Social support and adaptation to stress by the elderly

Neighborhood Qualities Are Related to Better Mental Health, Quality of Life, and Loneliness Over 6 Years: Pathways Through Social Engagement and Social Support to Aging Well

BACKGROUND AND OBJECTIVES

Growing research evidence supports the importance of neighborhoods for the well-being of older people. The aim of this study was to investigate key pathways (social engagement and social support) through which neighborhood qualities (accessibility, safety, and social cohesion) may affect older people's mental well-being (mental health, quality of life, and loneliness) over 6 years.

RESEARCH DESIGN AND METHODS

A structural equation model was used to test the model while controlling for individual limitations such as physical health and socioeconomic status. The population sample included 2,750 New Zealanders over the age of 55 (M = 65.64 ± 6.30) years who responded to Health, Work and Retirement (HWR) longitudinal surveys in 2016 and 2022.

RESULTS

The results showed that greater neighborhood accessibility to important facilities in 2016 predicted better mental health and quality of life and less loneliness in 2022 through provision of social support. Neighborhood social cohesion predicted social engagement, which was related to higher social support predicting better mental health and quality of life and less loneliness in 2022.

DISCUSSION AND IMPLICATIONS

These findings confirm a body of research highlighting the importance of neighborhood qualities and show the socially oriented pathways through which neighborhoods support aging well. These findings have direct implications for the development of social policy that focuses on the development of housing situations to support healthy aging.

The hidden network: community sense, social desirability, and their protective influence on negative emotions in aging populations

Background

With aging populations, understanding mechanisms linking social factors to emotional well-being in the older adult is critical. This study examines how social capital, social support, community sense, and social desirability interact to influence negative emotions.

Methods

A cross-sectional survey of 904 older adult individuals in Liaoning, China, utilized standardized scales: GDS-10 (negative emotions), SSRS (social support), BSCS (community sense), and MCSDS (social desirability). Mediation and moderation analyses were conducted.

Results

The results demonstrated significant negative correlations between social capital/social support and negative emotions. Social support was identified as a mediating factor linking social capital to reduced negative emotions. Additionally, community sense and social desirability moderated the relationship between social support and negative emotions, with stronger community belonging and higher social desirability amplifying the protective effect of social support.

Conclusion

These findings underscore the importance of fostering social capital, strengthening social support networks, cultivating community integration, and addressing social desirability biases to alleviate negative emotions in the older adult. The study provides actionable insights for designing targeted mental health interventions aimed at improving emotional well-being in aging populations.

Loneliness: A Scoping Review of Reviews From 2001 to 2023

The growing number of primary studies and reviews on loneliness, and the multidisciplinary efforts to comprehend this complex phenomenon from various perspectives, underscore the heightened recognition of its impact on individual and societal well-being and health. To comprehensively assess the size and scope of this research field, we conducted a scoping review of 35 English-language reviews of primary studies on loneliness, published between 2001 and 2023. Focusing specifically on psychological research, these reviews covered a total of N = 1,089 studies, which were conducted between 1986 and 2022. In addition to providing a broad overview of the structure of the field, the present scoping review aimed to explore the methodological landscape of loneliness research, including data collection, sample demographics, and measures, and to present key topics and evidence in the field. By deepening the understanding of loneliness and identifying data gaps and methodological challenges, our analyses provide critical insights for future research endeavors, thereby fostering advances in the field.

Economic and relationship-strengthening intervention to reduce alcohol use in couples living with HIV in Malawi: a study protocol for a randomised controlled trial of Mlambe

INTRODUCTION

Heavy alcohol use has the potential to derail progress towards UNAIDS 95-95-95 targets for countries in sub-Saharan Africa (SSA). Within couples, alcohol use is closely linked with factors such as intimate partner violence and economic insecurity and can result in poor adherence to antiretroviral therapy (ART) and HIV clinical outcomes. We hypothesise that a combined economic and relationship intervention for couples that builds on the prior success of standalone economic and relationship-strengthening interventions will be efficacious for improving HIV clinical outcomes and reducing alcohol use. The synergy of these interventions has not been assessed in SSA-specifically among people living with HIV who drink alcohol. To test this hypothesis, we will test Mlambe, an economic and relationship-strengthening intervention, found to be feasible and acceptable in a pilot study in Malawi. We will conduct a full-scale, randomised controlled trial (RCT) to evaluate the efficacy and cost-effectiveness of Mlambe.

METHODS AND ANALYSIS

We will enrol 250 adult married couples having at least one partner living with HIV and reporting heavy alcohol use. There will be two arms: Mlambe or an enhanced usual care control arm. Couples in the Mlambe arm will receive incentivised matched savings accounts and monthly sessions on financial literacy, relationship skills, and alcohol reduction education and counselling. Participants will be assessed at baseline, 11 months, 15 months and 20 months to examine effects on heavy alcohol use, HIV viral suppression, ART adherence and couple relationship dynamics. Study hypotheses will be tested using multilevel regression models, considering time points and treatment arms. Programmatic costs will be ascertained throughout the study and incremental cost-effectiveness ratios will be computed for each arm.

ETHICS AND DISSEMINATION

The RCT has been approved by the University of California, San Francisco (UCSF) (Human Research Protection Program; Protocol Number 23-40642), and the study has been approved by the National Health Sciences Research Committee (NHSRC; Protocol Number 24/05/4431) in Malawi. Adverse events and remedial actions will be reported to authorities both in Malawi and at UCSF. Results will be disseminated to study participants, local health officials and HIV policy makers and through presentations at conferences and publications in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Protocol Registration; NCT06367348 registered on 19 April 2024; https://register.

CLINICALTRIALS

gov/. Protocol Version 1.0: 22 October 2024.

Prevalence and Correlates of Intimate Partner Violence in the Perinatal Period in a Representative Sample of Quebec Mothers

Using a nationally representative sample of 1,264 biological mothers of children aged between 6 months and 5 years, this study identified the prevalence estimates of intimate partner violence occurring in the perinatal period (IPV-PP) and examined the associations between IPV-PP and various characteristics. Findings show that 10.9% of mothers reported victimization to at least one intimate partner violence episode during the perinatal period. Younger maternal age at childbirth, drug consumption, being a single mother, higher parental stress due to the child's temperament, and higher stress due to family and extrafamilial obligations were all associated with IPV-PP. Findings emphasized that IPV-PP is indeed an important public health matter in Quebec. Interventions should focus on victimization screening during the perinatal period and on enhancing victims' security and well-being.

Social provisions in patients with mitochondrial diseases

ABSTRACT

Background

Mitochondrial diseases often follow a chronic, multimorbid disease course in adults. Like other chronic conditions, mitochondrial diseases present a challenge to public and community health models and patients are potentially at higher risk of social isolation and loneliness. However, there is lack of data on social provisions in mitochondrial diseases.

Methods

We performed a cross-sectional observational study on patients with a confirmed genetic or clinical diagnosis of mitochondrial disease, recruited between September 2018 and December 2021. Participants completed the Social Provisions Scale (SPS) as a measure of social support. Designated carers similarly completed the SPS in carer-specific questionnaires.

