Associations of loneliness and social isolation with actigraph and self-reported sleep quality in a national sample of older adults

Sleep During the COVID-19 Pandemic: Longitudinal Observational Study Combining Multisensor Data With Questionnaires

BACKGROUND

The COVID-19 pandemic prompted various containment strategies, such as work-from-home policies and reduced social contact, which significantly altered people's sleep routines. While previous studies have highlighted the negative impacts of these restrictions on sleep, they often lack a comprehensive perspective that considers other factors, such as seasonal variations and physical activity (PA), which can also influence sleep.

OBJECTIVE

This study aims to longitudinally examine the detailed changes in sleep patterns among working adults during the COVID-19 pandemic using a combination of repeated questionnaires and high-resolution passive measurements from wearable sensors. We investigate the association between sleep and 5 sets of variables: (1) demographics; (2) sleep-related habits; (3) PA behaviors; and external factors, including (4) pandemic-specific constraints and (5) seasonal variations during the study period.

METHODS

We recruited working adults in Finland for a 1-year study (June 2021-June 2022) conducted during the late stage of the COVID-19 pandemic. We collected multisensor data from fitness trackers worn by participants, as well as work and sleep-related measures through monthly questionnaires. Additionally, we used the Stringency Index for Finland at various points in time to estimate the degree of pandemic-related lockdown restrictions during the study period. We applied linear mixed models to examine changes in sleep patterns during this late stage of the pandemic and their association with the 5 sets of variables.

RESULTS

The sleep patterns of 27,350 nights from 112 working adults were analyzed. Stricter pandemic measures were associated with an increase in total sleep time (TST) (β=.003, 95% CI 0.001-0.005; P<.001) and a delay in midsleep (MS) (β=.02, 95% CI 0.02-0.03; P<.001). Individuals who tend to snooze exhibited greater variability in both TST (β=.15, 95% CI 0.05-0.27; P=.006) and MS (β=.17, 95% CI 0.03-0.31; P=.01). Occupational differences in sleep pattern were observed, with service staff experiencing longer TST (β=.37, 95% CI 0.14-0.61; P=.004) and lower variability in TST (β=-.15, 95% CI -0.27 to -0.05; P<.001). Engaging in PA later in the day was associated with longer TST (β=.03, 95% CI 0.02-0.04; P<.001) and less variability in TST (β=-.01, 95% CI -0.02 to 0.00; P=.02). Higher intradaily variability in rest activity rhythm was associated with shorter TST (β=-.26, 95% CI -0.29 to -0.23; P<.001), earlier MS (β=-.29, 95% CI -0.33 to -0.26; P<.001), and reduced variability in TST (β=-.16, 95% CI -0.23 to -0.09; P<.001).

CONCLUSIONS

Our study provided a comprehensive view of the factors affecting sleep patterns during the late stage of the pandemic. As we navigate the future of work after the pandemic, understanding how work arrangements, lifestyle choices, and sleep quality interact will be crucial for optimizing well-being and performance in the workforce.

Association between sleep quality and living environment among Chinese older persons: a cross-sectional study

Sleep quality significantly affects the quality of life of older persons. Therefore, this study explored the relationship between sleep quality and living environment of older persons in China to provide a theoretical basis for therapies to alleviate sleep disorders in older persons. A total of 6211 subjects > 60 years of age in Anhui Province, China, were evaluated using the Pittsburgh Sleep Quality Index and a self-reported questionnaire. Multivariate logistic regression analysis revealed that living alone (OR = 1.26, 95% CI 1.09-1.46) and living in a rural area (OR = 1.19, 95% CI 1.06-1.34) were significantly associated with a high incidence of sleep disorders in older persons. Living near a park or foot paths suitable for exercise or walking was significantly associated with a lower incidence of sleep disorders in older persons (OR = 0.87, 95% CI 0.77-0.96). Individual factors such as female sex (OR = 1.30, 95% CI 1.14-1.48) and depression (OR = 2.80, 95% CI 2.47-3.19) were also associated with sleep quality in older persons. These data indicate a correlation exists between living environment and sleep quality.

