The relationship of psychosocial factors to total mortality among older Japanese-American men: the Honolulu Heart Program

Reaching 80 Years of Age: Clinical, Behavioral, and Psychosocial Related Risk Factors in a Large Cohort of Israeli Working Men

The objective of this study was to estimate the probability of long-term overall survival based on total number of risk factors (RF). We also sought to examine the role of midlife clinical, behavioral, and psychosocial predictors of longevity in a large cohort of Israeli men. This study was based on the Israeli Ischemic Heart Disease (IIHD) cohort that included over 10,000 men who were followed up for mortality over more than four decades. During the 43 years of follow-up, 4634 (46.1%) men survived to 80 years of age or older. We considered cigarette smoking, diabetes mellitus, high systolic blood pressure, hypercholesterolemia, low socioeconomic status, and serious family problems as RF at ages 40–65. Cox proportional hazards regression models, with age as the time scale, were constructed to estimate the hazard ratios (HRs) for failure to survive 80 years of age. Compared with men free of all the above RF, those with one identified RF (HR = 1.58, 95% CI: 1.42–1.75) and counterparts with two identified RF (HR = 2.18, 95% CI: 1.96–2.43) were at a significantly greater risk of death before 80. Additional RF further increased the risk of early mortality (HR = 3.62, 95% CI: 1.50–8.73 for men with 5 RF). The results suggest a role of physiological, behavioral, and psychological risk factors at midlife in predicting longevity.

The Psychological Impact of 'Mild Lockdown' in Japan during the COVID-19 Pandemic: A Nationwide Survey under a Declared State of Emergency

This study examined the psychological distress caused by non-coercive lockdown (mild lockdown) in Japan. An online survey was conducted with 11,333 people (52.4% females; mean age = 46.3 ± 14.6 years, range = 18–89 years) during the mild lockdown in the seven prefectures most affected by COVID-19 infection. Over one-third (36.6%) of participants experienced mild-to-moderate psychological distress (Kessler Psychological Distress Scale [K6] score 5–12), while 11.5% reported serious psychological distress (K6 score ≥ 13). The estimated prevalence of depression (Patient Health Questionnaire-9 score ≥ 10) was 17.9%. Regarding the distribution of K6 scores, the proportion of those with psychological distress in this study was significantly higher when compared with the previous national survey data from 2010, 2013, 2016, and 2019. Healthcare workers, those with a history of treatment for mental illness, and younger participants (aged 18–19 or 20–39 years) showed particularly high levels of psychological distress. Psychological distress severity was influenced by specific interactional structures of risk factors: high loneliness, poor interpersonal relationships, COVID-19-related sleeplessness and anxiety, deterioration of household economy, and work and academic difficulties. Even when non-coercive lockdowns are implemented, people’s mental health should be considered, and policies to prevent mental health deterioration are needed. Cross-disciplinary public–private sector efforts tailored to each individual’s problem structure are important to address the mental health issues arising from lockdown.

A real-time survey on the psychological impact of mild lockdown for COVID-19 in the Japanese population

To deter the spread of the coronavirus disease 2019 (COVID-19), many countries have imposed a lockdown with restrictions. On 7 April 2020, the Japanese government declared a state of emergency over the COVID-19 outbreak. Japan was in "mild lockdown" which was not enforceable and non-punitive with the declaration. We conducted an online survey to investigate factors associated with psychological distress in the "mild lockdown" under a declared state of emergency for COVID-19. We collected data on 11,333 inhabitants (52.4% women, 46.3 ± 14.6 years) living in the seven prefectures where the declaration was first applied. The investigation dates of this study, 11 and 12 May 2020, were in the final phase of the state of emergency. The survey was conducted in real-time to minimize participants' recall bias. In addition to psychological inventories often used worldwide, the questionnaires used in this survey included lifestyle and stress management items related to COVID-19 and various socio-demographic items including occupation (e.g. healthcare worker) or income.

Effectiveness of a village-based intervention for depression in community-dwelling older adults: a randomised feasibility study

Background

Although a focus on late-life depression may help preventing suicide in older adults, many older people, especially those living in rural areas, have relatively low accessibility to treatment. This study examined the feasibility and effectiveness of a village-based intervention for depression targeting older adults living in rural areas.

Methods

A community-based randomised pilot trial was performed in two small rural villages in South Korea. Two villages were randomly selected and assigned to the intervention or active control group; all older adults living in the two villages (n = 451) were included in the intervention program or received standard Community Mental Health Service (CMHS) care, and the effectiveness of the program was examined using representative samples from both groups (n = 160). The 12-week intervention included case management according to individual risk level and group-based activities. Healthy residents living in the intervention village who played major roles in monitoring at-risk older individuals were supervised by CMHS staff. The score on the Korean version of the Geriatric Depression Scale-Short Form (SGDS-K) was the primary outcome, while social network, functional status, and global cognitive function were secondary outcomes. Linear mixed models including the factors of intervention group, time, and their interaction were used to examine group differences in changes in primary and secondary outcomes from baseline to follow up.

