Loneliness as a mediator of the impact of social isolation on cognitive functioning of Chinese older adults

The Mediating Role of Health Empowerment in the Relationship Between Social Support and Loneliness Among Nursing Home Residents: A Correlational Study

BACKGROUND

Loneliness is a significant public health problem due to the physical, cognitive and psychosocial changes that occur with ageing. Social support and empowerment can be particularly important for older people, alleviating loneliness and improving mental well-being.

PURPOSE

The present study aimed to investigate the mediating role of health empowerment in the relationship between perceived social support and loneliness among nursing home residents.

STUDY DESIGN

The study was conducted with a correlational design and reported based on STROBE checklist.

METHODS

The study was completed with 277 older adults aged 65 years and over residing in nursing homes. Process Macro Model 4 was conducted to verify the mediating role.

RESULTS

The response rate was 95.6%. Most older adults experienced a feeling of loneliness, and the level of social support and empowerment perceived by most of them was high. The study found a mediating role of health empowerment in the relationship between social support and loneliness. Social support was significantly positively correlated with health empowerment and negatively correlated with loneliness. The significant standardised indirect effect of health empowerment on loneliness evidenced a partial mediating role.

CONCLUSION

This study concluded that health empowerment has a partial mediating role in the effect of perceived social support and loneliness.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses could develop effective strategies for preventing psychosocial problems in nursing home residents. Nurses could contribute significantly as educators, counsellors and leaders in planning interventions to empower older adults.

IMPACT

By empowering older adults regarding healthcare, nurses could increase their perception of social support, improving mental health by increasing effective coping with loneliness. Nurses could design intervention programmes to increase perceived social support, as well as health empowerment levels, and reduce older adults' loneliness in nursing homes.

PATIENT OR PUBLIC CONTRIBUTION

Older adults completed the instruments.

Adverse Childhood Experiences and Social Participation on Frailty State Transitions among middle-aged and older adults: evidence from a 10-year prospective study in China

OBJECTIVES

Adverse childhood experiences (ACEs) are associated with frailty, while the association with frailty state transitions and the role of social participation remain unclear. This study aimed to investigate the association between ACEs and frailty state transitions, alongside the moderating effect of social participation METHODS: Data from 9,621 adults aged 45 and older from the China Health and Retirement Longitudinal Study (2011-2020) were analyzed. Frailty was measured with the frailty index, while ACEs and social participation were measured with a validated questionnaire. The association between ACEs and frailty state transitions was estimated using multi-state models. An interaction analysis were used to examine the moderating effects of social participation.

RESULTS

Participants with higher ACEs scores (≥4) were associated with an increased probability of forward transition (robust to pre-frail, HR = 1.37, 95%CI: 1.21-1.54; prefrail to frail, HR = 1.39, 95%CI: 1.18-1.63) and decreased probability of backward transition (pre-frail to robust, HR = 0.64, 95%CI: 0.55-0.76). Additionally, participants with moderate and high level social participation were associated with an increased probability of backward transition (pre-frail to robust, HR = 1.11, 95%CI: 1.01-1.23; frail to pre-frail, HR = 1.17, 95%CI: 1.02-1.33, respectively). Social participation moderated the association between ACEs exposure and frailty (P for interaction <0.05), while participants with lower ACEs scores (1 and 2) and high social participation were associated with an increased probability of transition from frail to pre-frail (HR = 1.26, 95%CI: 1.04-1.89 and HR = 1.15, 95%CI: 1.08-1.69).

CONCLUSIONS

High ACEs scores were associated with an increased likelihood of adverse frailty development. Older adults with ACEs exposure might benefit from intervention strategies to improve social participation.

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.

Prevalence of Unwanted Loneliness and Associated Factors in People over 65 Years of Age in a Health Area of the Region of Murcia, Spain: HELPeN Project

Background/Objectives: Population aging poses many challenges to public health, highlighting loneliness and social isolation as severe problems that affect the physical and mental health of older adults. During the COVID-19 pandemic, these became aggravated. The objective of the present study was to assess the prevalence of loneliness and its relationship with social isolation, depression, cognitive deterioration, sleep quality, and the level of physical mobility and functioning of older adults in Health Area 3 of the Region of Murcia. Methods: A descriptive, observational, and cross-sectional study was performed. The inclusion criteria were age ≥ 65, living in Health Area 3 of the Region of Murcia, and not being institutionalized. The following variables were evaluated: sociodemographic variables, loneliness (UCLA scale), social isolation (DUFSS), depression (GDS), cognitive deterioration (Pfeiffer), sleep quality (PSQI), and mobility (Barthel index). A univariate and multivariate regression model was created to examine how the dependent variable was related to the independent variables. Results: A total of 102 older adults participated in the study. Of these, 31.4% perceived unwanted loneliness and 14.7% low social support. The multivariate regression analysis showed that social isolation, geriatric depression, and cognitive deterioration were significant predictors of loneliness. Conclusions: The findings highlight the importance of developing multifaceted interventions that address not only social isolation but also other interrelated factors such as depression, cognitive deterioration, and sleep quality. The strategies should be centered on community programs and support networks. It is fundamental to perform longitudinal studies to better understand the causal relationships between these variables.

A Cross-Lagged Panel Analysis of Social Participation in the Relationship Between Functional Limitations and Cognitive Functioning: Evidence From CHARLS

Functional limitations refer to the dependency to perform activities of daily living. Increasing evidence has demonstrated a bidirectional association between functional limitations and cognitive functioning, although the exact mechanism remains unclear. This study investigated whether social participation bidirectionally mediates the association between functional limitations and cognitive decline. We analyzed a sample of 16,385 middle-aged and older adults (aged over 50 years) using longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS; Waves 1-4). We utilized a cross-lagged panel model to examine the bidirectional mediation of social participation between functional limitations and cognitive functioning over a span of eight years. The results indicated that social participation bidirectionally and partially mediated the relationship between the onset of functional limitations and cognitive decline, indicating that social participation may play an important role in mitigating the disablement process.

Cognitive Dysfunction and Exercise: From Epigenetic to Genetic Molecular Mechanisms

Maintaining good health is crucial, and exercise plays a vital role in achieving this goal. It offers a range of positive benefits for cognitive function, regardless of age. However, as our population ages and life expectancy increases, cognitive impairment has become a prevalent issue, often coexisting with age-related neurodegenerative conditions. This can result in devastating consequences such as memory loss, difficulty speaking, and confusion, greatly hindering one's ability to lead an ordinary life. In addition, the decrease in mental capacity has a significant effect on an individual's physical and emotional well-being, greatly reducing their overall level of contentment and causing a significant financial burden for communities. While most current approaches aim to slow the decline of cognition, exercise offers a non-pharmacological, safe, and accessible solution. Its effects on cognition are intricate and involve changes in the brain's neural plasticity, mitochondrial stability, and energy metabolism. Moreover, exercise triggers the release of cytokines, playing a significant role in the body-brain connection and its impact on cognition. Additionally, exercise can influence gene expression through epigenetic mechanisms, leading to lasting improvements in brain function and behavior. Herein, we summarized various genetic and epigenetic mechanisms that can be modulated by exercise in cognitive dysfunction.

Reciprocal and Dynamic Associations between Social Isolation, Loneliness, and Disability among Chinese Older Adults

OBJECTIVES

This study aimed to examine reciprocal and dynamic associations between Social Isolation (SI), loneliness, and disability among Chinese older adults.

DESIGN

This is a prospective cohort study.