Associations between neighbourhood safety, social cohesion, sleep quality and sleep duration among older adults in India: Findings from the Study on Global Aging and Adult Health (WHO-SAGE), 2015

BACKGROUND

Most studies on later-life health in India focus on families, with far less attention given to the health repercussions of neighbourhood conditions among older Indians. We address this limitation in existing research by examining the associations between perceptions of neighbourhood safety and social cohesion and sleep duration and sleep quality among older adults in India.

METHODS

Data come from the Study on Global Aging and Adult Health (WHO-SAGE), India 2015 wave 2, with a sample of 7118 adults aged 50 years and above. Sleep quality and duration were assessed using subjective responses. Multivariable logistic and linear regression analyses were employed to test the research hypotheses.

RESULTS

Prevalence of poor sleep quality was higher among older adults living in unsafe neighbourhoods (4.46%) than peers residing in safe neighbourhoods (3.52%), and it was also higher among those living in neighbourhoods with poor social cohesion (5.31%) than counterparts who lived in socially cohesive communities (3.10%). Older adults in neighbourhoods with poor social cohesion had higher odds of reporting compromised sleep quality (adjusted odds ratio 1.75, CI: 1.22-2.51) than those living in socially cohesive neighbourhoods. Moreover, compared to those who perceived they were living in safe neighbourhoods, their peers who perceived their neighbourhoods as unsafe reported shorter sleep duration, with a negative beta coefficient of -0.27 (CI: -0.45 to -0.085).

CONCLUSION

That perceived unsafety and poor social cohesion within one's neighbourhood are associated with compromised sleep reflects the significance of making neighbourhoods safer and more integrated for later-life sleep health. In addition to micro-level strategies (e.g., balanced nutrition and physical activity), efforts to improve sleep health should optimise macro-level opportunities, such as rehabilitating and revitalising neighbourhoods, which may alleviate sleep disturbances and improve sleep outcomes among older adults.

Contributions of loneliness to cognitive impairment and dementia in older adults are independent of other risk factors and Alzheimer's pathology: a narrative review

Loneliness significantly contributes to cognitive impairment and dementia in older adults. Loneliness is a distressing feeling resulting from a perceived lack of social connection (i.e., a discrepancy between desired and actual social relationships), while social isolation is a related term that can be defined by number and type of social relationships. Importantly, loneliness is distinct from social isolation in that it is associated with a distressing self-perception. The primary focus of this narrative review is the impact of chronic loneliness on cognitive impairment and dementia among older adults. Loneliness has a significant association with many factors that are related to worse cognition, and therefore we include discussion on health, mental health, as well as the physiological effects of loneliness, neuropathology, and potential treatments. Loneliness has been shown to be related to development of dementia with a hazard ratio (HR) risk comparable to having a single APOE4 gene. The relationship of dementia to loneliness appears to be at least partially independent of other known dementia risk factors that are possibly associated with loneliness, such as depression, educational status, social isolation, and physical activity. Episodic memory is not consistently impacted by loneliness, which would be more typically impaired if the mild cognitive impairment (MCI) or dementia was due to Alzheimer's disease (AD) pathology. In addition, the several longitudinal studies that included neuropathology showed no evidence for a relationship between loneliness and AD neuropathology. Loneliness may decrease resilience, or produce greater cognitive change associated with the same level of AD neuropathology. Intervention strategies to decrease loneliness in older adults have been developed but need to consider key treatment targets beyond social isolation. Loneliness needs to be assessed in all studies of cognitive decline in elders, since it significantly contributes to the variance of cognitive function. It will be useful to better define the underlying mechanism of loneliness effects on cognition to determine if it is similar to other psychological factors related to excessive stress reactivity, such as neuroticism or even depression, which are also associated with cognitive decline. It is important from a health perspective to develop better strategies to decrease loneliness in older adults.

Bidirectional Associations Between Loneliness, Emotional Support, and Sleep in Daily Life

OBJECTIVE

Evidence suggests a link between positive social relationship perceptions and improved sleep (e.g., quality, efficiency) across the life span. Less work has probed the directionality of these relationships. Here, we report findings from the first study to examine bidirectional between- and within-person associations between loneliness and emotional support with daily life measures of sleep.

METHODS

Participants were 389 healthy adults aged 40 to 64 years (61% female) who completed hourly surveys assessing loneliness and perceptions of emotional support over the course of 4 days. Measures of actigraphy-assessed sleep and nightly sleep quality were also assessed for 7 to 10 days.