Results

95 mitochondrial disease patients and 24 designated carers completed the SPS. Social provisions were met for all six subscales of SPS in the mitochondrial disease cohort: (1) guidance 90.5% (n=86), (2) reassurance of self-worth 82.8% (n=77), (3) social integration 88.4% (n=84), (4) attachment 83.2% (n=79), (5) opportunity of nurturance, 61.1% (n=58) and (6) reliable alliance 95.8% (n=91). All social provisions were also met in the carer cohort.

Conclusion

Patients with mitochondrial diseases and their carers demonstrate a high perceived level of social support in the setting of a tertiary referral centre specialised in mitochondrial disease despite the burden of chronic disease.

Health impacts in pathology workforce during mergers and acquisitions (M&A)

AIMS

To compare burn-out in laboratory professionals (LPs) with exposure to consolidation to those without, and to investigate the role of social support as a moderator in the exposure to mergers and acquisitions (M&A).

METHODS

Surveys were sent to the clinical LPs, including 732 with exposure to M&A and 819 without. The dependent variable was burn-out, and the independent variable was exposure to M&A. In investigating the role of social support in exposure group, a logistic regression was used with education, time since M&A, gender, merger types, practice setting, lab hierarchy and race as covariates.

RESULTS

Exposure to M&A was associated with higher levels of burn-out (p<0.05). In logistic regression of the workforce exposed to M&A, the odds for LP developing a high level of burn-out are lowered by 7.1% for every unit of increase in social support (OR 0.93; 95% CI 0.88 to 0.98; p=0.004).

CONCLUSION

LPs exposed to M&A are more likely to experience higher levels of burn-out but having social support can protect against burn-out, which has policy implications for leadership managing laboratories in times of M&A.

The Use of Social Media to Express and Manage Medical Uncertainty in Dyskeratosis Congenita: Content Analysis

BACKGROUND

Social media has the potential to provide social support for rare disease communities; however, little is known about the use of social media for the expression of medical uncertainty, a common feature of rare diseases.

OBJECTIVE

This study aims to evaluate the expression of medical uncertainty on social media in the context of dyskeratosis congenita, a rare cancer-prone inherited bone marrow failure and telomere biology disorder (TBD).

METHODS

We performed a content analysis of uncertainty-related posts on Facebook and Twitter managed by Team Telomere, a patient advocacy group for this rare disease. We assessed the frequency of uncertainty-related posts, uncertainty sources, issues, and management and associations between uncertainty and social support.

RESULTS

Across all TBD social media platforms, 45.98% (1269/2760) of posts were uncertainty related. Uncertainty-related posts authored by Team Telomere on Twitter focused on scientific (306/434, 70.5%) or personal (230/434, 53%) issues and reflected uncertainty arising from probability, ambiguity, or complexity. Uncertainty-related posts in conversations among patients and caregivers in the Facebook community group focused on scientific (429/511, 84%), personal (157/511, 30.7%), and practical (114/511, 22.3%) issues, many of which were related to prognostic unknowns. Both platforms suggested uncertainty management strategies that focused on information sharing and community building. Posts reflecting response-focused uncertainty management strategies (eg, emotional regulation) were more frequent on Twitter compared with the Facebook community group (χ21=3.9; P=.05), whereas posts reflecting uncertainty-focused management strategies (eg, ordering information) were more frequent in the Facebook community group compared with Twitter (χ21=55.1; P<.001). In the Facebook community group, only 36% (184/511) of members created posts during the study period, and those who created posts did so with a low frequency (median 3, IQR 1-7 posts). Analysis of post creator characteristics suggested that most users of TBD social media are White, female, and parents of patients with dyskeratosis congenita.

CONCLUSIONS

Although uncertainty is a pervasive and multifactorial issue in TBDs, our findings suggest that the discussion of medical uncertainty on TBD social media is largely limited to brief exchanges about scientific, personal, or practical issues rather than ongoing supportive conversation. The nature of uncertainty-related conversations also varied by user group: patients and caregivers used social media primarily to discuss scientific uncertainties (eg, regarding prognosis), form social connections, or exchange advice on accessing and organizing medical care, whereas Team Telomere used social media to express scientific and personal issues of uncertainty and to address the emotional impact of uncertainty. The higher involvement of female parents on TBD social media suggests a potentially greater burden of uncertainty management among mothers compared with other groups. Further research is needed to understand the dynamics of social media engagement to manage medical uncertainty in the TBD community.

The Protective Role of Group Activity Prior to COVID-19 Pandemic Quarantine on the Relation between Loneliness and Quality of Life during COVID-19 Pandemic

BACKGROUND

Studies of aging have suggested that QoL is positively associated with active social contacts and supportive face to face social networks. However, social networks and contacts in later life decrease due to a variety of reasons; the narrowing of social networks contributes to increased social isolation and loneliness and leads to the deterioration of well-being and QoL among adult persons. The goal of this study was to explore the relationship between loneliness feelings and QoL during the COVID-19 quarantine as potentially moderated by group physical activity prior to the COVID-19 pandemic quarantine.

METHODS

A convenience sample of 99 older adults aged 60 and over was interviewed. Using bootstrapping, we tested the strength and significance of the conditional moderation effect of group physical activity prior to the COVID-19 pandemic quarantine on the relationship between loneliness feelings and QoL during the COVID-19 quarantine.

RESULTS

the results demonstrated a direct negative effect between loneliness feelings and QoL during the COVID-19 pandemic and that the relationship was moderated by group physical activity prior to the COVID-19 pandemic quarantine (p = 0.000).

CONCLUSION

the findings indicate that policy makers and professionals working with older adults should seek ways to attract older adults to participate in group physical activity and enjoy its long-term social benefits.

The effect of Mild Cognitive Impairment (MCI) on psychological distress among older adults in Ukraine

OBJECTIVES

Understanding the negative consequences of Mild Cognitive Impairment (MCI) in Ukraine among a population who have collectively experienced difficult life events, provided the impetus for the current study which analyzed whether the perception of psychological distress differed among older adults with two types of MCI (amnestic MCI [aMCI] & nonamnestic MCI [naMCI]) compared to their cognitively intact peers.

METHOD

A sample of 132 older adults were selected from an outpatient regional hospital in Lviv, Ukraine and assigned into either an MCI or non-MCI control group. A demographic survey, and the Symptom Questionnaire (SQ) were administered to both groups.

RESULTS

Results of an ANOVA comparing the SQ sub-scales between the Ukrainian MCI and control groups were analyzed. A multiple hierarchical regression analysis assessed the predictive value of MoCA scores on the SQ sub-scales. Compared to adults in the MCI group, adults in the control group reported significantly lower rates of anxiety, somatic, depressive symptoms, and total psychological distress.

DISCUSSION

While the level of cognitive impairment was a significant predictor for each sub-type of distress, the explained variance was minimal suggesting that other factors also played a role. Reference was made to a similar MCI sample in the U.S. which had lower SQ psychological distress scores than the Ukraine sample, further suggesting possible environmental effects on symptoms. The importance of depression and anxiety screening and treatment for older adults with MCI was also discussed.