Results

Overall, there was no significant group × time interaction with respect to the SGDS-K score, but older individuals with more depressive symptoms at baseline (SGDS-K ≥ 6) tended to have a lower likelihood of progressing to severe depression at post-intervention. The social network was strengthened in the intervention group, and there was a significant group × time interaction (F[df1, df2], 5.29 [1, 153], p = 0.023).

Conclusion

This study examined a 12-week village-based intervention for late-life depression in which the CMHS helped village-dwellers deal with late-life depression in their communities. Although the intervention improved social interactions among older adults, it did not reduce depressive symptoms. Further studies including more rural villages and long-term follow up are needed to confirm the effectiveness of this prevention program.

Trial registration

NCT04013165 (date: 9 July 2019, retrospectively registered).

Cognitive effects of dance-movement intervention in a mixed group of seniors are not dependent on hippocampal atrophy

Dance-movement intervention (DMI) offers multi-component stimulation of cognitive functions, and it may ameliorate cognitive deficits in the elderly. We investigated the effects of intensive DMI on the cognitive performances of healthy seniors (HS) and patients with mild cognitive impairment (MCI). In addition, we evaluated whether the baseline MRI hippocampus-to-cortex volume (HV:CTV) ratio (i.e., a marker of a typical AD-specific brain atrophy and of distribution of neurofibrillary tangles in the brain) has any impact on the DMI-induced cognitive changes. The research cohort consisted of 99 subjects who were randomly assigned (in a 1:1 ratio) to a DMI group or to a control (life-as-usual) group. The DMI group consisted of 49 subjects with an average age of 69.16 years (SD = 5.36), of which 34 were HS (69.4%) and 15 had MCI (30.6%). The control group consisted of 50 subjects aged 68.37 years (SD = 6.10), of which 31 were HC (62%) and 19 (38%) had MCI. The DMI group underwent a 6-month intervention, which consisted of 60 lessons supervised by a qualified instructor. Statistical analysis yielded a significant improvement of the figural fluency task as measured by the five-point test in the DMI group as compared to the control group [t (97) = 2.72; p = 0.008]. The baseline HV:CTV ratio was not associated with cognitive changes on that task or with changes in any cognitive domain's Z scores. We observed DMI-induced effect on the test evaluating executive functions across the spectrum of HS and MCI, which was not dependent on the magnitude of AD-related brain pathology.

Social Network Trajectories in Myocardial Infarction Versus Ischemic Stroke

BACKGROUND

Changes in social networks are rarely examined before and after various diseases because of insufficient data. CHS (The Cardiovascular Health Study) offers an opportunity to compare social network trajectories surrounding well-adjudicated myocardial infarction (MI) or stroke events. We tested the hypothesis that social networks will be stable after MI and decrease after stroke.

METHODS AND RESULTS

We examined trajectories of the Lubben Social Network Scale score (LSNS, range 0-50) before and after vascular events over 11 years. The LSNS assesses engagement in family networks, friends' networks, and social supports. We used a linear mixed model with repeated measures and fixed effects to compare the change in social network score before and after events in 395 people with MI and 382 with ischemic stroke. Over a mean of 12.4 years of follow-up for MI and 11.1 years for stroke, we examined an average of 4 social network scores for each participant. We controlled for sociodemographics, baseline cognitive function, and comorbidities. The participants' mean age was 73.5, 51% were women, and 88% were non-Hispanic white. After MI, the social network trajectory remained stable compared with the baseline trajectory (-0.06 points per year, adjusted P=0.2356). After stroke, the social network trajectory declined compared with the baseline trajectory (-0.14 points per year, adjusted P=0.0364).

CONCLUSIONS

Social networks remained stable after MI and declined after stroke. This small and persistent decline after adjustment for potential confounders is notable because it deviates from stable network trajectories found in CHS participants and is specific to stroke.

A longitudinal study of depression in old age I: outcome and relationship to social networks

OBJECTIVES

To ascertain the relationship between social network type and depression over time.

METHOD

A longitudinal outcome study of depressed elderly patients attending an old age psychiatric service was carried out. Subjects were seen at baseline and regular intervals over two years.

RESULTS

Depression severity at baseline and at follow-up times differed according to subjects' social network. Those with more socially integrated networks had the best outcome and those who had more dependent networks had a poorer outcome. There was a lot of movement between networks over time for subjects, with many moving towards more dependent networks.

CONCLUSIONS

When treating depression in the elderly it is important to consider the social network and milieu in which the patient resides. Treatments should include strategies encouraging the maintenance and formation of social integration.