SETTING AND PARTICIPANTS

The global trend of population aging has resulted in a significant rise in the prevalence of disabilities, SI, and loneliness among older adults. These factors can severely impact the health and well-being of older adults. Therefore, it is crucial to implement more efficient interventions aimed at reducing disabilities, addressing SI, and combating loneliness among older adults in order to improve their overall health and well-being.

METHODS

Using a large, nationally representative sample spanning 16 years, we employed the general cross-lagged panel model to explore the relationships among 50,348 older adults with a mean age of 81.83 at baseline. Disability was measured by a comprehensive index tool that incorporated multiple dimensions. SI was measured using an SI index, and loneliness was evaluated using a single-item measure.

RESULTS

SI emerged as a stronger predictor of disability than loneliness. Longitudinal analysis revealed accumulative disadvantages in the association between SI and disability. Additionally, disability was found to contribute to increased SI and loneliness. However, our study did not detect any variance in the strength of the cross-lagged effects between social isolation and disability.

CONCLUSIONS AND IMPLICATIONS

The findings suggest that reducing SI is crucial for reducing disability among older adults. Initiating early interventions to minimize initial SI could aid in preventing later-life disability. Additionally, addressing disabilities may positively impact the reduction of loneliness and SI within this population.

Dyadic contagion in cognitive function: A nationally-representative longitudinal study of older U.S. couples

Later-life cognitive function is strongly influenced by one's environment. At this life stage, a partner's behaviors and attributes-including their own cognitive status-are a key environmental determinant. A recent "social allostasis" theory also yields specific predictions on patterns of mutual influence-or "contagion"-in cognitive function. Yet, no population representative studies have examined these coupled dynamics. Using recently developed fixed-effects cross-lagged panel modeling (FE-CLPM) methods and ten-year data from the Health and Retirement Study-nationally-representative of U.S. adults over 50-the current study filled this gap. Results supported dyadic cognitive contagion over the long- but not short-run. Short-term associations suggested intriguing "cognitive cycling" possibilities among both men and women that need further investigation. Overall, results supported a theoretical model of coupled "cognitive careers," and relational inducement of allostatic load. Especially among men, recurrent impulses also cumulatively induced substantial path-dependent cognitive improvements, supporting the added value of repeated over one-time interventions. Theoretical and substantive implications are discussed.

Exploring the association between social isolation and utilization of primary health services by older adults: evidence from China

Objective

This study aims to investigate the impact of social isolation on the utilization of primary health services among older adults in China.

Methods

Data from the China Longitudinal Aging Social Survey (CLASS) conducted in 2018 were utilized. A binary logistic regression model was established, and propensity score matching (PSM) was employed for analysis.

Results

The results of the binary logistic regression showed that family isolation within social isolation had a significant negative impact on the utilization of primary health services for older adults. In contrast, there was no significant association between friend isolation, community isolation, and the utilization of primary health services. Furthermore, the PSM results, using three matching methods (nearest neighbor matching, radius matching, and kernel matching), confirmed that family isolation significantly reduced older adults' utilization of primary health services, consistent with the baseline regression findings.

Conclusion

Reducing the occurrence of family isolation among older adults may be a cost-effective intervention measure. Efforts should be directed toward improving family support for older adults, promoting the utilization of primary health services, and strengthening disease prevention.

Intervention to reduce loneliness among older adults in the community: Making friends with volunteers

AIM

This study aimed to examine the effects of providing a program that introduced volunteers to make friends with older adults to reduce loneliness and increase loneliness literacy.

METHODS

Eight community development associations in Taiwan participated in the study. In the first stage, older people living alone or with only a spouse, or those with a family, but without substantial interactions, were screened for loneliness. Older adults with a higher risk of loneliness were given priority to be invited to participate in this intervention. This 3-month intervention program was designed by each community development association and delivered at the older adults' homes. A total of 87 older persons completed both waves of the interviews.

RESULTS

Loneliness was reduced (UCLA-6 Loneliness Scale scores decreased from 13.5 to 11.6), and loneliness literacy improved (loneliness literacy scores increased from 38.9 to 42.0) compared with what it was before the program. In a generalized linear model, when controlling for covariates, loneliness was reduced, but not significantly (B = -0.934, P > 0.05), whereas loneliness literacy improved significantly for older participants (B = 2.088, P < 0.05).

CONCLUSIONS

Making friends with older adults who are lonely might improve their loneliness literacy. Geriatr Gerontol Int 2024; 24: 240-245.

Social Isolation, Physical Activity, and Subsequent Changes in Cognition Among Middle- and Older-Aged Adults: Results From the Canadian Longitudinal Study on Aging

OBJECTIVE

The objectives of this study were to a) evaluate associations between social isolation and change in cognition over a 3-year period, and b) evaluate whether physical activity mediates the association between social isolation and cognition change.

METHODS

Using baseline and follow-up 1 data from the Canadian Longitudinal Study on Aging, latent change score models, incorporating direct and indirect pathways, were constructed to estimate the indirect effect of social isolation on cognitive change through physical activity. Multigroup models were constructed based on age group (45-65 versus 65+ years) and sex to allow for varying estimates across age and sex. The final analytic sample included 51,338 participants.

RESULTS

Indirect effects of social isolation on cognition through physical activity were evident in men and women 65+ years old for memory change ( = -0.005 [99.9% confidence interval = -0.007 to -0.002], p < .001 in both groups) and in male adults 65+ years old for executive function change ( = -0.01 [99.9% confidence interval = -0.02 to -0.006], p < .001). Statistically significant indirect effects were not observed for adults between 45 and 65 years old.

CONCLUSIONS

Social isolation is associated with diminished physical activity, and in turn, diminished physical activity is associated with decline in memory in older women and men, with larger declines in executive function in older men. Public health initiatives to promote physical activity-perhaps incorporating social interaction-among older adults experiencing social isolation could be one way to mitigate the negative impact of social isolation on cognitive health.

The influence of social participation and depressive symptoms on cognition among middle-aged and older adults

Background

The global aging phenomenon has raised concerns about the cognitive abilities of older individuals. This study aimed to explore the relationship between social participation, depressive symptoms, and cognitive function among middle-aged and older adults.

Methods

This study utilized data from the China Longitudinal Study of Health and Retirement (CHARLS) from wave 1 to wave 4. We used linear regression and generalized estimation equations to investigate the correlation between social participation, depressive symptoms, and cognitive function. Moreover, three models were constructed by adjusting covariates, and we used the sobel test and bootstrap method to analyze the mediating effects of depressive symptoms on social activities and cognitive function.

Results

The results of both linear regression and generalized estimation equation showed that social participation had a positive correlation with cognitive function (P < 0.05), and the impact of social participation on cognition increased with the number of social activity types. Meanwhile, depressive symptoms had a negative association with cognitive function (P < 0.05). Furthermore, there was no interaction between social participation and depressive symptoms on cognitive function. Finally, after adjusting the model, social participation could affect cognitive function by affecting depressive symptoms (P < 0.05).

Conclusion

The study emphasizes the mediating role of depressive symptoms in the relationship between social participation and cognitive function. Notably, no interaction was observed between social participation and depressive symptoms. These findings highlight the potential of active social participation in reducing depressive symptoms and enhancing cognitive function in middle-aged and older adults.