RESULTS

Individuals with lower average daily loneliness showed higher sleep quality and efficiency than individuals with higher loneliness (r = -0.19, p < .001; r = -0.14, p = .008, respectively), and greater average emotional support was likewise linked with better sleep quality (r = 0.18, p < .001). Controlling for neuroticism attenuated the effects of average loneliness on sleep. Within-person analyses showed unexpected bidirectional effects. Specifically, days in which people felt relatively lonelier were followed by nights with greater sleep efficiency (γ = 1.08, p = .015), and nights when people reported relatively poorer sleep quality were followed by days with greater emotional support (γ = -0.04, p = .013). These unexpected findings are probed in exploratory analyses.

CONCLUSIONS

Individuals with higher loneliness and lower emotional support report poorer sleep quality and efficiency, on average. Day-to-day fluctuations in perceptions of social relationships may affect the following night's sleep, and vice versa.

Loneliness and Marital Quality as Predictors of Older Adults' Insomnia Symptoms

The current study examined associations between marital quality, loneliness, and sleep within a nationally representative sample of older adults who participated in Wave 2 of the National Social Life, Health, and Aging Project (NSHAP). Participants (N = 559) had a spouse or partner and completed a novel sleep module that included subjective (i.e., insomnia symptoms) and objective (i.e., wake after sleep onset;WASO) markers of sleep. Upon controlling for demographics and markers of mental and physical health, a distinct pattern of findings emerged for subjective versus objective markers of sleep. Regarding subjective sleep, older adults who experienced greater loneliness reported more insomnia symptoms, but only when spousal emotional support was low-moderate. Regarding objective sleep, older adults who reported more affectionate touch from their spouse experienced less WASO. Collectively, these findings identify specific aspects of marital quality that may have unique implications for partnered older adults' subjective and objective sleep quality.

Trends in the prevalence of social isolation among middle and older adults in China from 2011 to 2018: the China Health and Retirement Longitudinal Study

BACKGROUND

Epidemiological studies have shown that social isolation, which is prevalent in older adults, is associated with a range of adverse health outcomes, but the prevalence of and trends in regard to social isolation remain ambiguous in China. The aim of this study was to elucidate the trends regarding the prevalence of social isolation among middle-aged and older adults in China from 2011 to 2018 and to further identify associated risk factors.

METHODS

A repeated cross-sectional study, The data were derived from panel sample data of four waves conducted from May 2011 to August 2018 in the nationally representative China Health and Retirement Longitudinal Study (CHARLS) using multistage probability sampling. Social isolation was ascertained by the five item Steptoe Social Isolation Index. The potential covariates were demographic characteristics, lifestyle factors, and health status. Linear-by-linear association was used to assess the trends in regard to social isolation over time under the influence of the potential covariates. Linear-by-linear association and an age-period-cohort analysis were used to explore the trends, and two-level (time, individual) generalized estimating equation models (GEE) linked multivariate binary logistic regression were performed to identify risk factors.

RESULTS

A high prevalence of social isolation and a moderate upward trend from 2013 to 2018 were observed among a U-shaped trend prevalence of social isolation from 2011 to 2018 across China, with rates of 38.09% (95% CI = 36.73-39.45) in 2011, 33.66% (32.32-35.00) in 2013, 39.13% (37.59-40.67) in 2015, and 39.95% (38.59-41.31) in 2018 (p < 0.001). The prevalence of social isolation increased with age and educational attainment. Females had a higher prevalence than males. The prevalence of social isolation was found to be significantly lower in pensioners than in non-pensioners between 2011 and 2018 (p < 0.001). The prevalence of social isolation was 38.9%, 34.9%, 38.5%, and 44.08% about three times higher among those who doid not use the Internet and 13.44%, 11.64%, 12.93%, and 16.73% than among those who doid in 2011, 2013, 2015 and 2018 respectively. The participants with short (0-5 h) and long sleep (9 or more hours), and poor self-rated health had a higher prevalence of social isolation than the others. Older age, lower educational attainment, living in a rural region, lack of medical insurance or pension, lack of internet use and poor health were risk factors (p < 0.05).