Broadening definitions of family for older lesbians: modifying the Lubben social network scale

Lesbian seniors have triple vulnerability (gender, sexual orientation, and age), necessitating inquiry into their social support needs, yet research about that is scare. Investigators identify relationships between social support and senior health. The Lubben Social Network Scale, Revised (LSNS-R), has provided such evidence and has been used to study many diverse senior groups. We modified it to include a Family of Choice category and qualitative questions to give context to responses among a sample of older lesbians. Our pilot demonstrated that the modification made a difference in accurately measuring social support among the sample, yet further investigation is warranted.

Prevalence of frailty and factors associated with frailty in the elderly population of Lleida, Spain: the FRALLE survey

The aim of this study was to assess the prevalence of frailty and to identify factors associated with frailty in older people living in the community through a cross-sectional study of community-dwelling persons age 75 and older. A total of 640 individuals were interviewed using the FRALLE survey between 2009 and 2010. This survey measures frailty through the five Fried criteria, and through questions on sociodemographics, health habits, health status, social relations and data on health-related quality of life. The mean age of the participants was 81.3 ± 5.0; 39.7% were men. The prevalence of frailty was 9.6% (95% confidence interval (CI): 7.6-11.5) and that of pre-frailty was 47% (95% CI: 42.7-51.2). After the logistic regression, age (over 85 years) (odds ratio (OR): 3.61; 95% CI: 1.65-7.91; p<0.001), depressive symptoms (OR: 3.13; 95% CI: 1.37-7.13; p=0.0006), comorbidity (OR: 5.20; 95% CI: 1.78-15.16; p=0.0002), cognitive impairment (OR: 3.22; 95% CI: 1.48-7.02; p=0.0003), poor social ties (OR: 0.57; 95% CI: 0.43-0.77; p<0.001) and poor physical health (OR: 0.98; 95% CI: 0.97-0.98; p<0.001) were significantly associated with frailty. There is great variability in the prevalence of frailty depending on the study considered. The lack of homogeneity in the measurement of the five criteria, the age of participants and the degree of dependence could explain the differences observed. Here, the factors associated with frailty were age, comorbidity, cognitive impairment and depressive symptoms, while the diversity of social interaction and health-related physical function were protective factors.

A threshold model of social support, adjustment, and distress after breast cancer treatment

This study examined a threshold model that proposes that social support exhibits a curvilinear association with adjustment and distress, such that support in excess of a critical threshold level has decreasing incremental benefits. Women diagnosed with a first occurrence of breast cancer (N = 154) completed survey measures of perceived support (Social Provisions Scale), quality of life (Functional Living Index--Cancer), adjustment (Psychological Adjustment to Illness Scale) and psychological distress (Brief Symptom Inventory) approximately 3 weeks after surgical treatment and 8-16 months later. Consistent with a threshold model, multiple regression analyses suggested a significant curvilinear relationship between social support and distress at Time 1 and Time 2 and between social support and adjustment at Time 2. Consistent with this model, the significant bivariate correlations between social support and outcomes were accounted for almost entirely by women in the lowest quartile of support. Social support among women in the highest 3 quartiles was unrelated or only marginally related to adjustment and distress.

[Reliability and validity of the Japanese version of the abbreviated Lubben Social Network Scale]

AIM

To investigate the reliability and validity of the Japanese version of the abbreviated Lubben Social Network Scale (LSNS-6), which is used worldwide as a screening tool for social isolation in elderly individuals.

METHODS

An interview-format questionnaire survey was given to 232 elderly community residents undergoing general health checkups. In addition to the Japanese version of the LSNS-6, other questionnaire items regarding social support, the Japanese version of the Zung Self-Rating Depression Scale (SDS), base attributes, and self-ratings of health, physical function and suicidal ideation were obtained. The internal consistency, test-retest, and interrater reliability of the Japanese version of the LSNS-6 were determined using the Cronbach α correlation, Spearman correlation, and intraclass correlation coefficients, respectively. Construct validity was investigated by comparison with the results of a previous study, while concurrent validity was determined in relation to SDS scores as well as questionnaire items on social support.

RESULTS

The Cronbach α coefficient was 0.82, the correlation coefficient for the test-retest was 0.92 (P<0.001), and the intraclass correlation coefficient for interrater reliability was 0.96 (95% confidence interval [CI] 0.90-0.99). Mean scores on the Japanese version of the LSNS-6 increased as the number of household members increased (P=0.033), but decreased among elderly individuals at risk of suicide (P=0.026), and tended to decrease among those with a poor self-rated health score (P=0.081). Scores on the Japanese version of the LSNS-6 had a significant negative correlation with SDS scores (P<0.001) On 4 of the 5 questionnaire items on social support, and those without social support had significantly lower mean scores on the Japanese version of the LSNS-6 (P<0.05) than those with social support.

CONCLUSIONS

We confirmed the reliability and validity of the Japanese version of the abbreviated LSNS-6.

