Advancing social connection as a public health priority in the United States

Adverse changes in close social ties in aging women and men: A population-based longitudinal study of the CLSA (2011-2021)

Close social ties are important for health but these can decline as people age. Moreover, losses of close social ties may be worse for women, older age and low socioeconomic groups. We characterized alterations in both marital status or living arrangement over 6 years by gender, and assessed patterns by age, country of origin, geographic location, education, wealth, and household income. We used three waves of Canadian Longitudinal Study on Aging data on 25,327 adults (45-85 years at baseline) to construct transition variables and multinomial logistic regressions with post-estimated predicted probabilities. Close social ties were stable over time, with most Canadians remaining partnered (77 % of men and 62 % of women) or co-living (82 % of men and 72 % of women). Adverse close social ties over time were gendered and socially patterned, with women 75+ years and of low socioeconomic status (SES) having the greatest risks. Becoming widowed or remaining non-partnered was relatively more likely for women with oldest age (RRR range: 6.08-15.64) or with low SES (RRRs: 2.29-47.06), and for men with oldest age (RRRs: 1.07-8.77) or low SES (RRRs: 2.03-31.72). Becoming or remaining lone-living was relatively more likely for women of oldest age (RRRs: 5.57-8.72) or low SES (RRRs: 2.16-65.78) and also for men of oldest aged (RRRs: 2.33-2.57) or low SES (RRRs: 2.08-49.62). Tailored healthy aging strategies to foster close social connections of women or men in older and low SES groups seems warranted.

Alcohol Misuse, Marital Functioning and Marital Instability: An Evidence-Based Review on Intimate Partner Violence, Marital Satisfaction and Divorce

Alcohol use is a primarily social behavior, and marriage is an important aspect of social relationships. This article reviews alcohol use and its impact on several facets of the marital relationship, including the impact of alcohol use on intimate partner violence (IPV), marital satisfaction, marital functioning, and divorce. There is considerable evidence of the role alcohol plays in IPV and recent research identifies moderators of the alcohol-IPV relationship. These include personality constructs, social pressure, marital satisfaction, and traits, such as hostility and impulsivity. Marital satisfaction and alcohol use demonstrate bidirectional causality, whereas marital satisfaction predicts alcohol use behaviors, and alcohol use also predicts marital satisfaction. Longitudinal studies provide evidence that divorce is temporally associated with alcohol use, including Alcohol Use Disorder. Finally, there are a number of causative factors that interplay in the dissolution of marriage; alcohol use is one of these factors. Excessive alcohol consumption is a common reason for divorce among many couples. Across all associations between alcohol use and IPV, marital satisfaction, marital functioning, and divorce, sex and gender consistently appear as a moderator in these relationships. Another consistent finding is in respect to concordant drinking, such that marital partners who have similar patterns of alcohol consumption fare better than those with discrepant patterns of consumption. Future research should focus on greater inclusion of same-sex, LGBTQQ+, and socio-culturally diverse couples. Additionally, future studies should use Actor-Partner Interdependence Modeling (APIM) to effectively examine non-independent partner data.

Dance and Stress Regulation: A Multidisciplinary Narrative Review

BACKGROUND

Physical exercise is known to aid stress regulation, however the effects of specific exercise types are under-researched. Dance combines in a unique way several characteristics that are known to have stress regulatory effects, such as music listening. Nonetheless, dance has not received particular attention in investigations of its stress regulatory effects.

OBJECTIVE

We used a multidisciplinary narrative review as a novel approach to explore the complex relationship between dance and stress by integrating psychological, neurobiological, physiological, and socio-cultural findings. In particular, we looked at the effects of music and rhythm; partnering and social contact; and movement and physical activity.

FINDINGS

There is strong empirical evidence for the beneficial stress regulatory effects of music, social contact, and movement, illustrating that dance can promote coping and foster resilience. Neurobiological research shows that these findings can be explained by the effects that music, social contact, and movement have on, amongst others, dopamine, oxytocin, and β-endorphin modulation and their interplay with the stress system. Socio-cultural considerations of the significance of dance help to understand why dance might have these unique effects. They highlight that dance can be seen as a universal form of human expression, offering a communal space for bonding, healing and collective coping strategies.

DISCUSSION

This review is the first to integrate perspectives from different disciplines on the stress regulatory effects of dance. It shows that dance has a large potential to aid coping and resilience at multiple levels of the human experience. At the same time, we identified that the existing evidence is often still limited by a narrow focus on exercise characteristics like intensity levels. This hinders a more holistic understanding of underlying stress regulatory mechanisms and provides important directions for future research.

The impact of social isolation and loneliness on the well-being of carers of a person with dementia in aotearoa New Zealand

Dementia is a leading cause of disability, and as the population ages, there will be a greater need for friends and family to care for people with Dementia. Unfortunately, informal care for a person with dementia is associated with poor psychological and physical health and lower quality of life of the caregiver. The aim of the present study was to understand how to best support caregivers within their communities by examining their experience of loneliness, isolation, and their relationship with well-being. The study used a representative sample of the New Zealand population in terms of ethnicity, age, gender, education, and income and asked people if they were a primary caregiver of a person with Alzheimer's Disease or related disorder. Both loneliness and isolation were linked to overall well-being; however, loneliness was a stronger predictor of satisfaction with relationships and feeling part of one's community. The findings highlight the importance of examining the multi-factorial constructs of social connectedness and question research attributing loneliness solely to reduced social involvement. As such, interventions for caregivers of a person with dementia need to target feelings of loneliness as well as their social isolation.

I'll be there for you: The effects of exercise engagement on social support provision within undergraduate students' personal networks

Objective: To use social network analysis to examine exercise participation relative to health and wellness support provision within students' networks. Participants: 513 undergraduates from a large private university completed online surveys. Methods: Multilevel modeling assessed exercise engagement at the individual and dyadic level and support provision from network members. Results: More support was perceived by first and second-year students and individuals who reported more exercise engagement. Significant others, roommates, siblings, female network members, and those who exercised often provided greater support. Greater support was reported when both the participant and their social tie were involved in the campus group-exercise program. Conclusion: This study suggests individual and dyadic-level exercise was related to undergraduates feeling more supported. Findings support campus group exercise programs as opportunities to create reciprocal supportive ties for college students. Future research could further explore ways exercise and social support, particularly in group settings, affect health and well-being.

Loneliness, social isolation, and living alone: a comprehensive systematic review, meta-analysis, and meta-regression of mortality risks in older adults

Loneliness, social isolation, and living alone are significant risk factors for mortality, particularly in older adults. This systematic review and meta-analysis aimed to quantify their associations with all-cause and cause-specific mortality in older adults, broadening previous research by including more social factors. Comprehensive searches were conducted in PubMed, APA PsycINFO, and CINAHL until December 31, 2023, following PRISMA 2020 and MOOSE guidelines. Studies included were prospective cohort or longitudinal studies examining the relationship between loneliness, social isolation, living alone, and mortality. Quality was assessed using the Newcastle-Ottawa Scale. Meta-analyses used random-effects models with the Restricted Maximum Likelihood method. Subgroup and meta-regression analyses explored the relationships further. Of 11,964 identified studies, 86 met the inclusion criteria. Loneliness was associated with increased all-cause mortality (HR 1.14, 95% CI 1.10-1.18), with substantial heterogeneity (I² = 84.0%). Similar associations were found for social isolation (HR 1.35, 95% CI 1.27-1.43) and living alone (HR 1.21, 95% CI 1.13-1.30). Subgroup analyses revealed variations based on factors like sex, age, region, chronic diseases, and study quality. Meta-regression identified longer follow-up, female sex, validated social network indices, adjustments for cognitive function, and study quality as significant predictors of mortality risks. These findings highlight the need for public health interventions to address these social factors and improve health outcomes in older adults. However, further research is needed due to variability and heterogeneity across studies. Also studying the cumulative effect of these factors on mortality risks will be of considerable interest.