CONCLUSIONS

We found a U-shaped prevalence of social isolation trends from 2011 to 2018 and revealed increasing trends from 2013 to 2018 among middle-aged and older adults in China. The findings of the study highlight the urgent need for interventions to reduce social isolation including improving sleep quality and internet skills. Disadvantaged groups in terms of age, economic status, and health status should be the focus of such interventions, especially in the era of COVID-19.

Relationship of Living and Eating Arrangements to Mental Distress Among Older Korean Immigrants: Gender Difference in the Mediating Role of Loneliness

This study examined how different living/eating arrangements were associated with loneliness and depressive symptoms among older Korean immigrants. We examined gender differences considering: (1) patterns of living/eating arrangements and their relations with loneliness and mental distress and (2) indirect effect of living/eating arrangements on mental distress through feeling lonely. Data were drawn from the Study of Older Korean Americans that surveyed older; Korean immigrants during 2017-2018 (N = 2150). Living/eating arrangements were classified in the combination of four categores. Using the PROCESS macro, we tested gender differences in the mediation effect of loneliness on the relationship between living/eating arrangements and mental distress while controlling for background/health characteristics and social connectedness-related variables. The mediating role of loneliness was manifested differentially between men and women. By administering simple measures of living/eating arrangements, practitioners could potentially identify key targets to improve social and mental well-being, particularly among older immigrants with limited resources.

Associations of daytime napping and nighttime sleep quality with depressive symptoms in older Chinese: the Guangzhou biobank cohort study

BACKGROUND

Poor sleep quality has been linked to depression in older adults, but results of the association between daytime napping and depression remains limited and conflicting. Moreover, whether the association of daytime napping with depression varies by nighttime sleep quality is unclear. Hence, we examined the associations of daytime napping and nighttime sleep quality with depressive symptoms in older Chinese.

METHODS

A total of 16,786 participants aged ≥50 from the Guangzhou Biobank Cohort Study second-round examination (2008-2012) were included in this cross-sectional study. Geriatric Depression Scale (GDS-15), Pittsburgh Sleep Quality Index (PSQI), napping and demographic data were collected by face-to-face interview using a computerized questionnaire. Logistic regression was used to calculate odds ratio (OR) of depressive symptoms for napping and sleep quality.

RESULTS

The prevalence of depressive symptoms (GDS score > 5) and poor global sleep quality (PSQI score ≥ 6) was 5.3 and 31.9%, respectively. Compared to non-nappers, nappers showed significantly higher odds of depressive symptoms, with OR (95% confidence interval (CI)) being 1.28 (1.11-1.49). The odds of depressive symptoms for daytime napping varied by nighttime sleep quality (P for interaction = 0.04). In good-quality sleepers, compared to non-nappers, nappers had significantly higher odds of depressive symptoms, with OR (95% CI) being 1.57 (1.23-2.01), whereas no association was found in poor-quality sleepers (OR = 1.13, 0.94-1.36).

CONCLUSION

Napping was associated with higher odds of depressive symptoms in older people, and the association was stronger in good-quality sleepers.

Do Social Support and Loneliness Influence Emerging Adults' Mental Health during the First Year of the COVID-19 Pandemic?

Youths' mental health is at a crisis level, with mental health problems doubling in the US since the pandemic began. To compound the mental health crisis, there is a global loneliness epidemic, with emerging adults worldwide experiencing some of the highest rates. One study with two phases examined the influence of social support and loneliness on mental health in US emerging adults during the pandemic, including changes in these relationships over one year. Emerging adults (N = 449) completed online questionnaires via Prolific in May 2020 (Phase 1) and again from January to May 2021 (N = 253; Phase 2). More perceived support was related to reduced loneliness, with family support having the most significant influence. Loneliness mediated the link between perceived support and adverse health outcomes. Higher loneliness predicted more perceived stress and sleep difficulties concurrently and over time. There was a bidirectional relationship between loneliness and depression, such that higher levels of either variable at Time 1 predicted increases in the other over time. Results highlight the detrimental impact of loneliness on emerging adults' mental health.

Social Isolation and Worsening Health Behaviors Among Older Adults During the COVID-19 Pandemic

OBJECTIVES

We examine the relationship between social isolation, poor health behaviors, and the perceived worsening of older adults' health behaviors following the coronavirus outbreak. We assess the extent to which psychological pathways mediate the relationship between social isolation and worsening health behaviors.