Development and validation of the HOPE prognostic index on 24-month posthospital mortality and rehospitalization: Italian National Research Center on Aging (INRCA)

BACKGROUND

A fast and simple tool is needed to test for the risk of mortality and rehospitalization in older patients.

OBJECTIVE

The aim of this study was to construct and validate a prognostic index using specific items from the Comprehensive Geriatric Assessment (CGA) in a large population of older hospitalized adults.

METHOD

This was a prospective study of a 24-month follow-up period, between 2005 to 2008 in 3,043 elderly patients (mean age, 81 ± 6) discharged from three acute geriatric wards in the Marche region of Italy. Baseline predictors of demographics and 25 items from the CGA regarding functional and cognitive status, depression, co-morbidity, social isolation, and quality of life were used to build a summary score, the Hospitalized Older Patient Examination (HOPE) Index. The HOPE index was developed in 1,533 patients and validated in 1,510 consecutively hospitalized patients. Outcome measures were 24-month mortality and rehospitalization.

RESULTS

Three risk categories of HOPE based on the best sensitivity and specificity for mortality and rehospitalization were: Low (≤4), moderate (4-8), and high (≥8). Categorizing data across the HOPE index, mortality ranged from 7.9% to 14.5% in the development cohort and 6.2% to 14.0% in the validation cohort, whereas rehospitalization ranged from 68.3% to 79.4% and 69.8% to 79.8%, respectively. Kaplan-Meier survival curves demonstrated that risk for mortality increased with a worsening across the HOPE index (p < 0.001). In the development and validation cohorts, a close agreement was found for HOPE on mortality and rehospitalization with a receiver operating characteristic (ROC) of 0.69 (95% confidence interval [CI] 0.61-0.74) vs. 0.67 (95% CI 0.57-0.70) and rehospitalization of 0.62 (95% CI 0.58-0.66) vs. 0.60 (95% CI 0.56-0.63), respectively. In the development and validation cohorts, Cox proportional hazard models showed that a high HOPE index predicted risks of 2.38 (1.34-4.23) and 2.86 (1.24-6.61) on mortality and 1.27 (1.09-1.44) and 1.37 (1.10-1.64) on rehospitalization, respectively.

CONCLUSIONS

HOPE may be useful for long-term clinical planning, discharge, and follow-up.

Social relationships and mortality risk: a meta-analytic review

BACKGROUND

The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality.

OBJECTIVES

This meta-analytic review was conducted to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk.

DATA EXTRACTION

Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships.

RESULTS

Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were found across the type of social measurement evaluated (p<0.001); the association was strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus with others) (OR = 1.19; 95% CI 0.99 to 1.44).

CONCLUSIONS

The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality. Please see later in the article for the Editors' Summary.

Predictors of mortality among elderly people living in a south Indian urban community; a 10/66 Dementia Research Group prospective population-based cohort study

Background

Eighty percent of deaths occur in low and middle income countries (LMIC), where chronic diseases are the leading cause. Most of these deaths are of older people, but there is little information on the extent, pattern and predictors of their mortality. We studied these among people aged 65 years and over living in urban catchment areas in Chennai, south India.

Methods

In a prospective population cohort study, 1005 participants were followed-up after three years. Baseline assessment included sociodemographic and socioeconomic characteristics, health behaviours, physical, mental and cognitive disorders, disability and subjective global health.

Results

At follow-up, 257 (25.6%) were not traced. Baseline characteristics were similar to the 748 whose vital status was ascertained; 154 (20.6%) had died. The mortality rate was 92.5/1000 per annum for men and 51.0/1000 per annum for women. Adjusting for age and sex, mortality was associated with older age, male sex, having no friends, physical inactivity, smaller arm circumference, dementia, depression, poor self-rated health and disability. A parsimonious model included, in order of aetiologic force, male sex, smaller arm circumference, age, disability, and dementia. The total population attributable risk fraction was 0.90.

Conclusion

A balanced approach to prevention of chronic disease deaths requires some attention to proximal risk factors in older people. Smoking and obesity seem much less relevant than in younger people. Undernutrition is preventable. While dementia makes the largest contribution to disability and dependency, comorbidity is the rule, and more attention should be given to the chronic care needs of those affected, and their carers.

A pilot study assessing social support among cancer patients enrolled on clinical trials: a comparison of younger versus older adults

Purpose:

This study tested the logistical feasibility of obtaining data on social support systems from cancer patients enrolled on clinical trials and compared the social support of older adults (age ≥65) and younger adults (<50 years of age) with cancer.

Methods:

Patients had to be eligible for a phase II or phase III oncology clinical trial and enter the study prior to treatment. Patients filled out the Lubben Social Network Scale (LSNS) at baseline. The Symptom Distress Scale (SDS) and single-item overall quality of life (QOL) Uniscale were assessed at baseline and weekly for 4 weeks.