Reimagining psychosis prevention: responding to the accessibility issues of At-Risk Mental State (ARMS) services through a selective public health approach

At-Risk Mental State (ARMS) services aim to prevent the onset of first-episode psychosis (FEP) in those with specific clinical or genetic risk markers. In England, ARMS services are currently expanding, but the accessibility of this preventative approach remains questionable, especially for a subgroup of FEP patients and those from specific ethnic minority communities. This commentary outlines the key debates about why a complimentary approach to psychosis prevention is necessary, and gives details for an innovative public health strategy, drawing on existing research and health prevention theory.

Mental health perspectives on nonsuicidal self-injury and suicidality among intramural, club, and varsity women college athletes

Objective: This study explores rates and correlates of NSSI and suicidality of women college athletes, taking into consideration sport competition level (i.e., intramural, club, varsity). Participants: Data were drawn from self-identified women college athletes (n = 8,842) who participated in the Healthy Minds Study. Methods: Mental health correlates of NSSI and suicidality were assessed with logistic regression. Results: Approximately 19%-24% of the women college athlete sample reported past-year engagement in NSSI; 8%-10% reported suicidal ideation; 3%-4% reported suicidal planning; and 0.8%-1% reported attempted suicide. Rates of NSSI and suicidal ideation were relatively higher for club sports women college athletes. Clinical mental health concerns, substance use concerns, positive mental health, and interpersonal concerns were correlates of NSSI and suicidality, with variations observed across competition level. Conclusions: Findings spotlight the urgency to intervene in NSSI and suicidality among women college athletes while being informed of demographic, sport, and mental health risk factors.

ENGAGE-TBI: adaptation of a community-based intervention to improve social participation after brain injury

BACKGROUND

Social isolation is prevalent after traumatic brain injury (TBI) and has negative implications for health and well-being. Interventions targeting social participation show promise for reducing social isolation. We adapted a social participation intervention, ENGAGE, to meet the needs of people with TBI. ENGAGE relies on social learning and guided problem-solving to achieve social participation goals.

METHODS

This study was conducted in two phases. First, we conducted focus groups with 12 participants with TBI to inform adaptations. We then tested the adapted protocol (n = 6). Post-intervention interviews informed additional refinements. We collected preliminary data on feasibility and effects on social participation (Activity Card Sort, PROMIS Ability to Participate in Social Roles, PROMIS Satisfaction with Participation in Social Roles) and social isolation (PROMIS Social Isolation).

RESULTS

Intervention adaptations included simplified processes for developing goals and plans, simplified workbook materials, greater time for reflection on lessons learned, and expanded peer mentorship. ENGAGE-TBI resulted in high satisfaction for 80% of participants and high engagement in intervention for 100% of participants. Attendance and retention benchmarks were achieved. Improvements in social participation exceeded the minimal clinically important difference on all measures.

CONCLUSIONS

The promising preliminary data support further investigation into the feasibility and effects of ENGAGE-TBI.

Protecting Against Loneliness: The Mediating Role of Sense of Community

Loneliness is a growing public health concern that impacts individual's well-being. However, mechanisms that protect against the effects of loneliness have not been examined widely. Guided by prior literature documenting that loneliness and a sense of community are related, this study sought to test the mediating role of a sense of community on loneliness and well-being and the moderating role of gender. A sample of 2993 Korean adults completed an online survey regarding their sense of community, loneliness, and well-being. We conducted mediation and moderated mediation analyses. The mediation analysis revealed that sense of community mediates the relationship between loneliness and well-being suggesting that sense of community may be an important area for intervention. Analyses did not reveal gender differences in the relationship between loneliness and sense of community. The findings of this study may be important when considering the design of community-based interventions to address loneliness.

Successful Aging Across Middle Versus High-Income Countries: An Analysis of the Role of eHealth Literacy Associated With Loneliness and Well-Being

BACKGROUND AND OBJECTIVES

"Successful aging" concerns the process of growing older while maintaining physical, cognitive, and social well-being, emphasizing independence for overall satisfaction and quality of life. We investigate the impact of eHealth literacy on reducing loneliness and sustaining well-being during the pandemic, comparing middle- and high-income countries.

RESEARCH DESIGN AND METHODS

Online surveys were conducted between April 4, 2020, and September 30, 2021, collecting responses (N = 2,091) from medium- and high-income countries in Europe, Asia, and North America. T-tests and ANOVAs were used to test how sociodemographic predictors were associated with differences in e-Health literacy, loneliness, and well-being.

RESULTS

Respondents from high-income countries reported significantly higher well-being scores than those from middle-income countries and respondents from high-income countries had significantly higher e-HEALS (e-Health literacy) scores compared to middle-income countries. No significant difference was observed in loneliness scores between high-income and middle-income country respondents. Well-being is associated with age, with younger adults (18-29 years) and those aged 40+ reporting higher levels. Higher education and income are linked to greater well-being. Gender differences are observed, with females and those with a partner reporting higher well-being. In middle-income countries, higher education levels are more linked to loneliness, while in higher-income countries, loneliness is observed across education levels.

DISCUSSION AND IMPLICATIONS

Future interventions by governments and policymakers should consider intersectionality in e-Health planning and offer digital literacy and digital skills training to those with lower education levels.

The Role of Behavioral Factors on Chronic Diseases-Practice and Knowledge Gaps

Background: Behavioral factors, such as smoking, alcohol consumption, stress, poor diet, and physical inactivity, but also sleep deprivation and negative social connections, play a critical role in the development and progression of major chronic diseases. These include cardiovascular diseases, diabetes, chronic respiratory conditions, and cancers. Methods: The objective of this review is to explore the influence of these modifiable risk factors on the global burden of chronic diseases and assess the potential impact of public health interventions and policy changes. Results: The evidence highlights a significant association between behavioral risk factors and increased morbidity and mortality from chronic diseases. Public health interventions and policy changes targeting these modifiable behaviors have shown substantial potential in reducing the prevalence and impact of chronic conditions. Strategies such as smoking cessation programs, dietary improvements, physical activity promotion, and stress reduction are critical in mitigating these risks. Conclusions: Addressing modifiable behavioral factors is essential for the prevention and control of chronic diseases. Bridging the gap between current knowledge and effective implementation of interventions is crucial for improving population health outcomes. Public health strategies focused on modifying key behavioral risks can significantly reduce the burden of chronic diseases, thereby improving overall health and reducing healthcare costs.

Social connection and its prospective association with adolescent internalising and externalising symptoms: an exploratory cross-country study using retrospective harmonisation

BACKGROUND

Social connection factors play a key role for young people's mental health. It is important to understand how their influence may vary across contexts. We investigated structural (e.g. household size), functional (e.g. social support) and quality (e.g. feeling close) social connection factors in relation to adolescent internalising and externalising symptoms, comparing two countries Brazil and the United Kingdom (UK).

METHODS

We pooled data from the UK Millennium Cohort Study (MCS) and the Brazilian High Risk Cohort Study (BHRCS). We included 12 social connection variables, identified through retrospective harmonisation and lived experience expert involvement. We tested measurement invariance and conducted multiple regressions to analyse associations between the social connection factors (age 14) and later internalising and externalising difficulties (age 17.5) in both cohorts. We investigated country-level interactions and used weights to account for attrition, survey design, population representativeness and sample size.

RESULTS

We found pooled main associations with later internalising symptoms for 'living with half-siblings' (p < .001), 'moving address' (p = .001), 'mother marital status' (p < .001-.003), 'bullying' (p = .001), 'being bullied' (p < .001) and 'difficulties keeping friends' (p < .001). For externalising, we found main associations with 'household size' (p = .041), 'moving address' (p = .041), 'mother's marital status' (p = .001-.013), 'bullying others' (p < .001) and 'being bullied' (p < .001). Country-level interactions suggested higher internalising symptoms were associated with 'household size' (p = .001) in Brazil and 'being bullied' (p < .001) in MCS. Additionally, 'half-siblings in household' (p = .003), 'poor mother-child relationship' (p = .018), 'single mother' (p = .035), 'bullying' (p < .001) and 'being bullied' (p < .001) were more strongly linked to externalising difficulties in MCS.