Patterns of Social Isolation and Low Social Support and Frailty Trajectories Among Chinese Older Adults

Objectives: This study aims to identify patterns of social isolation and low social support, and discover their associations with frailty trajectories among Chinese older adults. Methods: The paper used five waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS, 2005-2018). The latent class analysis, multi-trajectory modeling, and the multinomial logistic regression approaches were used to perform the analysis. Results: The paper identified five types of social isolation and low social support, and three typical frailty trajectories. Patterns of social isolation and low social support were associated with frailty trajectories among older adults. Conclusions: Distinct patterns of social isolation and low social support were significantly correlated with frailty trajectories. To improve frailty trajectories among older adults, interventions such as Healthy China 2030 should prioritize addressing the interplay between social isolation and low social support.

Social Isolation and Loneliness in a Population Study of Cognitive Impairment: The MYHAT Study

In this study, we examined associations of social isolation and loneliness with cognitive impairment among older adults from a Rust Belt region in Southwest Pennsylvania. We used data from the population-based Monongahela-Youghiogheny Healthy Aging Team (MYHAT) study. We found that (a) 11 items combined into two reliable composites of social isolation and loneliness; (b) unique to this study, providing unpaid help to others was an indicator of reduced social isolation; (c) social isolation and loneliness were positively associated with cognitive impairment; and (d) these associations were appreciably attenuated by general health and physical functional status and depressive symptoms, respectively. We concluded that social isolation and loneliness are differentially associated with older adults' cognitive health, and that their effects might operate through separate pathways. Approaches to address social isolation and loneliness should consider the community context and its implications for older adults' cognitive health.

Later-life depressive symptoms during the Covid-19 pandemic: Investigations of individual, cumulative, and synergistic effects of social isolation

OBJECTIVES

This study examines associations between social isolation and depressive symptoms among Hong Kong Chinese adults aged 65 and older by investigating the distinct effects of individual indicators, cumulative index, and typologies of social isolation during the Covid-19 pandemic.

METHODS

We used a sample of 260 older adults from a cross-sectional, city-wide online survey targeting 1,109 aged 45+ adults through purposive sampling. Seven indicators of social isolation (not married; living alone; not engaging in social/organizational activities; no social contact with friends or families; lack of family and friends networks; loneliness) using Cornwell & Waite's framework were selected to construct three unique types of social isolation measures. We used latent class analysis (LCA) and regression models to examine the effects of varied typologies of social isolation on depressive symptoms.

RESULTS

Individual model of social isolation showed that lack of social contact and feeling lonely were significant predictors of depressive symptoms. A strong linear-trend gradient effect of cumulative social isolation on depressive symptoms was also observed. The LCA model identified four typologies of social isolation (socially isolated; living alone but socially engaged; married but lacking social ties, and not socially isolated); those in the 'socially isolated' and 'married but lacking social ties' groups had the most depressive symptoms.

CONCLUSION

Three operationalizations of social isolation demonstrated different utilities and implications in assessing the impacts of social isolation on depressive symptoms. Social contacts and loneliness, rather than living status or other characteristics of isolation, were the factors most strongly associated with depressive symptoms. Support programs should target lonely older adults who lack social engagement opportunities, as they are at increased risk of depression.

The indirect effect of cognitive reserve on the relationship between age and cognition in pathological ageing: A cross-sectional retrospective study in an unselected and consecutively enrolled sample

Cognitive reserve (CR) allows individuals to maintain cognitive functionality even in the presence of pathologies. The compensation hypothesis suggests that CR plays an indirect role between age and cognitive decline, contrasting the negative effect of ageing on cognition. We test this hypothesis in an unselected and consecutively enrolled sample of memory clinic attendees (n = 134) who completed the CR Index questionnaire and three neuropsychological tests assessing global cognition (MMSE, FAB, CDT). Participants were divided into two groups based on standard diagnostic criteria (DSM-5): those who were cognitively impaired (n = 92) and those who were preserved (n = 42). A principal component analysis was used to extract a composite measure of global cognitive functioning from the three neuropsychological tests, and mediation analysis was used to examine the relationship between CR, age and global cognitive functioning in the two groups. Results revealed that: (i) age had a significant direct negative effect on the global cognitive score in both groups; (ii) the three socio-behavioural proxies of CR together suppress the direct negative relationship between age and global cognitive score in cognitively impaired patients but not in cognitively preserved participants. This study confirms the association between CR, age and cognition and allows us to validate its role in a population with cognitive impairment and extend findings to a low-to-middle educated population. These results hold important implications for public health and wellness promotion, emphasising the beneficial role of maintaining healthy and active physical, cognitive and social lifestyles.

Physical Mobility, Social Isolation and Cognitive Function: Are There Really Gender Differences?

OBJECTIVE

This study aimed to examine the mediating role of social isolation between physical mobility and cognitive function, and whether there are gender differences in the above mediating effects among Chinese older adults.

METHODS

This is a prospective and cohort study. We obtained data from the 2011 (Time 1, T1), 2015 (Time 2, T2) and 2018 (Time 3, T3) waves of China Health and Retirement Longitudinal Study, including 3,395 participants aged 60 years or above. Cognition was evaluated by Telephone Interview of Cognitive Status, words recall, and figure drawing, which was widely used in previous research. We used a cross-lagged model to test the hypothesis that social isolation mediated the association between physical mobility and cognitive function among Chinese older adults.

RESULTS

The total effects of T1 physical mobility limitations on T3 cognitive function (β = -0.055, bootstrap p < 0.001) were significantly negative. Social isolation played a mediating role among both males and females (male: β = -0.008, bootstrap p = 0.012; female: β = -0.006, bootstrap p = 0.023), demonstrating that the mediating effect of social isolation between physical mobility and cognitive function was not gender specific.

CONCLUSION

This study confirmed that social isolation mediated the association between physical mobility and cognitive function among both Chinese male and female older adults. These findings indicate that reversing social isolation can be a priority intervention target for cognitive decline prevention and promote successful ageing, particularly among older adults with impaired physical mobility.

Critical components of social prescribing programmes with a focus on older adults - a systematic review

AIMS

The aim of this study was to identify and evaluate critical components within social prescribing programmes that can impact loneliness, health, or well-being among older adults.

METHODS

A systematic review with a narrative synthesis was conducted by systematically searching five databases. A total of 1193 hits were identified, screened, and assessed. Twelve studies were included, with data being extracted and deductively analysed in an iterative manner and then tabulated together with outcomes in order to find common narratives.

RESULTS

Three critical components were identified: Assessment before prescription, matching participants with relevant activities, and individualised support from link worker. These critical components seemed important for the success of social prescribing programmes since they had an impact on loneliness, health, and well-being. All together, these results highlight the importance of person-centeredness in the prescribing process.

CONCLUSIONS

The three critical components identified may prove useful in further research, evaluation, or implementation of social prescribing programmes. Important aspects for further evaluation are discussed.

Social Isolation, Loneliness, and Cognitive Performance in Older Adults: Evidence From the ELSI-Brazil Study

BACKGROUND

The association between social isolation and cognitive performance has been less investigated in low-to-middle-income countries (LMIC) and the presence of depression as a moderator on this association has not been examined. The authors examined the associations of social isolation and perceived loneliness with cognitive performance in the Brazilian Longitudinal Study of Aging.

METHODS

In this cross-sectional analysis, social isolation was evaluated by a composite score including marital status, social contact, and social support. The dependent variable was global cognitive performance, which considered memory, verbal fluency, and temporal orientation tests. Linear and logistic regressions were adjusted for sociodemographic and clinical variables. The authors added interaction terms of depressive symptoms with social isolation and loneliness to examine whether depression, measured through the Center for Epidemiologic Studies-Depression Scale, modified these associations.