Results:

There was no significant difference in overall mean Lubben social support levels by age. Older patients had more relatives they felt close to (85% versus 53% with 5 or more relatives, P = 0.02), heard from more friends monthly (84% versus 53% with 3 or more friends, P = 0.02), less overall symptom distress (P = 0.03), less insomnia (P = 0.003), better concentration (P = 0.005), better outlook (P = 0.01), and less depression (P = 0.005) than younger patients.

Conclusions:

Younger subjects reported worse symptoms, a smaller social support network, and fewer close friends and relatives than older subjects. Having someone to discuss decisions and seeing friends or relatives often was associated with longer survival.

Life sustaining irritations? Relationship quality and mortality in the context of chronic illness

The social integration and mortality link are well documented but not well understood. To address this issue, the present study examined the context within which relationship quality affects mortality over a 19-year period. Participants were 40 years and older from Waves 1 (1986) and 2 (1989) of the nationally representative Americans' Changing Lives Study (N=2098). Interviews included questions about health and positive and negative relationship qualities with spouse, children, and friends/relatives. A total of 39% (N=827) of participants were deceased by 2005. In support of the main effect model, Cox proportional hazard regressions revealed that consistently low levels of positive support and an increase in negativity from spouse or child from 1986 to 1989 were associated with increased mortality. In support of the buffering effect, among people with chronic illnesses, negative relations at baseline were associated with decreased mortality. We conclude that the social relations-mortality link is more complex than previously understood and is influenced by the context.

Between freedom and reclusion: social support as a quality-of-life component in the family caregiver-dependent person binomial

This is a qualitative study which uses Grounded Theory as its methodological framework and Symbolic Interactionism as a theoretical base to understand the experience of family caregivers for Cerebrovascular Accident (CVA) patients with regard to social support during their rehabilitation process at home. The components (themes and categories) of the phenomenon assuming home care and specifically the themes assuming care with support and assuming care without support were inter-related for the purpose of comparison and analysis, in order to apprehend how the interaction between them occurred. It was observed that, in addition to the recovery of the patient's autonomy, social support is one of the intervenient components in the quality of life for the family caregiver-disabled person binomial, particularly with respect to the caregiver's freedom to resume his/her life plan.

Amount of social contact and hip fracture mortality

OBJECTIVES

To study the association between amount of social contact and mortality after hip fracture in elderly participants.

DESIGN

Prospective cohort.

SETTING

Community residents of Baltimore, Maryland.

PARTICIPANTS

Six hundred seventy-four elderly participants.

MEASUREMENTS

Amount of telephone and direct personal contact between participants and their relatives and friends and mortality up to 2 years after fracture.

RESULTS

No social contact with friends during the 2 weeks before the fracture was associated with a five times greater risk of death over 2 years than daily contact with friends during the 2 weeks before the fracture (hazard ratio (HR)=5.04, 95% confidence interval (CI)=2.75-9.23). Participants with less than daily contact were also at greater risk of dying, although the CI spanned 1 (HR=1.76, 95% CI=0.99-3.13). Participants who had no contact with family members prefracture were more than twice as likely to die as those who communicated daily during the 2 weeks before fracture (HR=2.26, 95% CI=1.36-3.77). Participants who had less than daily contact were also more than twice as likely to die (HR=2.55, 95% CI=1.65-3.94).

CONCLUSION

This study suggests that lower social contact before hip fracture is associated with poorer survival after 2 years.

Aspectos estruturais e funcionais do apoio social de idosos do Município de São Paulo, Brasil

Este trabalho teve como objetivo descrever a distribuição das redes sociais e de apoio em idosos no Município de São Paulo, Brasil, por características sócio-econômicas e demográficas. Estudou-se amostra probabilística de 1.568 idosos (60 ou mais anos) da cidade de São Paulo (inquérito sobre Saúde, Bem-estar e Envelhecimento - SABE), focalizando-se as dimensões estruturais e funcionais das redes sociais. Para a análise dos dados utilizou-se a regressão logística simples e múltipla. As melhores condições nas redes sociais foram observadas nos menores patamares de renda e as piores entre os mais velhos e os "não casados". Para as mulheres, as chances de estarem "não casadas" aumentaram significativamente quanto pior era o seu nível educacional. O "status de coabitação" foi o que mais influenciou o apoio funcional, onde "morar só" aumentou significativamente as chances de não ocorrerem as trocas sociais. Os modelos de regressão logística múltipla construídos separadamente por gênero sugerem que idade, estado civil, renda per capita e escolaridade estão associados com as redes sociais entre os idosos. No entanto, essas relações manifestam-se de modos desiguais entre gêneros e entre as características sócio-demográficas para as diferentes dimensões da rede social.

The effect of social relationships on survival in elderly residents of a Southern European community: a cohort study

Background

Comparative evidence regarding the effects of social relationships on mortality in Mediterranean communities will increase our knowledge of their strengths and the ways in which they influence longevity across cultures. Men and women may benefit differently from social relationships because of cultural differences in gender roles. Psychosocial mechanisms such as social support, which may explain the effects of social networks, may also vary by culture.