CONCLUSIONS

Social connection factors, mostly structural, contributed to adolescent internalising and externalising difficulties in both countries. Factors relating to bullying and family composition seem to play a stronger role in each country. Cultural and socioeconomic factors might explain these differences. Future research should investigate cross-regional differences to meaningfully inform global mental health efforts.

Exploring Physical Activity Among Mexican American Immigrants in New York City Before and During the COVID-19 Pandemic: A Two-Wave Panel, Mixed-Method Analysis

The COVID-19 pandemic was associated with decreases in moderate-to-vigorous physical activity and increases in sedentary time for children and adults, and there is some evidence that Latino populations were particularly affected. This article leverages a two-wave panel, mixed-method social network dataset collected before and during the pandemic with Mexican American immigrants living in New York City to examine social networks and other factors associated with physical activity and explore participants' perceptions about how the pandemic affected their physical activity. Participants (n = 49) completed in-person, egocentric social network interviews between January and June 2019 and virtual follow-up egocentric social network interviews between May and November 2021. Qualitative data collection with a subsample (n = 25) occurred between October and December 2022. Social network quantitative analyses found that age and female sex were negatively associated with participants' baseline physical activity level, but the proportion of alters (important persons identified by the participant) with whom the participant did physical activity at baseline was positively associated. Baseline physical activity level was inversely related to the change in physical activity, and the change in the proportion of alters who were close to the participant was negatively associated with physical activity change at follow-up. Qualitative results supported the quantitative findings, providing rich narratives regarding the importance of social support for physical activity during the pandemic. Social networks among Mexican American immigrants in New York City provided motivation and support for physical activity but became harder to sustain during a pandemic. The findings can inform strategies to create environments that are conducive to physical activity while also protecting public health.

Improving prevalence estimates of mental health and well-being indicators among sexual minority men: a propensity-weighting approach

The prevalence and relative disparities of mental health outcomes and well-being indicators are often inconsistent across studies of sexual minority men (SMM) due to selection biases in community-based surveys (nonprobability sample), as well as misclassification biases in population-based surveys where some SMM often conceal their sexual orientation identities. The present study estimated the prevalence of mental health related outcomes (depressive symptoms, mental health service use, anxiety) and well-being indicators (loneliness and self-rated mental health) among SMM, broken down by sexual orientation using the adjusted logistic propensity score (ALP) weighting. We applied the ALP to correct for selection biases in the 2019 Sex Now data (a community-based survey of SMMs in Canada) by reweighting it to the 2015-2018 Canadian Community Health Survey (a population survey from Statistics Canada). For all SMMs, the ALP-weighted prevalence of depressive symptoms was 15.96% (95% CI, 11.36%-23.83%), while for mental health service use, it was 32.13% (95% CI, 26.09%-41.20%). The ALP estimates lie in between the crude estimates from the two surveys. This method was successful in providing a more accurate estimate than relying on results from one survey alone. We recommend to the use of ALP on other minority populations under certain assumptions. This article is part of a Special Collection on Mental Health.

Family is all that matters: Prospective associations between structure, function, and quality of social relations and self-rated health in the National Social Life, Health, and Aging Project (NSHAP)

We prospectively examined the association between structure, function, and quality of social relations and self-rated health (SRH) in U.S. adults followed over 10 years in the population-based National Social Life, Health, and Aging Project (NSHAP). Large social network and high positive/negative social support were measured at baseline and defined as the highest quartile. These three binary measures were reported from friends, family, and partner and combined into a multifactorial exposure variable. SRH was measured through a 5-point Likert scale and dichotomised. Odds ratios (OR) for poor SRH were estimated with covariate-adjusted logistic regression. In total, 1,592 participants were included. Based on the combined multifactorial exposure variable as well as independent exposure variables, only lower levels of negative social support were prospectively associated with better SRH (aOR = 0.65; 95%CI 0.44-0.98). From the different social ties, only family-related negative social support was associated with poor SRH (aOR = 0.59; 95%CI 0.39-0.90). This association was similar between genders, but only statistically significant among women. Sensitivity analysis with depressive symptoms as outcome supported the hypothesis that the findings for SRH may be partially driven by mental health (aOR = 0.65; 95%CI 0.48-0.90). Concluding, negative social support particularly from family is prospectively associated with poor SRH.

Development and refinement of a communication guide to help young adults in Texas reconnect and reduce loneliness

Objective

Loneliness among young people is a contemporary public health crisis exacerbated by the COVID-19 pandemic. The present research examined the development of a modest yet meaningful health communication intervention resource that would become an asset in a larger health campaign: a communication guide aimed at helping young people reach out and reconnect with others.

Methods

Study One established the need for a loneliness intervention in Texas with survey data (N = 795). A communication guide was developed based on research and theory. Study Two employed focus group interviews with potential audience members (N = 31) to critically assess and inform revisions to the communication guide.

Results

Study One results indicated that a substantial proportion of young adult Texans felt as though their social connection had decreased and their loneliness had increased since the onset of the pandemic. Themes in focus group responses from Study Two suggested several strengths of the communication guide and some opportunities for revision.

Conclusion

A communication guide with tips for reconnecting could be a valuable tool to empower young people and promote social connection.

Innovation

This study involved the development and refinement of a new communication resource that was informed by a priority audience of a major health communication campaign.

Profiling Social Detachment in Older People in Taiwan: A Cluster Analysis

OBJECTIVES

The Social Detachment Questionnaire for the Older Population (SDQO) is a validated tool that assesses various dimensions of social relationships. This study aimed to profile social detachment among older people in Taiwan using the SDQO and explore its use in distinguishing groups with varying levels of social engagement.

METHODS

A telephone-based survey was conducted, collecting demographic data and responses to the SDQO and Brief Symptom Rating Scale-5 (BSRS-5). Cluster analysis based on SDQO dimension scores was performed to identify groupings. Regression analyses examined the association between social engagement clusters, demographic variables, and BSRS-5 scores. A receiver operating characteristic curve was established and the area under the curve was calculated to identify the cutoff for distinguishing individuals with high and low social engagement.

RESULTS

In a representative sample of 2549 individuals aged 55 and above in Taiwan, cluster analysis identified two groups based on social engagement levels as measured by the SDQO. The low social engagement cluster, indicating higher social detachment, was more likely to consist of older individuals (≥ 75 years), those without children, and those with lower education levels (≤ 9 years). After adjusting for demographics, the low social engagement cluster was associated with higher BSRS-5 scores. The optimal SDQO cutoff for identifying low social engagement was 27/28.

CONCLUSIONS

The SDQO can identify socially detached older people, who are more likely to experience increased psychological distress. Screening older individuals with demographic risk factors using the SDQO could help identify those most vulnerable to adverse health outcomes related to social detachment.

Social isolation, depression, and anxiety among young adult cancer survivors: The mediating role of social connectedness

BACKGROUND

Social isolation and social connectedness are health determinants and aspects of social well-being with strong associations with psychological distress. This study evaluated relationships among social isolation, social connectedness, and psychological distress (i.e., depression, anxiety) over 1 year in young adult (YA) cancer survivors 18-39 years old.

METHODS

Participants were YAs in a large cohort study that completed questionnaires every 2 months for 1 year. Social isolation, aspects of social connectedness (i.e., companionship, emotional support, instrumental support, and informational support), depression, and anxiety were assessed with Patient-Reported Outcomes Measurement Information System short form measures. Mixed-effect models were used to evaluate changes over time. Confirmatory factor analysis and multilevel structural equation modeling were used to define social connectedness as a latent construct and determine whether relationships between social isolation and psychological distress were mediated by social connectedness.