RESULTS

Among 6,986 participants (mean age = 62.1 ± 9.2 years), higher levels of social connections were associated with better global cognitive performance (B = 0.02, 95%CI: 0.02; 0.04). Perceived loneliness was associated with worse cognition (B = -0.26, 95%CI = -0.34; -0.18). Interactions of depressive symptoms with social connections scores were found on memory z-score and with loneliness on global and memory z-scores, suggesting a weaker association between social isolation or loneliness and cognition among those with depressive symptoms.

CONCLUSION

In a large sample from an LMIC, social isolation and loneliness were associated with worse cognitive performance. Surprisingly, depressive symptoms decrease the strength of these associations. Future longitudinal studies are important to assess the direction of the association between social isolation and cognitive performance.

Functional Hearing Impairment, Psychological Resilience, and Social Well-Being Among Chinese Older Adults in Low-Income Households

PURPOSE

Hearing loss (HL) is prevalent and relates to social health in old age. This study aims to examine the association between functional HL and social well-being (SWB) in older adults and to investigate whether psychological resilience mediates this association.

METHOD

The analytical sample of 4,531 older adults aged ≥ 60 years was from the Sample Survey on Vulnerable Populations from Poor Families in Urban/Rural China (2018). SWB was measured by social networks and social engagement using the Lubben Social Network Scale and Index of Social Engagement Scale, respectively. Functional hearing impairment was defined by a dichotomized measure of self-perceived hearing difficulty. Psychological resilience was assessed by a 25-item Connor-Davidson Resilience Scale. Structural equation modeling was performed to determine associations of HL with SWB and the mediating roles of psychological resilience.

RESULTS

Functional HL was associated with reduced SWB among older adults living in low-income households. Hearing-impaired individuals were more likely to be socially isolated and less socially engaged compared to those with normal hearing. The association persisted in gender subsamples and in non-low-income households but not in older adults aged ≥ 70 years. Psychological resilience partially mediated the association of hearing impairment with SWB, accounting for 50.9% of the variance in the change of SWB.

CONCLUSIONS

Functional hearing impairment may be a modifiable risk factor for social restrictions and downstream older adults' health. Promotion of hearing health care and accessibility to coping resources including psychological support may improve social wellness among the older adults and benefit healthy aging.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22750736.

Social distancing, emotional suffering, and cognitive performance in mature and older adults: a literature review

Variables related to social distancing can have negative effects on the emotional well-being and cognition of adults and the elderly.

Objective

The aim of this study was to analyze the available studies that address the relationship between situations of social distancing, socioemotional aspects, and cognition in the lives of mature and older adults.

Methods

A literature review study was carried out between December 2021 and January 2022, involving the SciELO, PubMed, and ScienceDirect databases, with studies published between February 2018 and December 2021.

Results

A total of 754 studies were identified, and after selection, 18 were included. Notably, 16 showed significant effects of social distancing on cognition and socioemotional aspects, that is, the greater the social distancing, the lower the capacity for cognitive performance and the higher the index of symptoms of depression and anxiety, for example.

Conclusions

Greater engagement in social activities and a closer contact with friends and family are protective factors against symptoms of depression and anxiety and cognitive decline.

Association between social integration and risk of dementia: A systematic review and meta-analysis of longitudinal studies

BACKGROUND

Dementia is an emerging public health issue. Growing evidence emerged on the association between social integration and the risk of dementia. However, the magnitude of the association between different aspects of social integration and the risk of dementia is unclear.

METHODS

Five databases were systematically searched. Newcastle-Ottawa scale for assessing the quality of the reporting was used for quality appraisal. Longitudinal cohort studies examining the association between social integration and the risk of dementia were analyzed using random effects model. A series of sensitivity analyses was conducted to enhance the robustness of the findings.

RESULTS

Forty publications generated from 32 studies/databases were included. The meta-analysis showed that strong social engagement (overall RR = 0.81, 95% CI = 0.74-0.89, p < 0.001) and frequent social contact (overall RR = 0.86, 95% CI = 0.76-0.97, p = 0.018) were positively associated with decreased risk of dementia. The influence of social support (overall RR = 0.92, 95% CI = 0.80-1.06, p = 0.238) and close social contact (overall RR = 0.74, 95% CI = 0.48-1.13, p = 0.167) was not significant. Loneliness was significantly associated with an increased risk of dementia (overall RR = 1.42, 95% CI = 1.26-1.60, p < 0.001), whereas the influence of social isolation (overall RR = 1.58, 95% CI = 0.80-3.12, p = 0.192) was not significant. A larger social network size (RR = 0.75, 95% CI = 0.59-0.97, p = 0.028) was a promising influencing factor even though the number of studies was insufficient for a meta-analysis. However, the heterogeneity among studies was generally high even though sensitivity analysis was conducted.

CONCLUSIONS

Our findings reveal that high social engagement and frequent social contact are significantly associated with a lower risk of dementia, whereas loneliness is associated with a higher risk. The promising impact of large social network size is also identified. Substantial heterogeneity appeared in most of the analysis, making the inference tentative. Nevertheless, the sensitivity analysis provided valuable implications that enhancing social engagement and reducing loneliness may prevent or delay the onset of dementia among middle-aged and older adults.

Living alone and all-cause mortality in community-dwelling older adults: The moderating role of perceived neighborhood cohesion

OBJECTIVES

The adverse effect of living alone on health has been well-documented in community-dwelling older adults. A less understood topic in this research area is whether some neighborhood characteristics may mitigate the negative impact of living alone on health outcomes and mortality. This study aimed to extend the existing work on living arrangements and health by examining the potential interactive effect of living alone and perceived neighborhood cohesion on all-cause mortality among older Chinese Americans.

METHODS

Data were drawn from 3154 (58.0% female) participants from a prospective cohort study of community-dwelling US older Chinese adults aged 60 and older in the greater Chicago area. Living arrangements and perceived neighborhood cohesion were assessed at baseline from 2011 to 2013. Mortality status was tracked through December 2021. Covariates, including sociodemographic characteristics, health and behavioral covariates, loneliness, depression, and social engagement, were assessed at baseline. Cox proportional hazards regression model was used to test our hypotheses.

RESULTS

Living alone was significantly associated with an increased risk of all-cause mortality among participants reporting low levels of perceived neighborhood cohesion but not among those reporting high levels of perceived neighborhood cohesion. This protective effect of perceived neighborhood cohesion was robust to the inclusion of covariates.

CONCLUSIONS

Our results suggest that strong perceived neighborhood cohesion may protect against the increased risk of premature mortality associated with living alone in community-dwelling older Chinese Americans.

The Reciprocal Relationship Between Social Engagement and Cognitive Function Among Older Adults in South Korea

A greater number of studies have examined the impact of social engagement on cognitive function rather than the other way around, leaving their reciprocal association underexplored. Furthermore, formal and informal social engagement are not differentiated, although they may have independent relationships with cognitive function. This study aims to identify (1) whether informal and formal social engagements are effective in maintaining cognitive health and (2) if cognitive function has a bidirectional effect on social engagement. The study applies a dynamic panel data structural equation modeling with a maximum likelihood estimator (ML-SEM) to the Korean Longitudinal Study of Aging (KLoSA) data. The results confirm that frequent participation in organizational activities is more robustly associated with cognitive function than memberships or informal social contact. Concerning the bidirectional relationship, the cognitive function increases the degrees of informal and formal engagement. The study thus validates a reciprocal association between social engagement and cognitive function.