Methods

Detailed information on the social relationships of a representative sample of 1,174 community-dwelling older adults was collected in Leganés, a city in central Spain. Mortality over a 6-year follow-up period was ascertained. Information on socio-demographic, health and disability variables was also collected. Cox proportional hazards models were fitted separately for men and women and for the combined sample.

Results

Having a confidant was associated with a 25% (95% CI 5–40%) reduction in the mortality risk. The hazard ratio for lack of social participation was 1.5 (95% CI 1.3–1.7). Being engaged in meaningful roles protected against mortality, while receipt of emotional support did not affect survival. These results were comparable for men and women. Having contact with all family ties was associated with reduced mortality only in men. Structural aspects of social networks make a unique contribution to survival, independently of emotional support and the role played in the lives of significant others.

Conclusion

In this elderly Southern European population, the beneficial effects of social networks, social participation, engagement in the life of significant others and having a confidant call for public policies that foster intergenerational and community exchanges.

Adult neurogenesis and neurodegenerative disease

Advances in stem cell biology of the adult brain and the discovery of adult neurogenesis have raised the hope that neurodegenerative disorders might ultimately become amenable to causal therapy. Stem cells contribute to cellular plasticity during the lifespan, and in some sense, brain development never ends. However, neurodegeneration is not just a lack of neuroregeneration, and cell genesis in the adult brain does not apparently lead to successful endogenous responses to neurodegeneration. The brain heals poorly; nevertheless, the onset, severity and progression of neurodegenerative disorders show large variation and can often be influenced by cognitive training and physical activity. Rather than providing endogenous repair, cellular plasticity, including adult neurogenesis might thus contribute to the 'cognitive reserve' that determines how well an organism can compensate for neurodegeneration. From this perspective, neurodegenerative disorders, such as Alzheimer's, Parkinson's, Lewy body and Huntington's diseases, might share a relevant biological principle that even links them to psychiatric disorders, like depression, which are not considered 'neurodegenerative' in a classical sense. However, the integration of neuroregenerative phenomena and most notably adult neurogenesis into the concepts of neurodegeneration is not without problems and remains speculative at present. Adult neurogenesis might be part of the physiological regenerative response and might thereby alter or alleviate symptoms, but it might also become impaired by the disease mechanism and thereby contribute to the symptoms of neurodegeneration. In any case, the extent to which effects on the level of cellular plasticity, be it degenerative or regenerative, are relevant functionally remains to be determined. The present review gives an overview of what is known about cell genesis and adult neurogenesis in neurodegenerative disorders and discusses how cellular plasticity might be part of concepts that integrate aspects of development and cellular plasticity into neurodegeneration.

Does marital status and altered contact with the social network predict colorectal cancer survival?

We examined whether changes in the frequency of contact with the social network (partner, children, grandchildren, other relatives, friends and colleagues) in a group of colorectal cancer patients were associated with survival. The study was based on a questionnaire survey from 1991. The study population consisted of 770 Danish colorectal cancer patients diagnosed in the period 1985-1990, and followed up for survival until March 2002. Using Cox regression analysis we found a significantly higher mortality among patients who had lost their partner before the operation compared to patients cohabiting with the same partner as before the operation (rate ratio (RR)=1.4, 95% confidence interval (CI): 1.1-1.8) possibly because of less active cancer treatment. This needs investigation in future studies. Contrary to expectations we also found a significantly higher mortality among patients reporting increased contact with their children compared to patients reporting unchanged contact frequency (RR=1.7, 95% CI: 1.3-2.4). However, a low physical functioning of the cancer patient may have confounded the latter result.

Performance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations

PURPOSE

There is a need for valid and reliable short scales that can be used to assess social networks and social supports and to screen for social isolation in older persons.

DESIGN AND METHODS

The present study is a cross-national and cross-cultural evaluation of the performance of an abbreviated version of the Lubben Social Network Scale (LSNS-6), which was used to screen for social isolation among community-dwelling older adult populations in three European countries. Based on the concept of lack of redundancy of social ties we defined clinical cut-points of the LSNS-6 for identifying persons deemed at risk for social isolation.

RESULTS

Among all three samples, the LSNS-6 and two subscales (Family and Friends) demonstrated high levels of internal consistency, stable factor structures, and high correlations with criterion variables. The proposed clinical cut-points showed good convergent validity, and classified 20% of the respondents in Hamburg, 11% of those in Solothurn (Switzerland), and 15% of those in London as at risk for social isolation.

IMPLICATIONS

We conclude that abbreviated scales such as the LSNS-6 should be considered for inclusion in practice protocols of gerontological practitioners. Screening older persons based on the LSNS-6 provides quantitative information on their family and friendship ties, and identifies persons at increased risk for social isolation who might benefit from in-depth assessment and targeted interventions.