RESULTS

Participants (N = 304) were mean (M) = 33.5 years old (SD = 4.7) and M = 4.5 years (SD = 3.5) post-initial cancer diagnosis. Most participants were female (67.4%) and non-Hispanic White (68.4%). Average scores for social well-being and psychological distress were within normative ranges and did not change (p values >.05). However, large proportions of participants reported at least mild social isolation (27%-30%), depressive symptoms (36%-37%), and symptoms of anxiety (49%-51%) at each time point. Across participants, more social isolation was related to less social connectedness (p values <.001), more depressive symptoms (p < .001), and more symptoms of anxiety (p < .001). Social connectedness mediated the relationship between social isolation and depression (p = .004), but not anxiety (p > .05).

CONCLUSIONS

Social isolation and connectedness could be intervention targets for reducing depression among YA cancer survivors.

A social information processing perspective on social connectedness

Social connectedness (SC) is one of the most important predictors for physical and mental health. Consequently, SC is addressed in an increasing number of studies, providing evidence for the multidimensionality of the construct, and revealing several factors that contribute to individual differences in SC. However, a unified model that can address SC subcomponents is yet missing. Here we take a novel perspective and discuss whether individual differences in SC can be explained by a person's social information processing profile that represents individual tendencies of how social information is perceived and interpreted and leads to motivated social behavior. After summarizing the current knowledge on SC and core findings from the fields of social perception and mentalizing, social motivation and social action, we derive a working model that links individual stages of social information processing to structural, functional, and qualitative aspects of SC. This model allows for deriving testable hypotheses on the foundations of SC and we outline several suggestions how these aspects can be addressed by future research.

Prospective association between social isolation, loneliness and lung function among Chinese middle-aged and older adults

OBJECTIVE

Previous research has highlighted a heightened occurrence of social isolation and loneliness in older adults diagnosed with chronic lung diseases. Nevertheless, there exists a dearth of studies that have explored the influence of impoverished social relationships on lung function. This study aimed to examine the longitudinal association between social isolation, loneliness and lung function over 4 years among middle-aged and older Chinese adults.

METHODS

This study employed two waves (2011 and 2015) of data from the China Health and Retirement Longitudinal Study (CHARLS). The analysis was limited to participants aged 45 years and above and stratified based on gender (3325 men and 3794 women). The measurement of peak expiratory flow (PEF) served as an indicator for assessing lung function. Lagged dependent variable regression models, accounting for covariates, were employed to explore the relationship between baseline social isolation and loneliness and the subsequent PEF.

RESULTS

For women, social isolation was significantly associated with the decline in PEF at follow-up (β = -.06, p < .001) even after adjusting for all covariates; no significant correlation was observed between loneliness and PEF. Among men, there was no significant association found between either social isolation or loneliness and PEF.

CONCLUSIONS

Social isolation is prospectively associated with worse lung function in middle-aged and older Chinese women but not men. The results highlight the importance of promoting social relationships in public health initiatives, especially in groups that are more vulnerable.

Unraveling Familism and Depressive Symptoms among Dominican Women: A Multidimensional Analysis

Familism is a multidimensional construct that includes familial support. However, limited research examines whether the sub-components of familism equally contribute to mental health and whether familism protects against depression beyond social support. To address these gaps, we test associations between the multidimensional components of familism (familial support, familial obligations, family as referents) and social support with depressive symptoms among immigrant Dominican women in New York City. We tested associations between the multidimensional components of familism, specifically, familial support, familial obligations, and family as referents (Sabogal et al., 1987), as well as social support, with depressive symptoms among 419 women. Multiple regression analysis indicated that whereas familial support predicted decreases in depressive symptoms (β = - 0.15), family obligations, and family as referents did not. However, only social support predicted decreased depressive symptoms (β= - 0.18) when accounting for covariates and familism subscales. Controlling for covariates, age predicted decreased depressive symptoms (β = - 0.19), whereas self-rated poor health exhibited the inverse effect (β = 0.17). These findings highlight the need for a nuanced understanding of familism, social support, and the association of cultural and demographic values on Latina mental health. These results illustrate the need for further analysis of social support and the multiple components of the familism construct.

Social isolation, loneliness, and functional disability in Chinese older women and men: a longitudinal cross-lag analysis

BACKGROUND

In this study, we explored the relationship between social isolation, loneliness, and functional impairment in 50-year-old participants, by sex.

METHODS

Using longitudinal data from the China Health and Retirement Longitudinal Study (2018 and 2020), 6,524 participants meeting the inclusion criteria were analyzed. A cross-lag model was established to explore the associations between social isolation, loneliness, activities of daily living (ADL), and instrumental ADL (IADL) disability over time, with results stratified by sex.

RESULTS

Social isolation was not significantly associated with ADL and IADL disability, but loneliness was. Autoregressive associations indicated that social isolation, loneliness, and functional disability in 2018 predicted their exacerbations in 2020 (p < 0.001). Cross-lag analysis showed that the time-lagged effect of loneliness on ADL disability was greater in women (β = 0.27) than in men (β = 0.06); the time-lagged effect of ADL disability on loneliness was greater in men (β = 0.16) than in women (β = 0.05). The bidirectional time-lagged effects of loneliness and IADL disability showed opposite patterns between the sexes.

CONCLUSION

Functional disability in China was significantly associated with loneliness but not with social isolation. Sex differences were observed in the time-lagged effect of loneliness on functional disability. These findings extend our understanding of the association between social relationships and functional disability in non-Western populations.

Perceptions and experiences of Korean American older adults with companion robots through long-term use: a comparative analysis of robot retention vs. return

To date, limited research has been conducted on technology use among socially marginalized groups, such as older immigrants who may have limited digital literacy. This pilot study aims to explore Korean American older adults' perceptions and experiences with a companion version of the social robot, Hyodol. We hypothesize that the Hyodol robot's social presence may facilitate technology use among this sample. To test this hypothesis, we invited 35 Korean American older adults to interact with Hyodol SAR over a four-month period. This extended engagement allowed us to investigate the underlying factors and dimensions shaping users' perceptions and experiences. We assessed perceptions through measures of robotic attitudes and usability, while user experiences were evaluated using overall assessment questions and behavioral indicators, such as instances where participants showed the robot to others. We conducted a comparative analysis between participants who chose to keep the robot ("Keepers") and those who opted to return it ("Returners"), providing insights into how each group utilized and interpreted the robots. Additionally, we examined the reasons Returners decided to not to retain the robot, aiming to identify barriers to acceptance and engagement. Our results indicated that participants' experiences of warmth and competence while interacting with the Hyodol robots did not significantly differ between the Keepers and Returners. However, distinct patterns emerged in their utilization and interpretation of the robot; the 24 Keepers demonstrated a more intimate level of engagement compared to the 11 Returners. In an era characterized by the growing integration of AI in human care, our findings suggest that social presence became valuable concepts for developing robot companions to enhance their effectiveness.

Understanding loneliness after widowhood: The role of social isolation, social support, self-efficacy, and health-related factors

BACKGROUND

Widowhood negatively affects trajectories of social isolation and loneliness. Given the inevitability of spousal bereavement for many, further investigation into potential modifiers of bereavement-related loneliness is warranted.

AIM

To examine the moderating effects of social isolation, social support, sociodemographic, self-efficacy, health, and quality of life factors on changes in loneliness before and after widowhood.

METHODS

We analysed 19 waves of data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, comprising 749 widowed and 8,418 married individuals (comparison). Coarsened exact matching weights were applied, controlling for age and time trends. Local polynomial smoothed plots illustrated social health trajectories from three years before to three years after spousal death. All analyses were gender-stratified.