METHODS

Drawing on data from the National Social Life Health and Aging Project Round 3 (2015) and its coronavirus immune disease 2019 (COVID-19) substudy (2020; N = 2,549), we use generalized linear models to explore how indicators of social isolation during the COVID-19 pandemic-infrequent in-person contact with friends and family in 2020 and decreased in-person contact with friends and family since COVID-19 started-are associated with (1) poor health behaviors (low physical activity, drinks per week, smoking, and poor sleep) in 2020 and (2) perceived worsening of health behaviors (reports of decreased physical activity, increased drinking and smoking, and feeling less rested) since the pandemic started.

RESULTS

Infrequent in-person contact was not associated with poor health behaviors. Decreases in in-person contact, on the other hand, were associated with worsening health behaviors. Older adults who reported decreases in in-person contact were more likely to perceive a decrease in physical activity, an increase in drinking, and feeling less rested. Emotional well-being, particularly loneliness compared to anxiety or depressive feelings, partially mediated the relationship between perceived worsening of health behaviors and a decrease in in-person contact with friends, and to a lesser extent, with family.

DISCUSSION

Our study suggests that in-person contact may play a distinct role in shaping older adults' well-being during the pandemic.

The relationship of social isolation and sleep in older adults: evidence from cross-sectional and longitudinal studies

OBJECTIVES

This study aimed to explore the relationship between social isolation and sleep in later life and the role of loneliness in this relationship.

METHODS

In Study 1, we conducted a cross-sectional analysis of the correlation between social isolation and sleep in community-dwelling older adults (N = 108). This relationship was assessed using subjective and objective measures. Moreover, we examined the mediating role of loneliness cross-sectionally (Study 1) and longitudinally (Study 2). Longitudinal study was based on three waves of data from the National Scale Life, Health, and Aging Project (N = 1, 554).

RESULTS

The results showed that social isolation was robustly associated with sleep in the general population of older adults. Specifically, subjective social isolation was associated with subjective sleep, and objective social isolation was associated with objective sleep. The results of the longitudinal study showed that loneliness mediated the reciprocal link between social isolation and sleep across time after controlling for autoregressive effects and basic demographics.

CONCLUSIONS

These findings address the gap in the literature on the link between social isolation and sleep in older adults, extending the understanding of improvement in older adults' social networks, sleep quality, and psychological well-being.

Social Isolation, Sleep Disturbance, and Cognitive Functioning (HRS): A Longitudinal Mediation Study

BACKGROUND

Social isolation is prevalent and associated with dementia, yet the directionality and mechanisms are less understood. This study examined the association between social isolation and cognitive functioning and explored the mediating role of sleep disturbance on the social isolation-cognition relationship.

METHODS

Data from 5 753 dementia-free Americans aged ≥50 of 2006 (T1), 2010 (T2), and 2014 (T3) waves of the Health and Retirement Study. Social isolation was measured by the Steptoe Social Isolation Index. Cognitive functioning was measured by the Telephone Interview of Cognitive Status. Sleep disturbance was measured with the modified Jenkins Sleep Scale. We used cross-lagged panel models to determine the associations between social isolation, sleep disturbance, and cognitive functioning.

RESULTS

Social isolation is significantly associated with subsequent cognitive functioning (T1 to T2: β = -0.055, standard error [SE] = 0.014, p < .001; T2 to T3: β = -0.044, SE = 0.016, p < .001). Lower cognitive functioning is significantly associated with greater subsequent social isolation (T1 to T2: β = -0.101, SE = 0.020, p < .001; T2 to T3: β = -0.058, SE = .011, p < .001). Sleep disturbance at T2 partially mediated the effect of social isolation (T1) on cognitive functioning (T3), accounting for 6.2% of the total effect (β = -0.003, SE = 0.001, p < .01).

CONCLUSIONS

Social isolation may deteriorate cognitive functioning and vice versa. The association between social isolation and cognition is partially explained by sleep disturbance.

How does loneliness "get under the skin" to become biologically embedded?