Características do apoio social oferecido a idosos de área rural assistida pelo PSF

Trata-se de um trabalho epidemiológico do tipo transversal, com o objetivo de descrever as características do apoio social e identificar associações entre as variáveis sociodemográficas e categorias de suporte social, em população rural do Bairro dos Aleixos, no município de Taquarituba SP. Para medir o apoio social, utilizou-se da escala Medical Outcomes Study (MOS), traduzida para o português e validada em nosso meio. A população caracterizou-se por mulheres, predominantemente da raça branca, entre 60 a 69 anos, casadas e/ou vivendo em concubinatos, de baixa renda e residindo em domicílios multigeracionais. Escores de apoio médios elevados foram identificados, indicando situação favorável entre os idosos estudados. Em termos médios, a categoria de apoio com pior escore foi "interação social positiva". A análise bivariada demonstrou uma diferença significativa entre escore de apoio afetivo e de apoio emocional com número de pessoas no domicílio e maior freqüência de escores altos de interação social (3º tercil) em idosos do sexo masculino e naqueles com maior grau de escolaridade. O estudo apontou ainda que escores de apoio social menores foram mais freqüentes em mulheres, analfabetos, viúvos ou solteiros, idosos com renda entre um e dois salários mínimos.

Perceived social support and mortality in older people

OBJECTIVES

This study examines the effect of perceived social support on all-cause mortality at a 10-year follow-up as well as the plausible mediating factors in this association.

METHODS

We measured perceived social support in 206 Finnish men and women aged 80 years old by using the Social Provision Scale, which consists of six dimensions: attachment, social integration, opportunity for nurturance, reassurance of worth, reliable alliance, and guidance.

RESULTS

By using a theoretical framework that divided perceived social support into assistance-related and non-assistance-related support, we found that the risk of death was almost 2.5 times higher in women in the lowest tertile of non-assistance-related social support (comprising infrequent experiences of reassurance of worth, emotional closeness, sense of belonging and opportunity for nurturance) than in women in the highest tertile. The risk remained strong even when we controlled for the indicators of baseline sociodemographics and psychological and physiological health and functioning. Among men, none of the perceived social support dimensions showed a significant association with mortality.

DISCUSSION

The results of this study present a challenge for society to find and develop new social innovations and interventions in order to promote a sense of emotional social support in older people, thereby contributing to their health and welfare.

Siblings of Okinawan centenarians share lifelong mortality advantages

Okinawa, an isolated island prefecture of Japan, has among the highest prevalence of exceptionally long-lived individuals in the world; therefore, we hypothesized that, within this population, genes that confer a familial survival advantage might have clustered. We analyzed the pedigrees of 348 centenarian families with 1142 siblings and compared sibling survival with that of the 1890 Okinawan general population cohort. Both male and female centenarian siblings experienced approximately half the mortality of their birth cohort-matched counterparts. This mortality advantage was sustained and did not diminish with age in contrast to many environmentally based mortality gradients, such as education and income. Cumulative survival advantages for this centenarian sibling cohort increased over the life span such that female centenarian siblings had a 2.58-fold likelihood, and male siblings a 5.43-fold likelihood, versus their birth cohorts, of reaching the age of 90 years. These data support a significant familial component to exceptional human longevity.

Factors associated with "Ikigai" among members of a public temporary employment agency for seniors (Silver Human Resources Centre) in Japan; gender differences

BACKGROUND

"Ikigai" is culturally defined in the society of Japan as a comprehensive concept describing subjective well-being. It is considered to be related to life-satisfaction, self-esteem, morale, happiness as well as evaluation towards meaning of one's life. Although previous studies examined factors associated with Ikigai with smaller samples, consistent results have not been obtained, especially from the viewpoint of gender differences. Identification of gender-specific factors related with Ikigai among the elderly, may be of value to enhance subjective well-being.

METHODS

Self-administered questionnaires were distributed among 4,737 randomly selected members of the Silver Human Resources Centre (SHRC), a public temporary employment agency for seniors, in Osaka, Japan. This represents about 10% of all registered members (n = 41,593) in the 38 SHRC centres in Osaka. A total of 4,376 subjects (male: 2,913; female: 1,463) provided a satisfactory response to the questionnaire (response rate: 92%). The status whether they have "Ikigai" or not was evaluated by self-anchoring scale ranging from 0 to 5 (0 = lowest rate and 5 = highest rate of having "Ikigai"). Also, self-rated life-change score through work (-3 to 3) was evaluated by three items, i.e.) changes in (1) the number of friends through work, (2) social interests and (3) the quantity of conversation with others (1 = increase, 0 = no change, and -1 = decrease).