RESULTS

Low social isolation and higher social support did not prevent increased loneliness following widowhood. Men in major cities were less likely to experience reductions in social isolation during bereavement, despite being less socially-isolated at baseline than men in regional/remote areas. The bereavement-loneliness relationship was consistent across all subgroups. For men, this relationship was weakened by older age and being born in a non-English-speaking country, but strengthened by poverty and living in a regional/remote areas. For women, it was weakened by older age, and strengthened by factors such as being born in a non-English-speaking country, poverty, employment or volunteering, and having a long-term mental health condition.

CONCLUSION

Loneliness is a common and potentially unavoidable experience during widowhood, highlighting the importance of screening by healthcare workers to improve wellbeing and prevent future mental health issues.

Healthy Aging and Older Adults With Autism: A Scoping Review

BACKGROUND AND OBJECTIVES

Autism spectrum disorder is a lifelong diagnosis. Although several studies have examined the effects of autism throughout childhood, few have considered older adulthood and the difference between the allistic (i.e., persons who are not autistic) population and autistic older adults. In literature regarding healthy aging, there is sparse evidence regarding the intersections of older adulthood and autism. The purpose of this scoping review was to examine the state of literature regarding autistic older adults and the domains of healthy aging, utilizing the framework conceived by Arksey and O'Malley (Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 2005;8(1): 19-32. doi:10.1080/1364557032000119616).

RESEARCH DESIGN AND METHODS

To identify the research question, we took the following steps: identify the relevant studies; select studies; chart the data; and collate, summarize, and report the results. The specific domains of healthy aging considered include physical health, mobility, mental health, cognition and memory, and social connectedness.

RESULTS

A total of 35 articles were selected for final review. Fifty-seven percent of these studies considered only 1 domain of healthy aging, 23% studied 2 domains, whereas 14% measured 3 domains and 6% assessed 4 domains. No study considered all 5 domains. Of the 5 domains considered for this scoping review, mental health and cognition and memory were the most represented domains in the studies.

DISCUSSION AND IMPLICATIONS

Overall, healthy aging among autistic older adults is largely understudied. More research is needed to better identify and tailor interventions and services for autistic older adults and their families to support healthy aging.

Positive Childhood Experiences and the Indirect Relationship With Improved Emotion Regulation in Adults With ADHD Through Social Support

OBJECTIVE

To identify direct and indirect associations between PCEs and social support to emotion regulation outcomes in adults with ADHD.

METHOD

Adults with ADHD (n = 81) reported PCEs, current social support, and emotion regulation. Conditional effects modeling examined the direct and indirect relationships between PCEs and emotion dysregulation through social support.

RESULTS

Higher PCEs were indirectly related to improved emotion regulation through increased social support generally (β = -.70, 95% CI [-1.32, -0.17], and specifically through belonging (β = -.43, 95% CI [ -0.87, -0.05], self-esteem (β = -.61, 95% CI [-1.08, -0.27], and tangible social support (β = -.50, 95% CI [-1.07, -0.02].

CONCLUSIONS

PCEs may protect emotion regulation in adults with ADHD through social support, possibly through facilitating social connections, increasing access to social support, and sustaining emotion regulation strategies.

Differential impact of emotional and social loneliness on daily alcohol consumption in individuals with alcohol use disorder

BACKGROUND

Loneliness is a predisposing and maintaining factor of alcohol use behavior. Several studies have linked loneliness to daily drinking and elevated alcohol use disorder (AUD) risk; however, operationalizations of both loneliness and drinking have varied greatly.

METHODS

The current study adopted a multidimensional framework of loneliness (i.e., emotional and social subtypes) to examine daily prospective relations between loneliness and drinking among non-treatment seeking individuals with AUD. Participants (N= 60) reported on current loneliness and drinking twice daily for 14-days. Scores on emotional and social loneliness were disaggregated into within- and between-person predictors, and a multilevel hurdle model proxy was fitted with drinking likelihood (logistic) and quantity (zero truncated negative binomial) specified as separate outcomes.

RESULTS

Emotional loneliness (within-person) was associated with increased drinking likelihood (OR=1.05, 95 % BCI [1.01, 1.10]) and quantity (IRR=1.05, 95 % BCI [1.02, 1.09]), while social loneliness (within-person) was associated with decreases in both drinking likelihood (OR=.94, 95 % BCI [.89,.99]) and quantity (IRR=.96, 95 % BCI [.93,.99]). Between-person loneliness scores were unrelated to both outcomes.

CONCLUSIONS

These discrepant findings by loneliness subtype may be ascribed to differences in subjective manifestations, in that emotional loneliness is a more severe form of loneliness that overlaps significantly with other negative affective states and promotes a coping response, while social loneliness may be readily alleviated by adaptive behavioral strategies for some, and social withdrawal for others. These findings offer insight into the nuances of loneliness-drinking relations and their clinical implications.

Social connection and self-neglect: A case for broader exploration

OBJECTIVE

Self-neglect (SN) is the most common report to Adult Protective Services (APS) and is associated with significant morbidity and mortality risks for older adults. Lack of instrumental support is a well-evidenced etiologic factor in the development and continuation of SN, but little is known about other modifiable social connection characteristics. The social connection framework provides evidence-based characteristics across structure, function, and quality missing from SN studies that could be identified if explored. These factors could provide prevention and intervention targets related to poor health.

METHODS

A narrative case study is presented using quantitative and qualitative data to explore social connection across structure, function, and quality in the context of SN.

RESULTS

The findings highlight the complexity of social connection that may be observed in SN cases reported to APS. Strategic utilization of direct and indirect social interventions to support social connection in this case are presented.

CONCLUSION

The results from this case give rise to considerations that may be generalizable to other SN cases. Recommendations for future research on social connection in this population are provided.

Using machine learning to understand social isolation and loneliness in schizophrenia, bipolar disorder, and the community

Social disconnection, including objective social isolation and subjective loneliness, is linked to substantial health risks. Yet, little is known about the predictors of social disconnection in individuals with mental illness. Here, we used machine learning to identify predictors of social isolation and loneliness in schizophrenia (N = 72), a psychiatric condition associated with social disconnection. For comparison, we also included two other groups: a psychiatric comparison sample of bipolar disorder (N = 48) and a community sample enriched for social isolation (N = 151). We fitted statistical models of social isolation and loneliness within and across groups. Each model included five candidate predictors: social avoidance motivation, depression, nonsocial cognition, social anhedonia, and social cognition. The results showed that social anhedonia explained unique variance in social isolation and loneliness in all samples, suggesting that it contributes to social isolation and loneliness broadly. However, nonsocial cognition explained unique variance in social isolation only within schizophrenia. Thus, social anhedonia could be a potential intervention target across populations, whereas nonsocial cognition may play a unique role in determining social disconnection in schizophrenia.

Exploring the association between multidimensional social isolation and heterogeneous cognitive trajectories among older adults: evidence from China

Objective

This study aims to elucidate the heterogeneous cognitive trajectories among older adults in China through a comprehensive, nationally representative longitudinal study. Furthermore, it seeks to investigate the impact of multidimensional social isolation on heterogeneous cognitive trajectories among older adults in China.

Methods

Utilizing data from three successive waves of the Chinese Longitudinal Aging Social Survey (CLASS) spanning 2016 to 2020, this investigation quantified baseline social isolation across three dimensions-family isolation, friend isolation, and subjective isolation-alongside cognitive function scores of older adults, measured across all three waves. Through latent class growth models, heterogeneous cognitive trajectories were delineated. The influence of family isolation, friend isolation, and subjective isolation on these cognitive trajectories was examined employing multinomial logistic regression analysis.