Bidirectional associations of intellectual and social activities with cognitive function among middle-aged and elderly adults in China

BACKGROUND

Previous studies evaluating the association between leisure activities and cognitive function produced conflicting results. Different types of leisure activities may have different effects on cognition, and very few studies have explored their bidirectional associations. Our study aimed to explore whether intellectual and social activities had bidirectional associations with cognitive function among the middle-aged and elderly adults in China.

METHODS

Data was derived from the China Health and Retirement Longitudinal Study. The data in this study were based on 11,549 participants aged 45 or older whose intellectual and social activities and cognitive function were assessed at baseline. Cross-lagged panel model was used to examine the temporal relationship of intellectual and social activities with cognitive function.

RESULTS

Totally, 5624 participants completed the third follow-up in 2018. The results showed that the better the cognitive function they had at baseline, the more intellectual activities they were engage in (β = 0.044, P < 0.001) and vice versa (β = 0.042, P = 0.001). Additionally, better cognitive function at baseline was significantly associated with more engagement in social activities (β = 0.028, P = 0.030); in contrast, higher engagement in social activities at baseline was not related to better cognitive function (β = -0.008, P = 0.523).

LIMITATIONS

Engagement in social and intellectual activities was assessed via questionnaire.

CONCLUSIONS

Our findings indicated that there was a bidirectional relationship between intellectual activities and cognitive function. However, participation in social activities did not slow down the decline in cognitive function. Participating in intellectual activities, compared to social activities, is especially beneficial for cognitive function.

New Dimension on Quality of Life Differences among Older Adults: A Comparative Analysis of Digital Consumption in Urban and Rural Areas of China

The purpose of this study was to compare the variability in quality of life in the area of digital consumption among older adults in urban and rural China during the COVID-19 pandemic. This study proposed a low-cost mixed research method, and the methodology used a quantitative study of a large regional sample combined with a qualitative study of a small regional sample. Data for the large-scale area sample were obtained from the China family panel study (CFPS) dataset, and data for the small-scale regional sample were obtained from Nanjing, China. The quantitative analysis of the large-scale regional sample used the least squares regression analysis (OSL) and propensity score matching (PSM). The qualitative analysis of the small-scale regional sample used the selection optimization and compensation (SOC) model. The findings show that economic income is a direct driver of digital consumption. Digital consumption had a significant positive relationship with the quality of life for urban and rural older adults. In addition, the study established the semantic network relationships of the coping strategies of digital consumption of older adults and their drivers. Finally, the theoretical and practical implications of these findings are discussed in the context of other related studies.

Potential neurobiological links between social isolation and Alzheimer's disease risk

It is estimated that 40% of dementia cases could be prevented by modification of lifestyle factors that associate with disease risk. One of these potentially modifiable lifestyle factors is social isolation. In this review, we discuss what is known about associations between social isolation and Alzheimer's disease, the most common cause of dementia. This is particularly relevant in the time of the COVID-19 pandemic when social isolation has been enforced with potential emerging negative impacts on cognition. While there are neurobiological mechanisms emerging that may account for the observed epidemiological associations between social isolation and Alzheimer's disease, more fundamental research is needed to fully understand the brain changes induced by isolation that may make people vulnerable to disease.

A wearable soft robot that can alleviate the pain and fear of the wearer

Social soft robotics may provide a new solution for alleviating human pain and fear. Here, we introduce a hand-held soft robot that can be clenched by the wearer. The robot comprises small airbags that can be inflated to provide the wearer with a feeling of being clenched. We then conducted an in-depth study of 66 adults who participated in a pain research protocol using thermal stimulation to investigate the effect of wearing the robot on pain perception and fear of injections. Pain assessment scale scores for perceived pain decreased significantly [Formula: see text] when participants wore the robot compared with the baseline condition in which the robot was not worn. In addition, the saliva test results showed a downward trend in oxytocin level when the robot provided the wearer with haptic feedback via the inflation of the internal airbags in response to the wearer's clench. Furthermore, the negative psychological state of participants, as measured using the positive and negative affect scale, improved significantly when wearing the robot. We also revealed that the salivary cortisol level, an indicator of stress, decreased significantly across all participants at the end of the experiment. In addition, participants' fear of injections was significantly improved after participation in the experiment. These results suggest that the wearable soft robot may alleviate the human perception of pain and fear in during medical treatments, such as vaccinations.

Assessing the role of depressive symptoms in the association between social engagement and cognitive functioning among older adults: analysis of cross-sectional data from the Longitudinal Aging Study in India (LASI)

OBJECTIVE

The present study aimed to examine the confounding effects of depressive symptoms and the role of gender in the association between social engagement and cognitive functioning among older Indian adults.

DESIGN

Large-scale cross-sectional survey data were analysed.

SETTING AND PARTICIPANTS

Data from the Longitudinal Aging Study in India (2017-2019) were used in the analysis. The sample included 23 584 individuals aged 60 years and above (11 403 men and 12 181 women).

OUTCOME MEASURES

The outcome variable was cognitive functioning, which was based on various measures including immediate and delayed word recall, orientation, executive functioning, arithmetic ability and object naming. Social engagement measure consists of marital status, living arrangement, availability of confidant, and participation in indoor games, and social and cultural functions. The Center for Epidemiological Studies-Depression Scale was used to assess depressive symptoms.

RESULTS

Significant gender differences in mean cognition scores (men: 25.8, women: 21.1; on a scale of 0-43) were observed. Two-way stratification between social engagement and depressive symptoms was significantly associated with cognitive functioning after controlling for selected explanatory factors. Older men with a low level of social engagements had significantly poor cognitive functioning (β=-1.12; 95% CI: -1.53 to -0.72) compared with men with a high level of social engagements. On the other hand, women with a higher level of social engagement performed poorly on cognitive tests (β=-1.54; 95% CI: -2.11 to -0.98) compared with men with higher social engagements. Three-way stratification between social engagement, gender and depressive symptoms suggests that social engagement's buffering effects are lower in women than in men. The Karlson-Holm-Breen method identified a significant confounding effect of depressive symptoms on the relationship between social engagement and cognitive functioning.

CONCLUSION

The positive association of social engagement with cognitive functioning was significantly confounded by depressive symptoms, suggesting the need for maintaining social relations that help improve mental health and cognitive functioning among older adults.

The Impact of Changing Social Support on Older Persons' Onset of Loneliness During the COVID-19 Pandemic in the United Kingdom

BACKGROUND AND OBJECTIVES

Social distancing measures aimed at controlling the spread of coronavirus disease 2019 (COVID-19) are likely to have increased social isolation among those older than 70 instructed to shield at home. This study examines the incidence of loneliness by gender over the first 10 months of the COVID-19 pandemic among persons aged 70 and older in the United Kingdom, and the impact of changing social networks and perceived social support on the new occurrence of loneliness.

RESEARCH DESIGN AND METHODS

Participants (N = 1,235) aged 70 and older with no reports of loneliness before the pandemic who participated in 7 rounds of the Understanding Society: COVID-19 Study (April 2020-January 2021) and the main Understanding Society Study conducted during 2019. Cox regression analyzed the time to a new occurrence of loneliness.

RESULTS

Among older people who hardly ever/never felt lonely before the pandemic, 33.7% reported some degree of loneliness between April 2020 and January 2021. Living in a single-person household, having received more social support before the pandemic, changes in support receipt during the pandemic, and a deteriorating relationship with one's partner during the pandemic increased the risk of experiencing loneliness. Older women were more likely than older men to report loneliness, even when living with a partner.