Supervisor Support, Self-Efficacy, and Employee Performance: The Mediating Role of Office De-Clutter

The study aims to test the impact of social support from supervisors and self-efficacy on employee performance through office de-clutter (a mediator) in banks. During the COVID-19 pandemic, the supporting factors (social support and self-efficacy) to de-clutter for maintaining employee performance is a novel contribution to the literature and is supported by the social exchange theory—SET. The employee’s performance can be maintained with lower levels of office clutter (de-clutter). The office clutter can be managed through the availability of managerial social support and employee self-efficacy. The impact of supervisor support and self-efficacy on employee performance is examined through the lens of the social exchange theory. A cross-sectional and quantitative study was conducted with 202 primary responses from bank employees. The responses were recorded using closed-ended questionnaires. A response rate of 73.9% was achieved. Reliability and validity were assessed using Cronbach’s alpha scores and AVE, respectively. PLS-SEM was used as a data analysis and hypotheses testing technique. The results revealed that supervisors’ social support and self-efficacy significantly and positively affect employee performance. Moreover, supervisors’ social support and self-efficacy helped in office de-clutter, further ensuring better performance.

Predictive Factors of Anxiety, Depression, and Health-Related Quality of Life in Community-Dwelling and Institutionalized Elderly during the COVID-19 Pandemic

The COVID-19 health emergency and restrictive measures have increased psychological problems, particularly anxiety and depression, in the general population. However, little is known about mental health conditions and the possible risk and protective factors of specific population groups, such as institutionalized vs. community-dwelling elderly. We investigated the abovementioned aspects in a sample of 65-89-year-old people during the third wave of COVID-19 in Italy. We employed a sociodemographic survey and four questionnaires on health-related quality of life (SF-36), loneliness (UCLA), spirituality (FACIT-Sp), and anxiety/depression (HADS). Our findings suggest that the physical, psychological, and spiritual well-being of the elderly had not been seriously impaired by the events related to the pandemic, although most of the participants reported a worsening of their social life and a moderate/high fear of COVID-19. In regression analyses, these two latter aspects turned out to be predictors of higher anxiety, while spiritual well-being and the possibility to get out of the house/institution emerged as protective factors against anxiety and for preserving quality of life, respectively. Our findings help refine the picture of the condition of the elderly in the aftermath of the pandemic, giving some hints about how to continue supporting their well-being and quality of life.

Psychosocial Resilience to Inflammation-Associated Depression: A Prospective Study of Breast-Cancer Survivors

Stress can lead to depression, in part because of activation of inflammatory mechanisms. It is therefore critical to identify resilience factors that can buffer against these effects, but no research to date has evaluated whether psychosocial resilience mitigates the effects of stress on inflammation-associated depressive symptoms. We therefore examined psychosocial resources known to buffer against stress in a longitudinal study of women with breast cancer (N = 187). Depressive symptoms and inflammation were measured over a 2-year period extending from after diagnosis into survivorship. Cancer-related stress and psychosocial resources-social support, optimism, positive affect, mastery, self-esteem, and mindfulness-were measured after diagnosis. As hypothesized, women who reported having more psychosocial resources showed weaker associations between stress and depressive symptoms and weaker associations between stress and inflammation-related depressive symptoms. Results highlight the importance of psychosocial resilience by demonstrating a relationship between psychosocial resources and sensitivity to inflammation-associated depressive symptoms.

Psychometric properties of the Perceived Social Support Questionnaire (PSSQ), a new measure of perceived social support among older adults

OBJECTIVE

Based on literature and available questionnaires, the present study aimed at creating and validating the Perceived Social Support Questionnaire (PSSQ): a 4-item scale assessing the perceived social support in older adults. Normative scores were also computed.

METHODS

Three hundred and two participants (mean age 87.68) selected from ongoing population-based studies completed a phone interview. Among these, 247 completed a second interview 4 months later allowing assessing the questionnaire fidelity over time.

RESULTS

The factor analysis evidenced two dimensions: availability of social support and satisfaction with it. Both dimensions had a satisfactory internal consistency but weak intraclass correlation coefficient. Univariate analyses revealed that age, number of calls per week and living environment marginally associated with the availability score. The satisfaction score was associated with perceived health status, sadness, depressive mood, feeling of loneliness, anxiety, and the perception of social support during the pandemic context. The norms computed were stratified on age.

CONCLUSIONS

The PSSQ is a short and easy-to-administer tool allowing assessing perceived social support in older population. Despite a weak fidelity that could actually be explained by changes in perceived social support over time, the questionnaire revealed good psychometric qualities and validity.

Trends and patterns of life satisfaction and its relationship with social support in Canada, 2009 to 2018

The present study aims to explore the trends and patterns of life satisfaction in Canada from 2009 to 2018 and to examine changes in the associations between social support and life satisfaction over time. Data were from ten annual Canadian Community Health Surveys (CCHS). Each survey represents 97% of the Canadian population. Point estimates and 95% confidence intervals (CIs) of life satisfaction were calculated at the population level. Generalized linear regression was used to explore the relationship between life satisfaction and social support both nationally and in different population subgroups. The annual life satisfaction score gradually increased both at national and provincial levels from 2009 to 2018. Individuals who were women, aged between 12 and 19 years, living in rural areas, were most satisfied with their lives. There was a positive correlation between social support and life satisfaction for the provinces and the study years for which information on social support was available. Our findings suggest strengthening social support could be a public health target for promoting greater life satisfaction. Timely availability and analysis of life satisfaction and social support data could better inform policy and promote wellbeing at a population level.

A Mixed Methods Study of Hearing Loss, Communication, and Social Engagement in a Group Care Setting for Older Adults

PURPOSE

The purpose of this study is to characterize the communication needs of older adults in group care environments and understand the factors that foster engaged communication.

METHOD

This mixed methods study provides an in-depth analysis of communication and engagement for older adults at two Program for All-inclusive Care for the Elderly (PACE) sites. Seventy-two PACE participants (M _age = 74 years) completed a hearing test, cognitive screener (MOST^™), the Institute of Medicine (IOM) Measures of Social and Behavioral Determinants of Health Questionnaire, and the UCLA Loneliness Scale. Using maximum variation sampling based on hearing status and UCLA Loneliness scores, 19 participants were invited to do (and 11 participants completed) one-on-one semi-structured interviews. In addition, 35 staff members participated in 5 focus groups. Field observations were interspersed throughout the data collection period.

RESULTS

Results suggest that communication challenges such as hearing loss, cognitive decline, and social isolation are highly prevalent in this convenience sample. Sixty-seven percent have at least a mild hearing loss in the better hearing ear. Eighty-two percent scored in the "very" or "most isolated" range of the IOM Measures of Social and Behavioral Determinants of Health questionnaire. The mean score on the MOST^™ cognitive screener was 17.6, which is below the dementia screening cutoff score of 18 points. A thematic analysis of the qualitative data suggests that the PACE programs support socialization and engagement. A conceptual framework was developed by integrating quantitative and qualitative findings to recognize what contributes to meaningful interactions or engaged communication.

CONCLUSION

Identifying communication challenges can enhance the benefits individuals can experience at care facilities and lessen the burden of the staff members trying to provide safe and effective care. In order to maximize the potential benefit of attending group-based day centers, the communication challenges and motivations of older adults need to be addressed.

Nutrition risk prevalence and associated health and social risk factors in Māori and non-Māori: Results from the New Zealand Health, Work and Retirement Study

OBJECTIVE

To determine the nutrition risk prevalence and associated health and social risk factors amongst community-living Māori and non-Māori older adults in New Zealand.