Results

The study included 6,378 participants aged 60 and above, revealing three primary cognitive trajectories: High baseline stable group (68.8%), High baseline but declining group (21.7%), and Low baseline deteriorating group (9.5%). Adjusting for variables such as personal physical characteristics, social networks, living and working conditions, and the surrounding policy environment, the findings indicated that family isolation did not significantly affect cognitive function's high-level decline or low-level deterioration. Conversely, friend isolation markedly increased the risk of high-level cognitive decline (OR = 1.289) and low-level cognitive deterioration (OR = 1.592). Similarly, subjective isolation significantly heightened the risk for both high-level decline (OR = 1.254) and low-level deterioration (OR = 1.29) in cognitive function.

Conclusion

Mitigating friend and subjective isolation among older adults appears to be a more effective strategy in preventing or delaying cognitive decline, potentially reducing the strain on healthcare and social welfare systems.

Loneliness, cerebrovascular and Alzheimer's disease pathology, and cognition

INTRODUCTION

Loneliness has a rising public health impact, but research involving neuropathology and representative cohorts has been limited.

METHODS

Inverse odds of selection weights were generalized from the autopsy sample of Rush Alzheimer's Disease Center cohorts (N = 680; 89 ± 9 years old; 25% dementia) to the US-representative Health and Retirement Study (N = 8469; 76 ± 7 years old; 5% dementia) to extend external validity. Regressions tested cross-sectional associations between loneliness and (1) Alzheimer's disease (AD) and cerebrovascular pathology; (2) five cognitive domains; and (3) relationships between pathology and cognition, adjusting for depression.

RESULTS

In weighted models, greater loneliness was associated with microinfarcts, lower episodic and working memory in the absence of AD pathology, lower working memory in the absence of infarcts, a stronger association of infarcts with lower episodic memory, and a stronger association of microinfarcts with lower working and semantic memory.

DISCUSSION

Loneliness may relate to AD through multiple pathways involving cerebrovascular pathology and cognitive reserve.

HIGHLIGHTS

Loneliness was associated with worse cognition in five domains. Loneliness was associated with the presence of microinfarcts. Loneliness moderated cognition-neuropathology associations. Transportability methods can provide insight into selection bias.

Social connection as a critical factor for mental and physical health: evidence, trends, challenges, and future implications

Rising concerns about social isolation and loneliness globally have highlighted the need for a greater understanding of their mental and physical health implications. Robust evidence documents social connection factors as independent predictors of mental and physical health, with some of the strongest evidence on mortality. Although most data are observational, evidence points to directionality of effects, plausible pathways, and in some cases a causal link between social connection and later health outcomes. Societal trends across several indicators reveal increasing rates of those who lack social connection, and a significant portion of the population reporting loneliness. The scientific study on social isolation and loneliness has substantially extended over the past two decades, particularly since 2020; however, its relevance to health and mortality remains underappreciated by the public. Despite the breadth of evidence, several challenges remain, including the need for a common language to reconcile the diverse relevant terms across scientific disciplines, consistent multi-factorial measurement to assess risk, and effective solutions to prevent and mitigate risk. The urgency for future health is underscored by the potentially longer-term consequences of the COVID-19 pandemic, and the role of digital technologies in societal shifts, that could contribute to further declines in social, mental and physical health. To reverse these trends and meet these challenges, recommendations are offered to more comprehensively address gaps in our understanding, and to foster social connection and address social isolation and loneliness.

Pilot Test of Mopati, a Multi-Level Adherence Intervention for People Living with HIV and Their Treatment Partners in Botswana

BACKGROUND

Low-cost, scalable strategies are necessary to reach the UNAIDS 2030 target of ending HIV as a public health threat. Use of treatment partners, informal caregivers selected by people living with HIV to support antiretroviral therapy adherence, is one such strategy that is included in many countries' HIV guidelines, including Botswana, a country with high HIV prevalence.

METHOD

From June 2021 to June 2022, we pilot tested a clinic-based treatment partner intervention ("Mopati"), including standardized language for providers to guide patients on treatment partner selection and workshops to train treatment partners on providing non-directive support to patients using a non-confrontational, non-judgmental approach. Sixty unsuppressed patients (30 per clinic) and 45 treatment partners (17 intervention, 28 control) were recruited from an intervention-control clinic matched-pair in Gaborone, Botswana.

RESULTS

Mopati had medium-to-large effects on increasing patients' adherence, adherence self-efficacy, intrinsic adherence motivation, and perceived non-directive support from treatment partners, and decreasing treatment partner caregiver burden. Aggregate viral suppression rates significantly increased in the intervention (vs. control) clinic. Qualitative data from 14 clinic staff, 21 patients, and 16 treatment partners indicated that Mopati was viewed as effective. Providers said the guidance empowered them to be proactive in communicating about adherence; most reported using the guidance.

CONCLUSION

This study shows preliminary support for the use of treatment partners in HIV care, and further evidence for interventions that leverage patients' existing support. This research can inform ways to improve adherence to HIV treatment as well as the treatment of HIV-related comorbid conditions in lower-resource settings.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04796610.

A proactive phone intervention for older adults to address loneliness identified by a health plan

Social isolation and loneliness are associated with poor health and higher health care costs among older adults. Our objective was to determine if older adults identified as at risk for loneliness by a Medicare Advantage health plan could benefit from a proactive telephone support program. We conducted a mixed-methods pilot efficacy study of outbound calls from an established community-based telephone program to support older adults identified as at risk for loneliness. One hundred and twenty-one older adults were enrolled and completed surveys at baseline, 3 months, and 6 months. Outcomes included loneliness (3-item UCLA loneliness scale), depression (PHQ-2 screen), anxiety (GAD-2 screen), and unhealthy physical and mental health days (CDC Healthy Days Measure). Quantitative data were analyzed using multivariable mixed-effects logistic regression, and open-ended responses were analyzed thematically. Over 6 months, participants had reductions in loneliness (46% to 28%, p<0.001), depression (36% to 25%, p = 0.07), anxiety (63% to 43%, p = 0.004), unhealthy mental days (14 to 8, p<0.001), and unhealthy physical days (15 to 11, p<0.001). Participants reported high satisfaction with calls, and many felt the calls improved overall mood or health. Findings can inform trials to address loneliness through telephone support and partnerships between community-based organizations and payors.

Developing a research agenda on NATure-based and Animal-assisted Intervention Strategies (NATAIS) in people with neurodegenerative diseases with a specific focus on social isolation and loneliness: a group concept mapping procedure

BACKGROUND

Social isolation and feelings of loneliness are very prevalent in people with neurodegenerative diseases and are associated with a lower quality of life and other negative outcomes. These problems were increased during the COVID-19 pandemic resulting in initiatives to address social isolation. Given the potential benefits of nature-based and animal-assisted intervention strategies (NATAIS), it is crucial to further investigate if and how these strategies might minimize negative effects of social isolation and feelings of loneliness in this population. Therefore, the aim of this project was to develop a research agenda for NATAIS in people with neurodegenerative diseases, especially during challenging times, such as pandemics.

METHODS

This article outlines the process and results of a group concept mapping procedure aimed at developing a research agenda based on a logic model. In total, 19 work group members participated through a combination of in-person and online group meetings. Additionally, face-to-face group sessions were held at two international scientific conferences, during which feedback was solicited from 12 experts in the field of NATAIS and psychogeriatrics.

RESULTS

The group concept mapping procedure resulted in 14 clusters describing various future research topics, which were further refined and detailed during group discussions. The remaining eleven clusters, encompassing important research themes within the field of NATAIS, were organized into a logic model and summarized into the research agenda. The overarching cluster 'ethical issues, possible risk factors, and their solutions' was considered the most relevant during times of increased social isolation, such as during a pandemic, along with the necessity for more accessible NATAIS.

CONCLUSIONS

This project resulted in a research agenda, directing future research and fostering collaboration between practitioners and researchers in the field of NATAIS. Such an enhanced partnership between science and practice has the potential to significantly contribute to the well-being of people with neurodegenerative diseases, in their daily lives and also during pandemics.

Addressing relationship quality of people with dementia and their family carers: which profiles require most support?