RESULTS

The factors associated with "Ikigai" for total subjects were the number of rooms in one's residence, annual income, healthy life style score (Breslow), the number of working days through SHRC, satisfaction with one's life history and life-change sore through work. The multivariable odds ratio (95% CI) of having "Ikigai" was 1.9 (1.1-3.3) for persons with no change in life thorough work compared with subjects with a score of < or = -1. Moreover, the multivariable odds ratios were 3.5 (1.9-6.6) for a life-change score = 1, 3.1 (1.7-5.7) for a score = 2 and 7.8 (4.0-15.2) for a score = 3 compared with persons with a score of < or = -1. For male subjects, other factors associated with having "Ikigai" were the number of rooms in their residence, annual income, the number of working days through SHRC, subjective assessment of health condition, and degree of satisfaction with their life history. For female, the corresponding factors were the presence of a spouse and degree of satisfaction with their life history.

CONCLUSION

Scores for life-changes through work were associated with a higher prevalence of having "Ikigai" for both male and female. For male, "Ikigai" tended to be associated with physical condition and socioeconomic factors such as the size of their residence or annual income, while for female, family relations such as having spouse and psychological factors such as satisfaction with one's life history were significant factors. In spite of the design limitations of this study, it is possible to conclude that the recognition of life change through obtaining work may enhance "Ikigai" among people who wish to engage in productive activities in their later stages of life for both male and female. SHRC has a potential to provide resources for fulfilling one's "Ikigai" through supporting working opportunities to realize life changes for both elder male and female.

Self-rated health and social role as predictors for 6-year total mortality among a non-disabled older Japanese population

We examined whether social role and self-rated health in an older population were predictors for 6-year total mortality among a non-disabled community-dwelling older population in Saku City, Nagano Prefecture, Japan, surveyed in 1992 and 1998. A total of 8090 men and women aged 65-99 years who reported no disability in performing activities of daily living (ADL) at the time of the survey in 1992 and provided information on their survival status at follow-up 6 years later were analyzed in this study. One dependent variable was survival status in 1998 and independent variables were various factors potentially associated with total mortality, which were obtained from a questionnaire survey at the baseline. During the 6-year interval, having poor self-rated health and poor social roles were identified as significant predictors for total mortality among both men and women. This study revealed that social role and self-rated health are independent predictors for 6-year total mortality for non-disabled Japanese aged 65 years or older.

Describing the Social Environment of Elderly Persons at the Time of Death

OBJECTIVES

To describe the social environment of elderly persons at the time of their death and its correlates.

DESIGN

Telephone interviews with the next-of-kin of deceased elderly persons.

PARTICIPANTS

Potential participants were the next-of-kin of all Jewish elderly individuals who died during the course of one year in a major city in the northern part of Israel. The final sample included 139 participants (58% response rate; 70% cooperation rate).

MEASUREMENTS

Information was collected regarding the decedents' social environment three days before their death and at the time of death. Eight types of informal sources of support and four sources of formal support were examined. The correlates examined included the decedents' demographic, health, social, and death characteristics.

RESULTS

The majority of the decedents died while surrounded by at least one family member. Having a larger social network was associated with a larger number of persons present at the time of death. Being informed about the impending death was associated with a larger number of persons from the formal and informal networks present at the time of death.

CONCLUSIONS

The common fear of dying alone and isolated was not confirmed by this study. Increased efforts should be invested in helping professionals to deal with the difficulties inherent to the process of diagnosing an upcoming death.

An active and socially integrated lifestyle in late life might protect against dementia

The recent availability of longitudinal data on the possible association of different lifestyles with dementia and Alzheimer's disease (AD) allow some preliminary conclusions on this topic. This review systematically analyses the published longitudinal studies exploring the effect of social network, physical leisure, and non-physical activity on cognition and dementia and then summarises the current evidence taking into account the limitations of the studies and the biological plausibility. For all three lifestyle components (social, mental, and physical), a beneficial effect on cognition and a protective effect against dementia are suggested. The three components seem to have common pathways, rather than specific mechanisms, which might converge within three major aetiological hypotheses for dementia and AD: the cognitive reserve hypothesis, the vascular hypothesis, and the stress hypothesis. Taking into account the accumulated evidence and the biological plausibility of these hypotheses, we conclude that an active and socially integrated lifestyle in late life protects against dementia and AD. Further research is necessary to better define the mechanisms of these associations and better delineate preventive and therapeutic strategies.

An international approach to community health care for older adults

Worldwide population ageing, concomitant increases in disability rates, and changes in family health care systems require an examination of current service delivery to optimize use of societal resources in the future. This article examines a community health care approach suggested by research conducted by the World Health Organization Kobe Centre for Health Development (WKC). The WKC approach, which uses a cross-national perspective, envisions a community health care system that integrates health and social services and spans health promotion, primary care, and long-term care. Prototypical approaches for organizing community health care include communal, marketplace, case management, and managed care. The ramifications of these approaches are examined from the perspectives of the older adult, the family, and formal service providers.