METHODS

As part of the 2014 Health, Work and Retirement postal survey, 2914 community-living older adults (749 Māori) aged 49-87 years completed the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II-AB) to determine nutrition risk status and sociodemographic and health measures.

RESULTS

Half (50.2%) of Māori and 32.7% of non-Māori were at nutrition risk. Independent risk factors were as follows: for Māori, being unpartnered and rating general health as fair, and for non-Māori, being unpartnered and rating general health as fair or poor, lower life satisfaction, higher number of health conditions and emotional loneliness.

CONCLUSIONS

Findings highlight the need for culturally appropriate intervention strategies, which provide opportunity for older adults to eat with others, especially for those who are unpartnered and lonely.

Changes in Psychosocial Resources as Predictors of Posttraumatic Growth: A Longitudinal Study of Low-Income, Female Hurricane Katrina Survivors

This study examined how well the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996) corresponds with self-reported pre- to posttrauma changes in related constructs, including sense of purpose in life, religiosity, and social support. Participants were 328 low-income mothers (85.2% non-Hispanic Black) who survived Hurricane Katrina and completed surveys approximately 1 year predisaster (Time 1), 4 years postdisaster (Time 2), and 12 years postdisaster (Time 3). PTG was assessed at Time 2 and Time 3, and related constructs were assessed at all waves. Pre- to postdisaster changes in the following related constructs were significantly associated with the corresponding PTGI subscales: purpose in life with Relating to Others, Personal Strength, and New Possibilities; religiosity with Spiritual Change; and perceived social support with Relating to Others. The results demonstrate a link between a number of self-reported pre- to posttrauma psychological changes measured over time and the PTGI. Replication of these results using measures more closely aligned to the PTGI subscales, among more representative samples and in the aftermath of other traumatic events, is warranted.

Development and Psychometric Testing of the Mental Health Scale for Childrearing Fathers

The mental health of fathers influences the development of children and the functioning of families significantly. However, there is no useful scale for the mental health screening of childrearing fathers. This study developed a Mental Health Scale for Childrearing Fathers (MSCF) and determined its reliability and validity. Childrearing fathers are working fathers who co-parent with their spouses. This survey was conducted in two stages: a pilot study and a main survey. Data were obtained from 98 fathers raising preschoolers in the pilot study and 306 fathers in the main survey. The collected data were used to confirm the construct validity, criterion-related validity, convergent validity, and internal consistency reliability. The final MSCF consisted of 25 items comprising four factors: peaceful familial connection, healthy mind and body, satisfying paternal alliances, and leading a meaningful life as a parent. The internal consistency reliability estimated using Cronbach's alpha coefficient for the total scale was 0.918. The validity of the MSCF was logically secured using a confirmatory factor analysis. The MSCF can be an effective tool for mental health screening among fathers in relation to the burden of childrearing during regular infant health checks.

Does Psychological Capital Mediate Occupational Stress and Coping Among Nurses in ICU

As an exploitable positive psychological state that individual performs during growth and development processes, psychological capital (PsyCap) was deemed as an essential factor in occupational health. This study aims to explore mediating effects of PsyCap on the relationship between job stress and coping style among ICU nurses. A cross-sectional sample of 288 nurses was recruited. A high-level of occupational stress (2.32 ± 0.69) and PsyCap (4.62 ± 0.93) were found among participants who mainly used a positive coping style (2.04 ± 0.59). PsyCap was significantly negatively correlated with job stress (β = -0.250; p < .01) and positively with coping style (β = 0.416; p < .01). Structural equation model analysis revealed that job stress negatively influenced PsyCap, while PsyCap positively influenced coping style. Results verified the mediating role of PsyCap and suggested that an increase in PsyCap contributes to better control of job stress and the improvement of one's coping style.

Gray Matter Volume Covariance Networks, Social Support, and Cognition in Older Adults

OBJECTIVE

We examined the neural substrates of social support in older adults. Social support is associated with better outcomes in many facets of aging-including cognitive and functional health-but the underlying neural substrates remain largely unexplored.

METHODS

Voxel-based morphometry and multivariate statistics were used to identify gray matter volume covariance networks associated with social support in 112 older adults without dementia (M age = 74.6 years, 50% female), using the Medical Outcomes Study Social Support Survey.

RESULTS

A gray matter network associated with overall social support was identified and included prefrontal, hippocampal, amygdala, cingulate, and thalamic regions. A gray matter network specifically associated with tangible social support (e.g., someone to help you if you were confined to bed) was also identified, included prefrontal, hippocampal, cingulate, insular, and thalamic regions, and correlated with memory and executive function.

DISCUSSION

Gray matter networks associated with overall and tangible social support in this study were composed of regions previously associated with memory, executive function, aging, and dementia. Longitudinal research of the interrelationships between social support, brain structure, and cognition is needed, but strengthening social support may represent a new path toward improving cognition in aging that should be explored.

Social trust and emotional health in rural older adults in China: the mediating and moderating role of subjective well-being and subjective social status

BACKGROUND

China is becoming an aging society. The emotional health of the elderly is gaining importance. Social trust is an important factor affecting emotional health, but existing studies have rarely considered the various effects of different types of social trust on rural elderly emotional health. Few studies have analysed the role of subjective well-being and subjective social status in the relationship between social trust and elderly emotional health.

METHODS

Using the data of the China Labor-force Dynamics Survey 2016 (CLDS 2016) and regression models, this study selected 2084 rural respondents aged 60 years and above to analyse the impact of social trust on their emotional health. Social trust was divided into three categories: trust in family members, trust in friends, and trust in neighbours. This study also examined the mediating and moderating effects of subjective well-being and subjective social status on the relationship between social trust and emotional health.

RESULTS

Trust in family members was significantly and positively associated with emotional health (coefficient = 0.194, P < 0.01) and subjective well-being (coefficient = 0.177, P < 0.01). Trust in friends was significantly and positively associated with emotional health and subjective well-being (coefficient = 0.097, P < 0.01; coefficient = 0.174, P < 0.01, respectively). Trust in neighbours was significantly and positively associated with emotional health and subjective well-being (coefficient = 0.088, P < 0.01; coefficient = 0.177, P < 0.01; respectively). Subjective well-being effectively reduced the impact of social trust in family, friends, and neighbours on the emotional health of the elderly by 0.023, 0.022, and 0.023, respectively. Trust in friends and neighbours significantly and positively affected respondents' subjective social status (coefficient = 0.120, P < 0.05; coefficient = 0.090, P < 0.10; respectively). Subjective social status effectively reduced the impact of social trust in friends and neighbours on the emotional health of the elderly both by 0.004. The positive relationship between trust in family members and emotional health is weakened by subjective well-being.

CONCLUSIONS

Social trust, especially family relationships, play an important role in maintaining the emotional health of the rural elderly. In response to population ageing, more social policies must be introduced to care for the rural elderly and help them lead a happy and satisfactory life.