Objective

The quality of the relationship between persons with dementia and family carers influences health and quality-of-life outcomes. Little is known regarding those at higher risk of experiencing a decline in relationship quality, who could potentially benefit the most from interventions. We aimed to identify these risk profiles and explore the underlying factors.

Methods

We applied a latent profile analysis to relationship quality data from a 1-year follow-up of 350 dyads of persons with dementia and their informal carers from the Actifcare cohort in eight European countries. Assessments included sociodemographic, clinical, functional, psychosocial and quality-of-life measures. Relationship quality was assessed with the Positive Affect Index. A discriminant analysis explored factors influencing the risk profiles.

Results

There were two relationship quality profiles among persons with dementia (gradually decreasing, 74.0%; low but improving, 26%) and two among carers (steadily poor, 57.7%; consistently positive, 42.3%). The 'gradually decreasing' profile (persons with dementia) was related to their levels of dependence and unmet needs, along with carers' social distress and negative feelings, lower baseline RQ and sense of coherence. The 'steadily poor' profile (carers) was influenced by their social distress and negative feelings, lower sense of coherence and perceived social support. These two predominant profiles showed significant decreases in quality-of-life over one year.

Conclusions

Specific profiles of persons with dementia and their carers are at risk of worse relationship quality trajectories. By considering modifiable related factors (e.g., carers' stress), our findings can help develop tailored, effective interventions.

Adult day services: a potential antidote to social isolation and loneliness in marginalized older adults

Loneliness and social isolation affect more than 1 in 4 community-dwelling older adults in the United States, who may also require long-term care support. Despite being seen as a solution to the long-term care crisis, most older adults prefer to age in place rather than using skilled nursing facilities. However, in-home care is unsustainable due to a shortage of direct care workers and may exacerbate social isolation by confining older adults to their homes. Adult Day Services (ADS) addresses both issues. ADS provides care to adults with physical, functional, and or cognitive limitations in non-residential, congregate, community-based settings. ADS also provides daily cognitive and physical stimulation, often with medical support, in a social and supported environment, centered around the needs and preferences of participants. Before the COVID-19 pandemic, nearly 5,000 ADS centers were widely available. However, with limited public support, the ADS industry has struggled as demand by the growing number of older adults and families need health and social support. The ADS industry must be recognized for its unique ability to buffer social isolation and loneliness in chronically ill older adults while serving as an effective platform for chronic disease management. This perspective piece highlights the critical role of ADS centers in reducing loneliness and social isolation and promoting healthy equity. We also explore the benefits of ADS, the financial, policy, and societal barriers to utilizing ADS, and the potential solutions to ensure its sustainability and growth.

Facilitators and barriers of technology adoption and social connectedness among rural older adults: a qualitative study

Background

Social disconnection is a public health concern among rural Australian older adults. While research suggests technology can enhance social wellbeing and protect against social disconnection, many older adults are not digitally literate, and little is known as to why and how technology adoption could be promoted in rural contexts. This study aimed to (1) explore the barriers and facilitators of technology adoption among rural older adults and (2) determine the potential utility of technology to promote social connectedness in the aged population. The Theoretical Domains Framework and the Behaviour Change Wheel (BCW) were employed to gain a comprehensive understanding of the digital and social behaviours of rural Australian older adults.

Methods

Semi-structured interviews were conducted with a convenience sample of 33 rural older adults aged between 65 and 87 years. Interviews were conducted over the phone, audio-recorded, and transcribed. Interview transcripts were coded and analysed using thematic analysis and the BCW.

Results

Numerous barriers and facilitators of technology adoption were identified, with the most prominent being knowledge, perceived value, perceived self-efficacy, and social support. Findings suggest that older adults' technology adoption is not simply a technical matter, but influenced by various individual, social, and environmental contexts. Consideration of these factors during development, marketing, training and implementation may facilitate technology adoption among older adults. With regard to social connectedness, several rural barriers emerged, including low population density, geographic isolation, limited community opportunities and poor public transport infrastructure.

Conclusion

Technology was consistently identified as a facilitator of the social experience, indicating that technology is a promising tool to enhance social connectedness among older adults, particularly those living in rural areas. Future research should focus on enhancing the capability, opportunity and motivation of older adults in technology adoption, with reference to the rural contexts.

On social health: history, conceptualization, and population patterning

We propose a psychologically-informed concept of social health to join physical and mental components in a more comprehensive assessment of human health. Although there is an extensive literature on the importance of social relationships to health, a theoretical framework is needed to coalesce this work into a codified conceptualisation of social health, defined here as adequate quantity and quality of relationships in a particular context to meet an individual's need for meaningful human connection. Informing this novel conceptualisation, we outline eight key propositions to guide future research and theory on social health, including five propositions focused on the conceptualisation of social health and three focused on its population patterning. The former five propositions include that social health is an outcome in its own right, that health interventions can have divergent effects on social versus physical and mental aspects of health, that social health has independent effects on quality of life, that it is a dynamic and contextual construct, and that it is embedded and encoded in the human body (and mind). The utility of the social health concept is further revealed in its significance for understanding and addressing population health concerns, such as health inequalities experienced by marginalised groups.

Associations between dimensions of the social environment and cardiometabolic health outcomes: a systematic review and meta-analysis

OBJECTIVES

The social environment (SE), that is, the social relationships and social context in which groups of people live and interact, is an understudied element of the broader living environment which impacts health. We aim to summarise the available evidence on the associations between SE and cardiometabolic disease (CMD) outcomes.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Scopus and Web of Science Core Collection were searched from inception to 28 February 2024.

ELIGIBILITY CRITERIA

We included studies for which determinants were SE factors such as area-level deprivation and social network characteristics and outcomes were type 2 diabetes mellitus and cardiovascular diseases incidence and prevalence.

DATA EXTRACTION AND SYNTHESIS

Titles and abstracts and full text were screened in duplicate. Data appraisal and extraction were based on the study protocol published in PROSPERO. Methodological quality was assessed with the Newcastle-Ottawa Scale. We synthesised the data through vote counting and meta-analyses.

RESULTS

From 10 143 records screened, 281 studies reporting 1108 relevant associations are included in this review. Of the 384 associations included in vote counting, 271 (71%) suggested that a worse SE is associated with a higher risk of CMD. 14 meta-analyses based on 180 associations indicated that worse SE was associated with increased odds of CMD outcomes, with 4 of them being statistically significant. For example, more economic and social disadvantage was associated with higher heart failure risk (OR 1.58, 95% CI 1.08 to 1.61; n=18; I2=95%). With the exception of two meta-analyses for men, meta-analysed sex-specific associations consistently showed results in the same direction as the overall meta-analyses.

CONCLUSION

Worse SE seems to be associated with increased odds of CMD outcomes, although certain SE dimensions are underexplored in relation to CMD.

PROSPERO REGISTRATION NUMBER

CRD42021223035.

Thermoneutral Housing has Limited Effects on Social Isolation-Induced Bone Loss in Male C57BL/6J Mice

Social isolation stress has numerous known negative health effects, including increased risk for cardiovascular disease, dementia, as well as overall mortality. The impacts of social isolation on skeletal health, however, have not been thoroughly investigated. We previously found that four weeks of social isolation through single housing led to a significant reduction in trabecular and cortical bone in male, but not female, mice. One possible explanation for these changes in male mice is thermal stress due to sub-thermoneutral housing. Single housing at room temperature (~20-25°C)-below the thermoneutral range of mice (~26-34°C)-may lead to cold stress, which has known negative effects on bone. Therefore, the aim of this study was to test the hypothesis that housing mice near thermoneutrality, thereby ameliorating cold-stress, will prevent social isolation-induced bone loss in male C57BL/6J mice. 16-week-old mice were randomized into social isolation (1 mouse/cage) or grouped housing (4 mice/cage) at either room temperature (~23°C) or in a warm temperature incubator (~28°C) for four weeks (N=8/group). As seen in our previous studies, isolated mice at room temperature had significantly reduced bone parameters, including femoral bone volume fraction (BV/TV), bone mineral density (BMD), and cortical thickness. Contrary to our hypothesis, these negative effects on bone were not ameliorated by thermoneutral housing. Social isolation increased glucocorticoid-related gene expression in bone and Ucp1 and Pdk4 expression in BAT across temperatures, while thermoneutral housing increased percent lipid area and decreased Ucp1 and Pdk4 expression in BAT across housing conditions. Overall, our data suggest social isolation-induced bone loss is not a result of thermal stress from single housing and provides a key insight into the mechanism mediating the effects of isolation on skeletal health.