Loneliness is linked to declining physical health across cardiovascular, inflammatory, metabolic, and cognitive domains. As a result, loneliness is increasingly being recognized as a public health threat, though the mechanisms that have been studied do not yet explain all loneliness-related health risk. Potential mechanisms include loneliness having 1.) direct, causal impacts on health, possibly maintained by epigenetic modification, 2.) indirect effects mediated through health-limiting behaviors, and 3.) artifactual associations perhaps related to genetic overlap and reverse causation. In this scoping review, we examine the evidence surrounding each of these pathways, with a particular emphasis on emerging research on epigenetic effects, in order to evaluate how loneliness becomes biologically embedded. We conclude that there are significant gaps in our knowledge of how psychosocial stress may lead to physiological changes, so more work is needed to understand if, how, and when loneliness has a direct influence on health. Hypothalamic-pituitary adrenocortical axis disruptions that lead to changes in gene expression through methylation and the activity of transcription factor proteins are one promising area of research but are confounded by a number of unmeasured factors. Therefore, wok is needed using causally informative designs, such as twin and family studies and intensively longitudinal diary studies.

The sustained attention characteristics of flight crews on exempt and non-exempt flights

We analyzed the characteristics of sustained attention changes in flight crews during exempt and non-exempt flights. Fourteen pilots (aged 30-43 y) participated in this study, with seven involved in each flight type, all of which were intercontinental (China to North America). Pilots completed continuous performance tests (CPT) at the required flight stages without compromising safety while on duty. No significant differences in sleep and sustained attention emerged between the exempt and non-exempt flight crews. Pilots' fatigue was highest in the early morning hours. Their general stability of efficiency increased during the day and decreased at night. Non-exempt flight crews appeared to sacrifice reaction rate to improve accuracy. Exempt crews appeared to increase their test proficiency. The task stability time of the non-exempt flight crews was better than that of the exempt ones. Short-term stability was better for exempt inbound flights rather than for outbound ones. Pilots were more prone to error runs as their total time awake increased, especially on non-exempt flights. The addition of crew members to exempt flights, allowance for more in-flight rest shifts, and over-stop rest on non-exempt flights may alleviate pilot fatigue and preserve alertness.

Associations of social isolation and loneliness with the onset of insomnia symptoms among middle-aged and older adults in the United States: A population-based cohort study

There is an inconsistent conclusion regarding the relationship of social isolation and loneliness with poor sleep. We investigated the associations of social isolation and loneliness with new-onset insomnia symptoms in a nationally-representative sample of 9,430 adults aged ≥50 who were free of any insomnia symptoms/sleep disorders at baseline (wave 12/13) and followed up to 4 years from the Health and Retirement Study. Social isolation was measured by Steptoe's Social Isolation Index. Loneliness was measured by the revised 3-item UCLA-Loneliness Scale. Insomnia symptoms were quantified using the modified Jenkins Sleep Questionnaire. During a mean follow-up of 3.52 years, 1,522 (16.1%) participants developed at least one insomnia symptom. Cox models showed that loneliness was associated with the onset of difficulties initiating or maintaining sleep, early-morning awakening, nonrestorative sleep, and at least one of these symptoms after adjusting for potential covariates; while social isolation was not associated with the onset of difficulties maintaining sleep, early-morning awakening, or at least one insomnia symptom after adjusting for health indicators. These results are consistent in sensitivity analyses and stratified analyses by age, sex, race/ethnicity, and obesity. Public health interventions aimed at fostering close emotional relationships may reduce the burden of poor sleep among middle-aged and older adults.

Relationship (in)congruency may differently impact mental health

Background

Being involved in romantic relationships has historically been related to better mental health compared to being single. However, research exploring heterogeneity within these status groups is still understudied. Our study examined the role of (in)congruency between relationship desire, dismissal, satisfaction with relationship status, and current relationship status on the mental health measured in terms of anxiety, depression, insomnia, and romantic loneliness.

Method

The online questionnaire survey included 790 participants aged 18 - 40 (M = 26.51, SD = 5.60) at baseline and 421 at a 1-month follow-up. Participants represented five relationship statuses (single, casual dating, LAT relationships, cohabitation, and engagement/marriage).

Results

Our results suggest that greater relationship desire and dismissal at baseline were associated with higher anxiety and depression in casual daters one month later, while greater relationship desire was linked to lower anxiety for individuals in living apart together relationships (LATs). Higher relationship dismissal in casual daters and engaged/married individuals was associated with lower insomnia. Higher satisfaction with relationship status was associated with lower depression in single individuals and lower romantic loneliness in cohabitors and engaged/married individuals.