Loneliness Among Cognitively Intact Residents of Nursing Homes With and Without Cancer: A 6-Year Longitudinal Study

Limited information exists regarding the natural development of loneliness and its determinants among cognitively intact nursing home residents. We aimed to examine loneliness among nursing home residents by following up for 6 years and to determine whether sociodemographic factors, diagnosis of cancer, sense of coherence, social support, and depression symptoms influence loneliness. The study was longitudinal and prospective and included baseline assessment and 6-year follow-up. After baseline assessment of 227 cognitively intact nursing home residents (Clinical Dementia Rating score ≤0.5), 52 respondents were interviewed a second time at the 5-year follow-up and 18 respondents a third time at the 6-year follow-up. Data from the interviews were recorded using a global question of loneliness, the Social Provisions Scale, Sense of Coherence Scale, and Geriatric Depression Scale. Scores on Groll’s index (p = .02) and the Sense of Coherence Scale (p = .04) were positively correlated with loneliness and negatively correlated with geriatric depression (p = .001). Having a diagnosis of cancer, social support, and age were not correlated with loneliness 6 years from baseline. Loneliness did not change during the 6 years of follow-up, and symptoms of depression and the sense of coherence appeared to be important components of loneliness. Finally, having a diagnosis of cancer and social support were not associated with loneliness.

Coping, life stress, and psychological and somatic distress

Theory and research have focused on the relationships among coping processes, stressful life events, and psychological and physical distress. This study was designed to examine the relationship of stressful life events and three styles of coping—emotion oriented, task oriented, and avoidance oriented—to physical and psychological distress. Questionnaires measuring coping styles, recent life stressors, and both physical symptoms and psychological symptoms were completed by 205 undergraduates (101 males and 104 females). It was hypothesized that task‐oriented coping would negatively predict distress and that emotion‐oriented coping would positively predict distress. The relationships of two types of avoidance‐oriented coping (distraction and social diversion) to distress were also examined. Multiple regression analyses revealed that task‐oriented coping was negatively related to distress, but only for males. Emotion‐oriented coping was significantly positively predictive of distress for both males and females. The two subcomponents of avoidance‐oriented coping—distraction and social diversion—were differentially related to measures of distress. Life event stress positively predicted distress, both as an independent contributor of variance and in interaction with several coping styles.

Identification, Trend Analysis and Influencing Factors of Mental Health Status of the Chinese Older Adults

This study aimed to analyse the classification, development trends and the influencing factors of the Chinese older adults’ mental health state. Based on longitudinal data of Chinese older adults from 2005 to 2014, 2077 older adults aged 64 to 105 were included and the Latent Class Model, Latent Growth Mixture Model and Multinomial Logit models were employed in this study. We find that there are three types of mental health state of the Chinese older adults: negative, positive and contradictory; and the contradictory type could easily turn into negative or positive mental health state. There are four types of dynamic trends of mental health state: persistently negative, persistently positive, pro-negative, and pro-positive. About 40% of the older adults could maintain positive mental health state, and the pro-negative accounts for larger proportion than the pro-positive. Better economic status, good living habits, cohabitation with family members and pension coverage are beneficial for positive mental health state of the Chinese older adults. There is significant heterogeneity in the state as well as development trends of mental health of the older adults. The older adults with contradictory and negative types of mental health state should get timely psychological help to avoid turning into negative state. A series of polices are needed to promote mental health for the older adults in China.

Emotion regulation processes as mediators of the impact of past life events on older adults' psychological distress

OBJECTIVE

Although it is known that certain emotion regulation processes produce a buffering effect on the relationship between life events and well-being, this issue has been poorly studied in the elderly population. Thus, the aim of the present study is to test and confirm a comprehensive model of the impact that past life events have on older adults' psychological distress, exploring the possible mediating roles of emotion regulation processes. These include rumination, experiential avoidance, and personal growth.

METHODS

In this cross-sectional study, 387 people over 60 years old residing in the community were assessed on life events, physical functioning, emotion regulation variables, psychological well-being, as well as symptoms of anxiety and depression.

RESULTS

The structural model tested achieved a satisfactory fit to the data, explaining 73% of the variance of older adults' psychological distress. In addition, the main results suggest possible mediation effects of both the physical functioning and the emotional variables: rumination, experiential avoidance, and personal growth in the face of hardship.

CONCLUSIONS

These findings confirm the importance of emotion regulation processes in the final stages of life. They reveal the various adaptive and maladaptive mechanisms that underlie the relationship between life events and psychological distress. The findings suggest - both in the explanatory models of psychological well-being and in psychotherapeutic interventions - the importance of emotion regulation in the elderly population's health.

Functional deficits and other psychiatric associations with abnormal scores on the Montreal Cognitive Assessment (MoCA) in older HIV-infected patients

OBJECTIVE

The authors assessed the association of physical function, social variables, functional status, and psychiatric co-morbidity with cognitive function among older HIV-infected adults.

DESIGN

From 2012-2014, a cross-sectional study was conducted among HIV-infected patients ages 50 or older who underwent comprehensive clinical geriatric assessment.

SETTING

Two San Francisco HIV clinics.

PARTICIPANTS

359 HIV-infected patients age 50 years or older.

MEASUREMENTS

Unadjusted and adjusted Poisson regression measured prevalence ratios and 95% confidence intervals for demographic, functional and psychiatric variables and their association with cognitive impairment using a Montreal Cognitive Assessment (MoCA) score < 26 as reflective of cognitive impairment.

RESULTS

Thirty-four percent of participants had a MoCA score of < 26. In unadjusted analyses, the following variables were significantly associated with an abnormal MoCA score: born female, not identifying as homosexual, non-white race, high school or less educational attainment, annual income < $10,000, tobacco use, slower gait speed, reported problems with balance, and poor social support. In subsequent adjusted analysis, the following variables were significantly associated with an abnormal MoCA score: not identifying as homosexual, non-white race, longer 4-meter walk time, and poor social support. Psychiatric symptoms of depressive, anxiety, and post-traumatic stress disorders did not correlate with abnormal MoCA scores.

CONCLUSIONS

Cognitive impairment remains common in older HIV-infected patients. Counter to expectations, co-morbid psychiatric symptoms were not associated with cognitive impairment, suggesting that cognitive impairment in this sample may be due to neurocognitive disorders, not due to other psychiatric illness. The other conditions associated with cognitive impairment in this sample may warrant separate clinical and social interventions to optimize patient outcomes.

A mixed-methods case study exploring the impact of participation in community activity groups for older adults on physical activity, health and wellbeing

BACKGROUND

Regular physical activity (PA) has many health benefits but declines with age. Community multi-activity groups offering volunteer-led socially-oriented activity programs could provide an opportunity for older people to maintain or increase PA levels and promote their health. The aim of this study was to examine the potential effect of becoming a member of an existing community activity group on PA levels, physical and mental health-related quality of life (HR QoL), comparing any impacts associated with participation in physical activity or social activity programs.

METHODS

This mixed-methods case study, combining a longitudinal quantitative-survey with qualitative focus groups to contextualise the survey results, focused on an Australian community organisation called Life Activities Clubs (LACs). LACs provide various physical activities (e.g. walking, cycling, dancing) and social activities (e.g. book groups, dine-outs, craft). Data were collected using a self-report survey administered at baseline, six and twelve-months after joining and group differences between participants of PA programs (PA group) and social programs (social group) were analysed using linear mixed-models. Two focus groups with LAC members were held, one representing each activity type and analysed using content and thematic analysis.