DISCUSSION AND IMPLICATIONS

During the 3 COVID-19-related lockdowns in the United Kingdom, changes in older people's social networks and support resulted in a significant onset of loneliness. Findings highlight the risks of shielding older persons from COVID-19 in terms of their mental well-being and the importance of strengthening intergenerational support.

Psychosocial Mediation of Light-Moderate Physical Activity and Cognitive Performance among Adults Aged 60+ in China

Physical activity is a key determinant of healthy ageing; yet, little is known about the varying degrees of benefits by intensity nor the mediating mechanisms that operate through psychosocial health. Leveraging structural mediation analysis using the 2018 China Health and Retirement Longitudinal Study (CHARLS) national survey data, we screened 4371 community-dwelling older adults, and investigated the mediation mechanism of psychosocial health on the link between light-moderate physical activity and cognitive performance. Physical activity intensity, psychosocial health, and cognitive performance were measured by the international physical activity questionnaire (IPAQ), the Center for Epidemiological Studies Depression Scale (CESD), and the mini-mental state examination (MMSE) instruments, respectively. Results show that, while light physical activity (LPA) and moderate physical activity (MPA) both significantly contribute to better cognitive performance, psychosocial health is a significant mediator only for LPA but not for MPA. For direct pathways, both LPA (std. β = 0.062, p < 0.001, 95% confidence interval = 0.032−0.091) and MPA (std. β = 0.049, p = 0.001, 95% CI = 0.019−0.078) have significant influence on cognitive performance. For mediation pathways, results show that there exists only one indirect channel through which psychosocial health mediates the influence of LPA (std. β = 0.024, p < 0.001, 95% CI = 0.016−0.033), which accounts for 27.9% of the total effect linking LPA and cognitive performance. Findings uncover an important indirect psychosocial mediation channel through which LPA affects cognitive performance among older adults.

The Development of Social Function Questionnaire for Chinese Older Adults

Objectives

Social function is an important indicator for physical and psychological health of older adults. However, there is a lack of a standardized questionnaire for measuring social function of older adults. This study developed a questionnaire to assess Chinese older adults' social function.

Methods

We used three samples (N = 2,257 aged ≥60 years) to test the reliability and validity of the questionnaire.

Results

Based on exploratory and confirmatory factor analyses with two samples, the final version of Social Function Questionnaire for Chinese Older Adults (SFQCOA) contained three dimensions with 12 items: social support, social adaptation, and social engagement. Criterion validity test with the third sample showed that SFQCOA was positively related to the healthy indices and negatively related to the unhealthy indices.

Conclusion

The validity and reliability of the questionnaire reach the requirements of psychometric standards, suggesting it is an effective tool for measuring social function of older adults.

Social Isolation, Cognitive Function, and Depression Among Chinese Older Adults: Examining Internet Use as a Predictor and a Moderator

Objectives

Despite the theoretical and practical interest in Internet use among older adults, evidence examining the impacts of Internet use on late-in-life health is limited. This study examines how Internet use affects depression and cognitive function in older adults and investigates if Internet use moderates the relationship between social isolation and depression/cognitive function.

Method

We performed regression analyses using data came from the second wave of the China Longitudinal Aging Social Survey of 2016. Our final sample featured 8,835 older adults.

Results

The results show 11.4% of Chinese older adults often used the Internet to engage in at least one activity. Internet use was negatively associated with depression, but it was positively related to cognitive function. Socially isolated older adults were more likely to have more depressive symptoms and higher level of cognitive function. There was also an interaction effect between Internet use and social isolation on depression/cognitive function. The negative effect of social isolation was stronger for older adults who used the Internet less. The moderating effect of Internet use was significant for both males and females. However, among those who used the Internet more, the depression levels of socially isolated male participants were much lower than female participants.

Conclusions

Our results reveal the importance of considering Internet use in buffering the negative effects of social isolation and the associated health burdens for aging populations. Recommendations for service practice and future research are discussed.

Relationship between physical activity and cognitive functioning among older Indian adults

In a culturally different and low-resource setting, where lifestyle habits, including dietary pattern and physical activities differ from those in high-income countries, the association between physical activity and cognition is expected to differ. We aimed to investigate the association between physical activity and cognitive functioning after controlling for potential confounders among older adults in India. Furthermore, gender differences in this relationship were analyzed. Using a national-level data from the Longitudinal Ageing Study in India (2017-2018), this paper employed propensity score matching (PSM) approach to examine the association between physical activities and cognitive functioning among Indian older adults. Cognitive impairment was measured through five broad domains (memory, orientation, arithmetic function, executive function, and object naming). We limit our sample to older adults aged 60 + years, and our final dataset contains 31,464 participants (men = 16,366, and women = 15,098). The results indicated that older adults who engaged in frequent physical activity have greater cognitive functioning than older adults without physical activity after adjusting for various individual, health, lifestyle, and household factors. This association holds true for both older men and older women. The results from the PSM revealed that the cognitive function score was increased by 0.98 and 1.32 points for the frequently physically active older men and women population, respectively. The results demonstrate the possible beneficial effects of frequent physical activity on cognitive functioning among older adults. Thus, regular physical activity can be considered as an effective lifestyle factor to promote healthy cognitive aging.

Participation Predicts Cognitive Functioning in Older Adults Using the PART-O Transformed Scores Systems

Participation has been shown to be a protective factor for cognition in older adults, but instruments to assess it are limited. The main objective was to determine the validity of two scoring systems (direct vs transformed) for the Participation Assessment with Recombined Tools-Objective (PART-O) by applying structural equation modeling to the relationship between the subscales and the cognitive functions, in a sample of 245 people over 60 years of age. The transformed scores model showed stronger relationships and larger explained variance in overall participation (55.4% vs 37.4%), especially in the Social Relations subscale (31.4% vs 14.6%). Participation was a direct predictor of cognitive functions in both models. Age and depression inversely influenced participation in the transformed scores model. The proposed score transformation for the PART-O provides a more appropriate measurement of the older adults' participation. Participation has a mediating role in the relationship between cognition and both age and depression.

The Psychosocial Impact of COVID-19 on Older Adults with Cancer: A Rapid Review

Background: Older adults with cancer are amongst the most vulnerable population to be negatively impacted by COVID-19 due to their likelihood of comorbidities and compromised immune status. Considering the longevity of the pandemic, understanding the subjective perceptions and psychosocial concerns of this population may help ameliorate the psychological aftermath. In this review, we systematically analyze the literature surrounding the psychosocial impact and coping strategies among older adults with cancer within the context of COVID-19. Methods: We conducted a rapid review of literature following PRISMA guidelines between January 2020 to August 2021 using (1) MEDLINE, (2) Embase, (3) CINAHL, and (4) PsychINFO and keyword searches for “cancer” and “COVID-19” focused on adults 65 years or older. Results: Of the 6597 articles screened, 10 met the inclusion criteria. Based on the included articles, the psychosocial impact of COVID-19 was reported under four domains, (1) impact of COVID-19 on quality of life (QoL), (2) concerns related to COVID-19, (3) coping with the impact of COVID-19, and (4) recommendations for future care. Results pertaining to perceived quality of life were inconsistent across the included articles. The most common concerns related to: contracting COVID-19, survivorship transitions, and feelings of isolation. Coping strategies reported by older adults included: spiritual care, lived experience, acceptance, and positive reinterpretation. Conclusions: We found many psychosocial impacts of the pandemic on older adults with cancer. The findings from this review can inform interventions related to shared decision-making and tailored patient care in the future.

