network mechanism of perception of old-age support risks of rural elders.

Accelerometer-Assessed Physical Activity and Cognitive Performance among European Adults Aged 50+: The Mediating Effects of Social Contacts and Depressive Symptoms

Background: Cognitive decline is a major public health concern worldwide and it is vital to identify and better understand effective population-based means to improve cognitive performance in old age. The current study set out to examine the links between accelerometer-based physical activity with cognitive performance in later life, as well the indirect pathways through one’s social network contacts and depression. Method: We used data from 855 participants aged 50 and above who took part in a cross-sectional accelerometer study as part of the Survey of Ageing, Retirement and Health (SHARE). Cognitive function was measured as an average score of fluency, immediate and delayed recall tests, social contacts were the average contact frequency with members of the social support network, and depression was the Euro-D summary score of depressive symptoms. A multiple mediation analysis was conducted to test the direct and indirect associations between total physical activity (intensity gradient) and cognitive function, as well as the mediation of this association by social contacts and depressive symptoms. Results: Intensity of physical activity was directly related to better cognitive performance (B = 0.170, p = 0.007). The association was partially mediated by social contacts (B = 0.022, 95% CI 0.005, 0.046) and depressive symptoms (B = 0.009, 95% CI 0.009, 0.025), such that total physical activity was linked to cognitive health via more frequent contacts with network members and low depressive symptoms. Conclusions: Practitioners might consider encouraging a physically active lifestyle that involves social interactions to support better cognitive aging and mental health.

Association Between Social Network and Cognitive Function: A Cross-Sectional Assessment From the Cardiovascular and Metabolic Diseases Etiology Research Center Cohort (2013-2018)

BACKGROUND

This study aimed to investigate how social networks are associated with cognitive function in the middle-aged and elderly Korean population.

METHODS

A total of 7,704 individuals over the age of 50 were included from the baseline recruitment of the Cardiovascular and Metabolic Diseases Etiology Research Center cohort from the years 2013 to 2018. Egocentric social network characteristics including network size, intimacy, and frequency of face-to-face meetings were measured as exposures, and the Korean version of Mini-Mental State Examination (K-MMSE) score was measured to reflect general cognitive function as an outcome. We also stratified the analysis by income level into tertiles, with income caps of 42,000 thousand won and 72,000 thousand won. A general linear regression model was used, adjusting for age, gender, socioeconomic factors, lifestyle factors, depressive symptoms, and study settings.

RESULTS

Social network properties were positively associated with cognitive function in both men and women. However, the specific estimates varied according to gender and income level. In men, frequency was most significantly associated with cognitive function (standardized β = 0.093, p-value <0 .0001). In women, the strength of the association with cognitive function was found in size (standardized β = 0.055, p-value = 0.001). The effect modification of income level could be seen in the association between frequency and cognitive function. The strongest association between frequency and cognitive function was found in the middle income group in men (standardized β = 0.114, p-value = 0.0063), and the low income group in women (standardized β = 0.076, p-value = 0.0039).

CONCLUSION

There were positive associations between social network properties (i.e., size, intimacy, and frequency of face-to-face meetings) and cognitive function. The degree of association varied according to social network properties, gender, and income level. Overall, among social network properties, social network size was an important factor in the cognition of women, whereas frequency was important in the cognition of men.

Close ties, near and far away: patterns and predictors of geographic network range among older Europeans

A growing number of older adults maintain connections in their core discussion networks at variant distances, raising concerns about the lack of discussants in proximity and the consequences on their social life. This study examines the typical geographic layouts for aging Europeans' core discussion networks and their implications for network function and quality. With a sample of community-dwelling respondents aged 50 and above from the Survey of Health, Aging, and Retirement in Europe, the present research identifies seven geographic layouts that extend previously identified family and diverse network types by adding spatial nuance. Individuals in mid-range and distant-family networks typically lack a discussant nearby but sustain high emotional closeness with family discussants at a distance and express high overall satisfaction with their network. Proximate-diverse networks with a strong representation of non-kin members nearby turn out to be less advantageous than prior research might suggest, providing relatively frequent contact but the lowest level of network satisfaction. Results also identify how individual characteristics link to the geographic layouts and describe their prevalence across European regions. Overall, relatively dispersed layouts are common for older adults across multiple countries and do not necessarily indicate lower emotional closeness and network satisfaction. The present study highlights the importance of looking beyond the mere presence of proximate connections in older adults' core networks.

Physical distancing is related to fewer electronic and in-person contacts and to increased loneliness during the COVID-19 pandemic among older Europeans

PURPOSE

During the COVID-19 pandemic older adults are asked to maintain physical distancing, which can be linked to loneliness. While older people are encouraged to use electronic communication to stay socially connected, it remains an open question whether electronic contacts are related to lower loneliness during the pandemic. This study examined the associations of physical distancing during the pandemic with loneliness and the role of in-person and electronic contacts with children and non-kin as explaining these associations across European regions.

METHODS

The study used data from Survey of Health, Ageing and Retirement in Europe (SHARE), collected during the COVID-19 pandemic in 2020. Mediation and moderation analyses tested the direct and indirect associations between physical distancing, contact frequency and loneliness, as well as the differences across European regions.

RESULTS

The results indicate that adults who reported higher frequency of physical distancing also felt lonelier during the pandemic. This association was partly explained by social contacts-those who practiced physical distancing maintained less in-person contact with children and non-kin and less electronic contact with non-kin, which were related to feeling lonelier. Adults in Southern European countries felt lonelier and reported more frequent contacts. The moderation analyses showed that the link between physical distancing and loneliness was found in the northern region, but not in the southern and eastern regions of Europe.

CONCLUSION

This study can indicate that attention should be paid to adults who may struggle to maintain social contacts in light of physical distancing guidelines.