RESULTS

35 people (mean age 67) completed the surveys and 11 people participated in the focus groups. PA levels and physical health-related QoL were maintained over 1 year in the PA group, and declined between baseline and 12-months in the social group. Focus groups suggested social aspects of PA programs increased motivation to maintain regular attendance and do more PA than participants would on their own and that physical activities provided health benefits. Mental HR QoL did not change in either group, focus groups suggested this was because the social aspects of both types of program provide benefits relating to mental health including stress relief, enjoyment and adapting to major life events, to prevent a decline in QoL.

CONCLUSIONS

Community PA programs appear to maintain PA levels and physical HR QoL in older adults, and both social and PA programs may maintain mental HR QoL. Incorporating both types of program into one organisation may also encourage less physically active members to try physical activities.

Connor-Davidson Resilience Scale: validation study in a Portuguese sample

OBJECTIVE

The objective of this paper was to evaluate the structural validity and convergent validity of the first Portuguese version of the Connor-Davidson Resilience Scale (CD-RISC).

SETTINGS

The data sets come from two studies conducted in Portugal, respectively, from the Resilience Effect in Coping with Trauma (RECT) project and from the Health Impact Assessment of Employment Strategies (HIAES) project.

PARTICIPANTS

The sample is composed of 476 participants from the RECT project and 405 participants from the HIAES project. In both projects, convenience samples were used.

MEASURES

The original CD-RISC items were translated to Portuguese and were used in a survey along with additional psychosocial and biomedical measures.

RESULTS

Independent exploratory factorial analysis (EFA) with each of the two samples revealed that the best solution in both samples had three factors consistent with the self-efficacy, spirituality and social support factors from the original scale. A Confirmatory factor analysis using the two samples together and specifying the three factors from the EFA revealed a good overall fit and, comparatively, better fit than a model specified with the five factors from the original scale. The study of the convergent validity revealed that bivariate correlations between the three factors and validated measures of stress, life satisfaction, mental health and physical health are globally consistent with previous research.

CONCLUSIONS

This study makes available to the broad Community of Portuguese Language Countries a validated measure of resilience extensively used for research and intervention. The results encourage future studies using this translated version of CD-RISC to explore further the three-factor structure found here and to test the convergent validity with new samples.

Working with women who use force: a feasibility study protocol of the Positive (+)SHIFT group work programme in Australia

INTRODUCTION

This study assesses the feasibility of the Positive Shift (+SHIFT) programme in the context of legal responses and social welfare provision in the state of Victoria, Australia.The +SHIFT programme, adapted from the Vista curriculum, is a group work and case management programme for women who use force. Building on traditional survivor support group strengths, the programme facilitates participants' engagement with viable alternatives to force while promoting healing. The study also aims to increase understanding about the characteristics and needs of women who use force in Australia.

METHODS AND ANALYSIS

This feasibility study will assess the +SHIFT programme's appropriateness in addressing women's use of force in the Victorian context. Process evaluation will be undertaken to identify recruitment, retention, women's participation, barriers to implementation, the appropriateness of proposed outcome measures and other issues. The feasibility of an outcome evaluation which would employ a longitudinal mixed methods design with measures administered at preprogramme, programme completion and 3 months postprogramme time points, along with semistructured interviews with participants, programme staff and referring professionals, will also be assessed.

ETHICS AND DISSEMINATION

Research ethics approval was obtained from the University of Melbourne Human Research Ethics Committee. Results of the study will be communicated to the programme providers as part of the action research process evaluation methodology. On completion, final results will be reported to programme providers and funding bodies, and published in academic journals and presented at national and international conferences.

Protocol for a quasi-experimental study of the effectiveness and cost-effectiveness of mother and baby units compared with general psychiatric inpatient wards and crisis resolution team services (The ESMI study) in the provision of care for women in the postpartum period

INTRODUCTION

Research into what constitutes the best and most effective care for women with an acute severe postpartum mental disorder is lacking. The effectiveness and cost-effectiveness of psychiatric mother and baby units (MBUs) has not been investigated systematically and there has been no direct comparison of the outcomes of mothers and infants admitted to these units, compared with those accessing generic acute psychiatric wards or crisis resolution teams (CRTs). Our primary hypothesis is that women with an acute psychiatric disorder, in the first year after giving birth, admitted to MBUs are significantly less likely to be readmitted to acute care (an MBU, CRTs or generic acute ward) in the year following discharge than women admitted to generic acute wards or cared for by CRTs.

METHODS AND ANALYSIS

Quasi-experimental study of women accessing different types of acute psychiatric services in the first year after childbirth. Analysis of the primary outcome will be compared across the three service types, at 1-year postdischarge. Cost-effectiveness will be compared across the three service types, at 1-month and 1-year postdischarge; explored in terms of quality-adjusted life years. Secondary outcomes include unmet needs, service satisfaction, maternal adjustment, quality of mother-infant interaction. Outcomes will be analysed using propensity scoring to account for systematic differences between MBU and non-MBU participants. Analyses will take place separately within strata, defined by the propensity score, and estimates pooled to produce an average treatment effect with weights to account for cohort attrition.

ETHICS AND DISSEMINATION

The study has National Health Service (NHS) Ethics Approval and NHS Trust Research and Development approvals. The study has produced protocols on safeguarding maternal/child welfare. With input from our lived experience group, we have developed a dissemination strategy for academics/policy-makers/public.

Online Positive Affect Journaling in the Improvement of Mental Distress and Well-Being in General Medical Patients With Elevated Anxiety Symptoms: A Preliminary Randomized Controlled Trial

BACKGROUND

Positive affect journaling (PAJ), an emotion-focused self-regulation intervention, has been associated with positive outcomes among medical populations. It may be adapted for Web-based dissemination to address a need for scalable, evidence-based psychosocial interventions among distressed patients with medical conditions.

OBJECTIVE

This study aimed to examine the impact of a 12-week Web-based PAJ intervention on psychological distress and quality of life in general medical patients.

METHODS

A total of 70 adults with various medical conditions and elevated anxiety symptoms were recruited from local clinics and randomly assigned to a Web-based PAJ intervention (n=35) or usual care (n=35). The intervention group completed 15-min Web-based PAJ sessions on 3 days each week for 12 weeks. At baseline and the end of months 1 through 3, surveys of psychological, interpersonal, and physical well-being were completed.

RESULTS

Patients evidenced moderate sustained adherence to Web-based intervention. PAJ was associated with decreased mental distress and increased well-being relative to baseline. PAJ was also associated with less depressive symptoms and anxiety after 1 month and greater resilience after the first and second month, relative to usual care.

CONCLUSIONS

Web-based PAJ may serve as an effective intervention for mitigating mental distress, increasing well-being, and enhancing physical functioning among medical populations. PAJ may be integrated into routine medical care to improve quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01873599; https://clinicaltrials.gov/ct2/show/NCT01873599 (Archived by WebCite at http://www.webcitation.org/73ZGFzD2Z).

Social Stratification and Risk for Cardiovascular Disease: Examination of Emotional Suppression as a Pathway to Risk

This article examines whether emotional suppression is associated with socioeconomic position (SEP) in a community sample of Black and White men, and whether emotional suppression may help explain the aggregation of multiple biopsychosocial risk factors for cardiovascular disease at lower SEP (social support, depression, cardiovascular stress reactivity). Aim 1 tests whether multiple indicators of SEP show a consistent graded association with self-reported trait suppression, and whether suppression mediates associations between SEP and perceived social support and depressive affect. Aim 2 tests whether suppression during a laboratory anger recall task mediates associations between SEP and cardiovascular reactivity to the task. All measures of higher SEP were associated with lower suppression. Findings in this racially diverse sample of adult men suggest that socioeconomic disparities in emotional suppression may be more likely to confer cardiovascular risk through disruption of affect and social relationships, than through direct and immediate physiological pathways.