Physical and Mental Health Differences Reported by Three Age Groups of Older Adults With Diabetes

Most studies have classified older adults with diabetes into one group despite substantial variation in health status across different stages of late adulthood. In this study, we examined difference in self-reported physical and mental health among three age groups of older adults with diabetes. Using data from the 2016 National Social Life, Health and Aging Project, Wave 3, we classified 424 individuals diagnosed with diabetes into three age groups, young-old (YO): 50-64 years; middle-old (MO): 65-74; and oldest old (OO): 75+ years. A one-way multivariate analysis of covariance was used to assess group differences, followed by univariate analyses. The results indicate that the YO group reported significantly lower physical health and higher depression than the MO group and higher levels of loneliness than the MO and OO groups. These findings indicate that physical and mental health may differ among different age groups of older adults with diabetes and suggest that the YO might be more vulnerable to diminished physical and mental health than the other age groups.

What Could Interfere with a Good Night's Sleep? The Risks of Social Isolation, Poor Physical and Psychological Health among Older Adults in China

This study provides one of the first population-based investigations of the longitudinal association between social isolation and sleep difficulty among older adults in China. We analyzed three waves of longitudinal data from the China Longitudinal Aging Social Survey (2014-2018), in which 8456 respondents contributed 16,156 person-year observations. Results from multilevel logistic regression models showed that social isolation was related to a higher risk of sleep difficulty. We also found that socially isolated older adults were more likely to report higher levels of depressive symptoms, a greater prevalence of loneliness and pain, and more chronic diseases compared to their socially integrated counterparts, which in turn increased their risks of sleep difficulty. Moreover, socially isolated older adults with chronic diseases were particularly vulnerable to the risk of sleep difficulty. These findings provide helpful guidance for policymakers and practitioners to design effective intervention strategies to help older adults with sleep problems.

Depresssion, anxiety and other cognitive consequences of social isolation: Drug and non-drug treatments

OBJECTIVE

During the COVID-19 pandemic, quarantine and staying at home is advised. The social relationship between people has become deficient, and human social isolation (SI) has become the consequence of this situation. It was shown that SI has made changes in hippocampal neuroplasticity, which will lead to poor cognitive function and behavioural abnormalities. There is a connection between SI, learning, and memory impairments. In addition, anxiety-like behaviour and increased aggressive mood in long-term isolation have been revealed during the COVID-19 outbreak.

METHODS

Term searches was done in Google Scholar, Scopus, ScienceDirect, Web of Science and PubMed databases as well as hand searching in key resource journals from 1979 to 2020.

RESULTS

Studies have shown that some drug administrations may positively affect or even prevent social isolation consequences in animal models. These drug treatments have included opioid drugs, anti-depressants, Antioxidants, and herbal medications. In addition to drug interventions, there are non-drug treatments that include an enriched environment, regular exercise, and music.

CONCLUSION

This manuscript aims to review improved cognitive impairments induced by SI during COVID-19.

Voice-Activated Virtual Home Assistant Use and Social Isolation and Loneliness Among Older Adults: Mini Review

A lack of social connectedness is common among older adults due to living alone, loss of loved ones, reduced mobility, and, more recently, social distancing created by the global Covid-19 pandemic. Older adults are vulnerable to social isolation and loneliness, which pose significant health risks comparable to those of smoking, obesity, physical inactivity, and high blood pressure. A lack of social connectedness is also correlated with higher mortality rates even when controlling for other factors such as age and comorbid conditions. The purpose of this mini review was to explore the emerging concepts of older adults' use of commercially available artificial intelligent virtual home assistants (VHAs; e.g., Amazon Echo, Google Nest), and its relationship to social isolation and loneliness. A secondary purpose was to identify potential areas for further research. Results suggest that VHAs are perceived by many older adult users as “companions” and improve social connectedness and reduce loneliness. Available studies are exploratory and descriptive and have limited generalizability due to small sample sizes, however, similar results were reported across several studies conducted in differing countries. Privacy concerns and other ethical issues and costs associated with VHA use were identified as potential risks to older adults' VHA adoption and use. Older adults who were using VHAs expressed the need and desire for more structured training on device use. Future research with stronger methods, including prospective, longitudinal, and randomized study designs are needed. Public education, industry standards, and regulatory oversight is required to mitigate potential risks associated with VHA use.

Combined association of multiple chronic diseases and social isolation with the functional disability after stroke in elderly patients: a multicenter cross-sectional study in China

Background

Multiple chronic diseases (MCDs) and social isolation are independent risk factors related to stroke and disability, but it is unknown whether the combination of these two conditions resulted from aging-related to functional disability in stroke patients. This study aimed to probe the relationship between the combination of MCDs, social isolation, and functional disability after stroke in elderly patients.

Methods

A multicenter and cross-sectional study was conducted in the Departments of Rehabilitation of 103 hospitals located in 23 cities across China. Stroke patients aged 60–90 years were selected for analysis. Demographic characteristics, lifestyles, and clinical information were investigated by questionnaires and medical records. MCDs (hypertension/ diabetes/ hyperlipidemia/heart disease/kidney disease) were categorized into three levels: 0, 1, and ≥ 2. Functional disability was assessed by the Barthel Index and categorized into four groups: no, mild, moderate, and severe disability. The multi-nominal logistic regression model was used to explore the independent and combined association of MCDs and social isolation with functional disability.

Results

A total of 4046 elderly stroke patients (55 % males) were included in the final analysis. The prevalence of social isolation, MCDs ≥ 2, and severe disability increased with aging. In the fully adjusted model, patients with social isolation or MCDs had a higher risk of functional disability significantly than those without. Patients with social isolation combined MCDs ≥ 2 were 35 times (95 % CI: 18.89–64.69) more likely to suffer severe disability after stroke, and 8 times (95 % CI: 18.89–64.69) for moderate disability than those without social isolation and MCDs.

Conclusions

MCDs, social isolation, and their combination were associated with a higher risk of functional disability after stroke in Chinese elderly patients. The elderly population should be encouraged to participate in more social activities, particularly in those with MCDs. Future secondary prevention and rehabilitation treatments to the functional ability of elderly stroke patients should underscore both social activity and the combined treatments of MCDs.

Trial registration

NO: ChiCTR2000034067.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02439-9.

Loneliness may mediate the relationship between depression and the quality of life among elderly with mild cognitive impairment

BACKGROUND

Depression and mild cognitive impairment (MCI) are often comorbid mental health issues in older adults. The current study explored the prospective mediating role of loneliness in the relationship between depression and the quality of life in elderly with MCI. A second aim was to examine differences in depression, loneliness, and the quality of life in the elderly with MCI among gender groups, and type of residence groups.

METHODS

A cross-sectional survey with purposive sampling was used. Older adults with MCI (N = 170) from old age homes in Lahore and Rawalpindi (n = 82) and family residences in Sargodha (n = 88) in Pakistan completed UCLA Loneliness Scale, Depression Anxiety Stress Scale, and Mild Cognitive Impairment Scale.

RESULTS

Most of the participants had severe to extreme depression (98.2%), and moderate to moderately high levels of loneliness (85.3%). Depression was significantly associated with loneliness (b = 0.29, P < 0.05) and poor quality of life in MCI (b = 0.49, P < 0.001). The indirect effect of depression on the quality of life in MCI through loneliness was significant (95% confidence interval (CI) [0.002, 0.156]). However, the indirect effect of quality of life in MCI on depression through loneliness was not significant (95% CI [-0.001, 0.043]). The elderly with MCI living in old age homes had higher depression, loneliness, and poor quality of life. Elderly women had higher levels of depression and poor quality of life, whereas older men were lonelier.