Sanity through Insanity: The Use of Dark Humor among United States Veterans

Humor is generally known to effectively help individuals manage distress. Yet a variety of ways exist to engage in humor, and not all of them may be equally associated with desirable outcomes. The purpose of this study is to examine the extent to which dark humor is associated with the subjective well-being of United States military veterans. An online survey was announced on several social media pages populated by US veterans, to which 93 fully responded. Our findings indicate that the use of dark humor does not appear to be associated with a sense of connectedness, but the reported use of self-defeating types of dark humor was associated with lower levels of life satisfaction. Our hypothesis that increased feelings of connectedness to civilian and veteran/active-duty friends would predict increased reports of overall subjective well-being was supported. The implications of these findings for understanding the functions of dark humor are discussed.

Analysis of changes in social isolation, loneliness, or both, and subsequent cognitive function among older adults: Findings from a nationwide cohort study

INTRODUCTION

The study aimed to investigate the associations of changes in social isolation, loneliness, or both, with cognitive function.

METHODS

Data were from 7299 older adults in the Chinese Longitudinal Healthy Longevity Survey. We defined four change patterns (no, incident, transient, and persistent) for social isolation and loneliness, and created nine-category variable to represent the joint changes. Tobit regression models and Cox models were performed.

RESULTS

Incident, transient, and persistent social isolation or loneliness may accelerate cognitive decline (p < 0.05). Incident, transient, and persistent social isolation were associated with higher cognitive impairment risk, while only persistent loneliness was associated with higher cognitive impairment risk (p < 0.001). Notably, short-term or persistent social isolation was associated with accelerated cognitive decline and incident cognitive impairment, regardless of different loneliness change status (p < 0.05).

DISCUSSION

Short-term or persistent social isolation and persistent loneliness may be a salient risk factor for cognitive decline and cognitive impairment.

HIGHLIGHTS

Incident, transient, and persistent social isolation were associated with accelerated cognitive decline and higher cognitive impairment risk. Persistent loneliness was associated with accelerated cognitive decline and higher cognitive impairment risk. Short-term or persistent social isolation with concurrent different loneliness change status accelerated cognitive decline and higher cognitive impairment risk.

The foundations of mind-body medicine: Love, good relationships, and happiness modulate stress and promote health

Although stress is an everyday fact of life, it can lead to poor health outcomes, particularly when intense or prolonged. However, humans have unique cognitive abilities and thus may be able to combat stress by engaging critical psychological defence mechanisms. In this review, we discuss the field of mind-body medicine, which focuses on improving our understanding of the mechanisms underlying this response and developing interventions that might be used to limit the effects of chronic stress. We review the findings of past and current research in this field that has focused on the impact of psychological, emotional, and behavioural factors, including love, social connectedness, and happiness on human health and the amelioration of pain as well as other signs and symptoms of disease. While these studies have not yet led to confirmed, quantifiable conclusions, the overall weight of evidence suggests that happiness (defined as a personal sense of well-being) may be directly associated with improved health parameters and reductions in debilitating symptoms. Collectively, these findings suggest that interventions designed to promote stress mitigation, notably those that encourage social activity, may lead to significant improvements in human health.

Social cognition and social motivation in schizophrenia and bipolar disorder: are impairments linked to the disorder or to being socially isolated?

BACKGROUND

People with schizophrenia on average are more socially isolated, lonelier, have more social cognitive impairment, and are less socially motivated than healthy individuals. People with bipolar disorder also have social isolation, though typically less than that seen in schizophrenia. We aimed to disentangle whether the social cognitive and social motivation impairments observed in schizophrenia are a specific feature of the clinical condition v. social isolation generally.

METHODS

We compared four groups (clinically stable patients with schizophrenia or bipolar disorder, individuals drawn from the community with self-described social isolation, and a socially connected community control group) on loneliness, social cognition, and approach and avoidance social motivation.

RESULTS

Individuals with schizophrenia (n = 72) showed intermediate levels of social isolation, loneliness, and social approach motivation between the isolated (n = 96) and connected control (n = 55) groups. However, they showed significant deficits in social cognition compared to both community groups. Individuals with bipolar disorder (n = 48) were intermediate between isolated and control groups for loneliness and social approach. They did not show deficits on social cognition tasks. Both clinical groups had higher social avoidance than both community groups.

CONCLUSIONS

The results suggest that social cognitive deficits in schizophrenia, and high social avoidance motivation in both schizophrenia and bipolar disorder, are distinct features of the clinical conditions and not byproducts of social isolation. In contrast, differences between clinical and control groups on levels of loneliness and social approach motivation were congruent with the groups' degree of social isolation.

Ageing with chronic conditions and older persons' experience of social connections: a qualitative descriptive study

Background Chronic conditions may limit older peoples' social engagement and wellbeing. Reduced social connections can result in loneliness and social isolation. This study aimed to explore the experience of social connection in older people living with chronic conditions, and the factors influencing their social participation. Methods A purposive sample of 19 community-dwelling older Australians (mean age 75.5years) with one or more chronic conditions participated in a qualitative descriptive study. Semi-structured interviews explored participants' perceptions of their social connections and the potential impact of their chronic conditions. Views about the role of general practice in supporting older persons' wellbeing were discussed. Data were analysed inductively using thematic analysis. Results Five themes were identified: (1) the experience of loneliness, (2) managing diminishing social contacts, (3) living with chronic conditions, (4) barriers to social connection, and (5) facilitators of social connection. Participants felt that ageing with chronic conditions contributed to loss of function and independence, which limited social connections, and increased loneliness and social isolation. Barriers to social connections included issues with mobility, transport and forming new networks. Families were a primary support, with continued community engagement and general practice support crucial to staying well and socially connected. Conclusions Understanding older peoples' experiences, and the barriers and facilitators of social connections can guide clinicians' interventions. General practice is a promising intervention point because of its high use by those with chronic conditions to stay well. General practice nurses are well-placed to collaboratively address the barriers older people face in maintaining social connections.

Loneliness, functional disability and lower urinary tract symptoms suggestive of benign prostatic hyperplasia in aging men: Insights from the China health and retirement longitudinal study

BACKGROUND

Research has demonstrated that social isolation and loneliness are linked to functional disability in older adults. With the intensification of global aging, functional disability and lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) have become common public health issues affecting elderly men.

METHODS

This study utilized data from the CHARLS database. The functional status of participants was evaluated through activities of daily living (ADL) and instrumental activities of daily living (IADL). Logistic regression analyses were employed to investigate variables associated with LUTS/BPH.

RESULTS

Univariate logistic regression revealed associations between loneliness (OR: 1.26; 95 % CI: 1.08-1.46) (excluding social isolation), ADL (OR: 2.17; 95 % CI: 1.86-2.52), IADL disability (OR: 1.37; 95 % CI: 1.16-1.60), and LUTS/BPH. Following rigorous adjustment for potential confounding factors, it was determined that ADL disability independently correlated with LUTS/BPH (OR: 1.92; 95 % CI: 1.17-3.17).

CONCLUSION

ADL disability is significantly linked to an elevated risk of LUTS/BPH in Chinese elderly men. These findings enhance our understanding of the relationship between functional status and LUTS/BPH.