Associations between the dimensions of perceived togetherness, loneliness, and depressive symptoms among older Finnish people

OBJECTIVES

We studied the associations between perceived togetherness, depressive symptoms, and loneliness over a six-month period among 222 people aged 75-79 who reported loneliness or depressive mood at baseline.

METHOD

The present cross-lagged models utilized baseline and six-month follow-up data of a randomized controlled trial that examined the effects of a social intervention on loneliness and depression (ISRCTN78426775). Dimensions of perceived togetherness, i.e. attachment, social integration, guidance, alliance, nurturance, and reassurance of worth, were measured with the Social Provisions Scale, depressive symptoms with a short form of the Geriatric Depression Scale, and loneliness with a single item.

RESULTS

After controlling for baseline loneliness and depressive symptoms, baseline higher attachment in all participants and baseline higher opportunity for nurturance in the social intervention group predicted lower depressive mood at follow-up. No cross-lagged associations between the dimensions of perceived togetherness at baseline and loneliness at follow-up were observed. In addition, depressive symptoms and loneliness at baseline tended to negatively predict the dimensions of perceived togetherness at follow-up.

DISCUSSION

Depressive symptoms and loneliness appear to be precursor for perceived togetherness, rather than dimensions of perceived togetherness to be antecedents of loneliness and depressiveness among older people.

Gender of children and social provisions as predictors of unplanned pregnancies in Pakistan: a cross-sectional survey

OBJECTIVE

Previous research indicates that attitudes to pregnancy and motherhood are influenced by social values, culture and religion. This study explores the relationship between social support and unwanted pregnancy among Pakistani women. This cross-sectional study was conducted at four teaching hospitals in Lahore in 2014.

RESULTS

A total of 500 pregnant women who visited the hospitals' obstetrics and gynecology departments were asked to respond to a questionnaire consisting of respondents' characteristics and the Social Provisions Scale (SPS). Logistic regression analyzed the predictors of unplanned pregnancy. Unwanted pregnancies were more likely to occur among pregnant women from rural areas, with low scores on the SPS 'reassurance of worth' sub-scale, no history of contraceptive use, and who already had at least one son than those with no sons.

The Aging Narcissus: Just a Myth? Narcissism Moderates the Age-Loneliness Relationship in Older Age

Objective: Recent research has indicated that sub-clinical narcissism may be related to positive outcomes in respect of mental and physical health, and is positively related to an extended lifespan. Research has also indicated narcissism levels may decline over the lifespan of an individual. The aims of the present study were to investigate these issues, exploring age-related differences in levels and outcomes of narcissism. Specifically, narcissism's relationship with loneliness, a deleterious but pervasive state among older-age individuals, was assessed. Methods: A total of 100 middle-aged (MAGE = 48.07; SD = 5.27; 53% female) and 100 older-aged participants (MAGE = 70.89; SD = 5.97; 51% female) completed the 40-item Narcissistic Personality Inventory and the UCLA Loneliness Scale, Version 3. Results: Older-age participants had significantly lower levels of narcissism, and significantly higher levels of loneliness than middle-aged participants. Age and narcissism significantly predicted self-reported loneliness levels, with narcissism moderating the relationship between age and loneliness. Conclusion: This study supports existing work, indicating that a degree of narcissism is of benefit to psychological functioning in respect of age-related loneliness, and is found to be a protective factor in mental health.

Moderators of Stress in Salvadoran Refugees: The Role of Social and Personal Resources

Refugee research has tended to focus exclusively on the mental health consequences of migration with little attention being devoted to factors that facilitate adjustment. Recently, several cross-cultural researchers have suggested that the growing literature on moderators of stress may elucidate why some migrants experience adverse effects whereas others remain relatively unscathed. This study examines the moderating effects of social and personal resources on the relationship between stress and subjective well-being in 60 recently-arrived and 60 established Salvadoran refugees in Canada. The participants completed a questionnaire that included scales pertaining to stress (life events, hassles, migration-related events), resources (social support, locus of control, self-esteem) and well-being (quality of life, life satisfaction). Varying results were found for both groups. For Recent Refugees, personal resources were found to moderate migration stress. In particular, locus of control buffered the relationships between migration stress and quality of life and life satisfaction, whereas self-esteem buffered the migration stress-quality of life relation. For Established Refugees, social support and self-esteem moderated the relationship between life events and life satisfaction. In addition, social support buffered the effects of hassles on quality of life. The findings underscore the relevance of integrating more firmly the study of refugee adjustment with current developments in stress research.

The Social Provisions Scale: psychometric properties of the SPS-10 among participants in nature-based services

PURPOSE

This article analyses the psychometric properties of the Social Provisions Scale 10-items version.

METHODS

The Social Provisions Scale was analysed by means of the polytomous Rasch model, applied to data on 93 young adults (16-30 years) out of school or work, participating in different nature-based services, due to mental or drug-related problems.

RESULTS

The psychometric analysis concludes that the original scale has difficulties related to targeting and construct validity. In order to improve the psychometric properties, the scale was modified to include eight items measuring functional support. The modification was based on theoretical and statistical considerations.

CONCLUSION

After modifications the scale showed not only satisfying psychometric properties, but it also clarified uncertainties regarding construct validity of the measure. However, further analysis on larger samples are required. Implications for Rehabilitation Social support is important for a variety of rehabilitation outcomes and for different patient groups in the rehabilitation context, including people with mental health or drug-related problems. Social Provisions Scale may be used as a screening tool to assess social support of participants in rehabilitation, and the scale may also be an important instrument in rehabilitation research. There might be issues measuring structural support using a 10-items version of the Social Provisions Scale but it seemed to work well as an 8-item scale measuring functional support.

Social Support and Its Impact on Ethnic Identity and HIV Risk among Migrant Workers

Migrant workers are disproportionately affected by HIV due to poverty, social isolation, lack of access to and availability of health care services, acculturation, language barriers, constant mobility, and lack of knowledge. This study examined the impact of changes in social support on ethnic identity and HIV risk behaviors among migrant workers in South Florida. For this study, baseline and 6-month follow-up data were collected from an HIV intervention study among migrant workers in South Florida (n = 270) who reported unprotected sex in the past 30 days. The Multigroup Identity Measure was used to assess ethnic identity and the Social Provisions Scale examined the degree to which respondents' social relationships provide various dimensions of social support. Social support was a significant predictor of ethnic identity and of ethnic identity subscales, ethnic identity belonging and ethnic identity explore. There were small but statistically significant short-term changes in ethnic identity and ethnic identity subscales among the migrant workers over the 6-month time period assessed after controlling for the intervention. Future studies should be conducted over a longer period of time to better assess this relationship and possible factors to reduce HIV risk behaviors. There is a need to focus on improving the quality of health and reduce HIV and other risks experienced by this marginalized community.