CONCLUSION

The relationship between depression and quality of life in the elderly with MCI may be bidirectional, and loneliness partially mediates only one of these relationships.

Is loneliness associated with mild cognitive impairment in low- and middle-income countries?

BACKGROUND

Loneliness may be a risk factor for mild cognitive impairment but studies on this topic are scarce, particularly from low- and middle-income countries (LMICs). Therefore, the aim of the present study was to investigate the association between loneliness and mild cognitive impairment (MCI) in six LMICs (China, Ghana, India, Mexico, Russia and South Africa).

METHODS

Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria. Multivariable logistic regression analysis and meta-analysis were conducted to assess associations.

RESULTS

The final analytical sample consisted of 19,092 and 13,623 individuals aged 50-64 years (middle-aged adults) and ≥65 years (older adults), respectively. Among the middle-aged, overall, loneliness was associated with a non-significant 1.43 (95% confidence interval [CI] = 0.93-2.21) times higher odds for MCI although significant associations were observed in China (OR = 1.51; 95%CI = 1.08-2.09) and South Africa (OR = 3.87; 95%CI = 1.72-8.71). As for older adults, overall, there was a significant association between loneliness and MCI (OR = 1.52; 95%CI = 1.12-2.07).

CONCLUSION

In this large representative sample of middle-aged and older adults from multiple LMICs, findings suggest that loneliness is associated with MCI. It may be prudent to consider reducing loneliness in low-economic settings to aid in the prevention of MCI and ultimately dementia.

Factors associated with social isolation and loneliness in community-dwelling older adults during pandemic times: a cross-sectional study

INTRODUCTION

Psychosocial aspects need to be discussed in the context of the Covid-19 pandemic. Currently, no studies have investigated the factors associated with social isolation and loneliness among community-dwelling older adults. Therefore, this study analyzed the association of social isolation and loneliness with socioeconomic, clinical, and health characteristics, and Covid-19-related variables, among community-dwelling older adults during the pandemic.

METHODS

A cross-sectional study was conducted via a telephone survey of community-dwelling older adults aged ≥60 years in Macapa, Amapa, Brazil. A structured form was used to collect data. Descriptive and inferential analyses were performed using Pearson's correlation test and a linear regression model.

RESULTS

Participants comprised 86 community-dwelling older adults with a mean age of 71.78+6.98 years. Among them, 9.3% were diagnosed with Covid-19, of whom 3.5% were hospitalized. Most participants reported no difficulty obtaining food, medicines, or attending routine medical appointments during the pandemic. Furthermore, 23.3% (n=20) were socially isolated, and 20.9% (n=18) reported feelings of loneliness. The mean values for fear, anxiety, and obsession were 19.01±7.25, 1.01±1.90, and 2.84±3.28, respectively. A moderate positive correlation was identified between loneliness and the number of diseases, and a weak positive correlation between loneliness and the number of medications and depressive symptoms and risk for sarcopenia. The linear regression model indicated that higher loneliness scores were associated with a greater number of diseases (β=0.288; p=0.007).

CONCLUSIONS

The findings suggest a probable resilience of the older population to Covid-19, despite the association of loneliness with many diseases in times of a pandemic.

Factors associated with social isolation and loneliness in community-dwelling older adults during pandemic times: a cross-sectional study

INTRODUCTION

Psychosocial aspects need to be discussed in the context of the Covid-19 pandemic. Currently, no studies have investigated the factors associated with social isolation and loneliness among community-dwelling older adults. Therefore, this study analyzed the association of social isolation and loneliness with socioeconomic, clinical, and health characteristics, and Covid-19-related variables, among community-dwelling older adults during the pandemic.

METHODS

A cross-sectional study was conducted via a telephone survey of community-dwelling older adults aged ≥60 years in Macapa, Amapa, Brazil. A structured form was used to collect data. Descriptive and inferential analyses were performed using Pearson's correlation test and a linear regression model.

RESULTS

Participants comprised 86 community-dwelling older adults with a mean age of 71.78+6.98 years. Among them, 9.3% were diagnosed with Covid-19, of whom 3.5% were hospitalized. Most participants reported no difficulty obtaining food, medicines, or attending routine medical appointments during the pandemic. Furthermore, 23.3% (n=20) were socially isolated, and 20.9% (n=18) reported feelings of loneliness. The mean values for fear, anxiety, and obsession were 19.01±7.25, 1.01±1.90, and 2.84±3.28, respectively. A moderate positive correlation was identified between loneliness and the number of diseases, and a weak positive correlation between loneliness and the number of medications and depressive symptoms and risk for sarcopenia. The linear regression model indicated that higher loneliness scores were associated with a greater number of diseases (β=0.288; p=0.007).

CONCLUSIONS

The findings suggest a probable resilience of the older population to Covid-19, despite the association of loneliness with many diseases in times of a pandemic.

Social Isolation and Self-Reported Cognitive Decline Among Older Adults in Japan: A Longitudinal Study in the COVID-19 Pandemic

OBJECTIVES

We aimed to examine the association between the transition to social isolation and cognitive decline in older adults during the coronavirus disease 2019 (COVID-19) pandemic.

DESIGN

Longitudinal study.

SETTING AND PARTICIPANTS

The study included participants from a community in a semiurban area of Japan. We conducted a mailed questionnaire survey of 2000 noninstitutionalized older adults who were randomly sampled. Of those who completed both the baseline and follow-up surveys in March and October 2020, respectively, participants aged ≥70 years without cognitive impairment at baseline were included in the analysis.

METHODS

Participants were classified into 4 groups based on their baseline and follow-up social isolation status, which were as follows: "remained nonisolated," "isolated from nonisolation," "nonisolated from isolation," and "consistent isolation." Self-reported cognitive function was assessed using the Cognitive Performance Scale, and level 2 (mild impairment) or higher (moderate to severe impairment) was defined as cognitive impairment.

RESULTS

Ultimately, 955 older adults were analyzed. The mean age of the participants was 79.6 years (standard deviation = 4.7) and 54.7% were women. During the follow-up period, 54 (5.7%) participants developed cognitive impairment. Multivariable logistic regression analysis revealed that compared with the group that remained nonisolated, the isolated from nonisolation and consistent isolation groups were significantly associated with the onset of cognitive impairment [isolated from nonisolation: odds ratio (OR) = 2.74, 95% confidence interval (CI) = 1.13-6.61, P = .026; consistent isolation: OR = 2.33, 95% CI = 1.07-5.05, P = .033].

CONCLUSIONS AND IMPLICATIONS

Social isolation during the COVID-19 pandemic was associated with a decline in cognitive function among older adults. Attention to the social isolation process during the pandemic may be necessary to protect older adults' cognitive health.

Redesigning Memory Care in the COVID-19 Era: Interdisciplinary Spatial Design Interventions to Minimize Social Isolation in Older Adults

Older adults living in memory care facilities are vulnerable to more than just COVID-19; they are especially harmed from social distancing guidelines, as social isolation and loneliness have important medical consequences in this population. COVID-19 has changed the way we perceive the built environment, and almost all public spaces are now adopting new design strategies to create safe indoor and outdoor environments. Eight interdisciplinary, evidence-based spatial design interventions and action plans are explored in this article with the aim of redesigning future memory care facilities to combat social isolation and loneliness in older adults during this unprecedented time and beyond.