Food Insecurity and Aging Outcomes in Older Adults Living with HIV

Little is known about food insecurity and its association with geriatric outcomes in older people living with HIV (PLWH). This was a cross-sectional study of 230 HIV-infected patients aged 50 and older recruited in December 2012 through June 2016. Poisson logistic regression models estimated the prevalence ratio (PR) and 95% confidence intervals (CI) for the association between food insecurity and the following geriatric outcomes: frailty, physical health and function, social support, mental health and cognition, and behavioral health. 157 (68%) participants were food secure, 35 (15%) had low food security, and 38 (17%) had very low food security. After adjusting the analyses for other significant covariates, at risk alcohol or drug use (PR = 3.14; 95% CI 1.75-5.64), being sedentary (PR = 3.30; 95% CI 1.09-10.00) depressive symptoms (PR = 1.77; 95% CI 1.13-2.76), and dependent instrumental activities of daily living (PR = 2.46; 95% CI 1.13-5.36) were significantly associated with very low food security. These results highlight a need for structural HIV interventions that incorporate targeted food assistance strategies for older PLWH.

Harnessing Peer Support in an Online Intervention for Older Adults with Depression

OBJECTIVE

This pilot study evaluated the feasibility and efficacy of two methods of delivering a cognitive behaviorally informed Internet intervention for depression for adults 65 years and older.

METHODS

Forty-seven participants were enrolled and assigned to receive one of two versions of the Internet intervention, either delivered individually (III) or with peer support (II+PS), or to a wait list control group (WLC). Primary outcomes included change in depressive symptoms from baseline to post-intervention (week 8), site use, self-reported usability, and coach time. Secondary outcomes included measures of social support and isolation and anxiety.

RESULTS

Follow-up data were provided by 85.1% (40 of 47) of enrolled participants. There were significant differences in depression change across groups (F_(2,37) = 3.81, p = 0.03). Greater reductions in depressive symptoms were found for the III (p = 0.02) and II+PS (p = 0.03) compared with WLC, and significantly less coach time was required in the II+PS (p = 0.003).

CONCLUSIONS

These results highlight the potential of cognitive-behaviorally informed Internet interventions for older adults with depression, and indicate that peer-supported programs are both acceptable and equivalent to individually delivered Internet interventions. Including peer support may be a viable and potentially more cost-effective option for disseminating online treatments for depression for older adults.

Cognitive Benefits of Online Social Networking for Healthy Older Adults

Objectives

Research suggests that older adults who remain socially active and cognitively engaged have better cognitive function than those who are isolated and disengaged. This study examined the efficacy of learning and using an online social networking website, Facebook.com, as an intervention to maintain or enhance cognitive function in older adults.

Method

Forty-one older adults were assigned to learn and use Facebook (n = 14) or an online diary website (active control, n = 13) for 8 weeks or placed on a waitlist (n = 14). Outcome measures included neuropsychological tests of executive functions, memory, and processing speed and self-report questionnaires about social engagement.

Results

The Facebook group showed a significant increase in a composite measure of updating, an executive function factor associated with complex working memory tasks, compared to no significant change in the control groups. Other measures of cognitive function and social support showed no differential improvement in the Facebook group.

Discussion

Learning and using an online social networking site may provide specific benefits for complex working memory in a group of healthy older adults. This may reflect the particular cognitive demands associated with online social networking and/or the benefits of social engagement more generally.

Geriatric Assessments and Association With VACS Index Among HIV-Infected Older Adults in San Francisco

OBJECTIVES

To perform geriatric assessments in older HIV-infected adults in San Francisco and examine the association with age and the Veterans Aging Cohort Study (VACS) index scores.

METHODS

A cross-sectional study was conducted from 2012 to 2014 among HIV-infected patients ≥50 years at 2 San Francisco-based HIV clinics. We evaluated 4 health domains: (1) physical health and function (activities of daily living), instrumental activities of daily living (IADL), falls, gait speed, (2) social support (physical and perceived support, loneliness), (3) mental health (depression, anxiety, posttraumatic stress disorder) and cognition, and (4) behavioral and general health (antiretroviral adherence and quality of life). Contingency table and rank-sum analyses examined associations between these domains with age and VACS index scores.

RESULTS

Three hundred fifty-nine patients completed assessments (median age 57; 85% male; 57% white; 72% >high school education). On functional assessment, 39% reported dependence with ≥1 IADL, and 40% reported falls in the previous year. Fifty-eight percent experienced loneliness, 60% the lowest levels of perceived social support, 55% depression, and 12% posttraumatic stress disorder. Forty percent had possible mild cognitive impairment. Thirty percent reported poor or fair quality of life. Older age was associated with lower CD4 counts, balance problems, slower gait, lower anxiety, poorer general health, and higher antiretroviral adherence. VACS Index score was associated with dependence in ≥1 IADL and antiretroviral adherence.

CONCLUSION

In a large sample of older HIV-infected adults, multiple significant aging-related conditions were identified. Integrating geriatric assessment tools into HIV/AIDS clinical care may help target interventions to optimize clinical care and quality of life for older HIV-infected individuals.

Regional Brain Volumes Moderate, but Do Not Mediate, the Effects of Group-Based Exercise Training on Reductions in Loneliness in Older Adults

Introduction: Despite the prevalence of and negative health consequences associated with perceived loneliness in older adults, few studies have examined interactions among behavioral, psychosocial, and neural mechanisms. Research suggests that physical activity and improvements in perceived social support and stress are related to reductions in loneliness. Yet, the influence of brain structure on these changes is unknown. The present study examined whether change in regional brain volume mediated the effects of changes in social support and stress on change in perceived loneliness after an exercise intervention. We also examined the extent to which baseline brain volumes moderated the relationship between changes in social support, stress, and loneliness. Methods: Participants were 247 older adults (65.4 ± 4.6 years-old) enrolled in a 6-month randomized controlled trial comprised of four exercise conditions: Dance (n = 69), Strength/Stretching/Stability (n = 70), Walk (n = 54), and Walk Plus (n = 54). All groups met for 1 h, three times weekly. Participants completed questionnaires assessing perceived social support, stress, and loneliness at baseline and post-intervention. Regional brain volumes (amygdala, prefrontal cortex [PFC], hippocampus) before and after intervention were measured with automatic segmentation of each participant's T1-weighted structural MRI. Data were analyzed in a latent modeling framework. Results: Perceived social support increased (p = 0.003), while stress (p < 0.001), and loneliness (p = 0.001) decreased over the intervention. Increased social support directly (-0.63, p < 0.01) and indirectly, through decreased stress (-0.10, p = 0.02), predicted decreased loneliness. Changes in amygdala, PFC, and hippocampus volumes were unrelated to change in psychosocial variables (all p ≥ 0.44). However, individuals with larger baseline amygdalae experienced greater decreases in loneliness due to greater reductions in stress (0.35, p = 0.02). Further, individuals with larger baseline PFC volumes experienced greater reductions in stress due to greater increases in social support (-0.47, p = 0.02). No group differences in these pathways were observed. Conclusions: The social support environment and resulting reductions in stress, as opposed to exercise mode, may represent important features of exercise programs for improving older adults' perceived loneliness. As amygdala volume has been linked to anxiety, depression and impaired cognitive control processes in the PFC, moderation findings suggest further investigation in this area is warranted. Trial Registration: ClinicalTrials.gov identifier NCT01472744 (https://clinicaltrials.gov/ct2/show/NCT01472744?term=NCT01472744&rank=1).