Conclusions

This study highlights that relationship (in)congruency may operate differently across various relationship status subgroups on mental health outcomes.

Sensor-based assessment of social isolation in community-dwelling older adults: a scoping review

Social isolation (SI) is a state of low social interaction with peers associated with various adverse health consequences in older adults living in the community. SI is most often assessed through retrospective self-reports, which can be prone to recall or self-report biases and influenced by stigma. Ambient and wearable sensors have been explored to objectively assess SI based on interactions of a person within the environment and physiological data. However, because this field is in its infancy, there is a lack of clarity regarding the application of sensors and their data in assessing SI and the methods to develop these assessments. To understand the current state of research in sensor-based assessment of SI in older adults living in the community and to make recommendations for the field moving forward, we conducted a scoping review. The aims of the scoping review were to (i) map the types of sensors (and their associated data) that have been used for objective SI assessment, and (ii) identify the methodological approaches used to develop the SI assessment. Using an established scoping review methodology, we identified eight relevant articles. Data from motion sensors and actigraph were commonly applied and compared and correlated with self-report measures in developing objective SI assessments. Variability exists in defining SI, feature extraction and the use of sensors and self-report assessments. Inconsistent definitions and use of various self-report scales for measuring SI create barriers to studying the concept and extracting features to build predictive models. Recommendations include establishing a consistent definition of SI for sensor-based assessment research and development and consider capturing its complexity through innovative domain-specific features.

Measuring social isolation in older adults: A rapid review informing evidence-based research and practice

OBJECTIVES

Older adults account for 18.5% of the Canadian population and are at risk of experiencing social isolation, compared to other age groups. Researchers define social isolation as a lack of social contact and relationships, but many social isolation measures do not reflect this definition. The aim of our study is to review the existing measures of social isolation with older adults to recommend evidence-based measures to researchers and practitioners.

METHODS

We conducted a rapid review on PsycInfo and PsycTests. We included articles that were written in English or French, were peer-reviewed, used an older adult sample, included a self-report social isolation measure, and reported psychometric information.

RESULTS

Following exclusion of ineligible articles, 12 measures were available for analysis. We further categorized the measures into: five most recommended measures, five measures that require further research, and two measures not recommended for use with older adults.

CONCLUSIONS

We observed a range of measures with varying suitability to be used with older adults; some were empirically driven but did not have strong psychometric properties, or vice-versa.

CLINICAL IMPLICATIONS

It is imperative that interventions aimed to address social isolation in older adults use evidence-based measures to assess progress and report treatment effectiveness.

A two-mediator serial mediation chain of the association between social isolation and impaired sleep in old age

Poor sleep is a long-term public health issue that has become increasingly prevalent among socially isolated older adults. However, research on the mechanisms explaining the link between social isolation and impaired sleep (IS) remains limited, particularly in low- and middle-income countries. This study explored the serial mediating effects of loneliness and mental distress on the association of social isolation with IS among Ghanaian older adults. We analyzed data from 1201 adults aged ≥ 50 from Ghana's AgeHeaPsyWel-HeaSeeB study (mean age = 66.14, SD = 11.85, age range = 50-111; women = 63.28%). Measures included the UCLA 3-item Loneliness Scale, modified Berkman-Syme Social Network Index, Sleep Quality Scale, and Mental Distress Questionnaire. We used bootstrapping techniques from Hayes' PROCESS macro program to estimate the hypothesized serial mediation. Social isolation was significantly associated with IS (β = 0.242, p < 0.001). Crucially, social isolation indirectly predicted IS via three significant mediating pathways. Loneliness accounted for 17.6% (β = 0.054, CI = 0.096, 0.016), mental distress accounted for 6.5% (β = 0.020, 95% CI = 0.004, 0.040), and loneliness and mental distress accounted for 32.2% (β = 0.099, 95% CI = 0.065, 0.138) of the overall effect. The total mediating effect was 56.4%. These findings suggest that the social isolation-sleep link is respectively and serially explained by loneliness and mental distress. Social integrative interventions for sleep quality in old age should target mental and emotional well-being.

Sensor-Based Assessment of Social Isolation and Loneliness in Older Adults: A Survey

Social isolation (SI) and loneliness are 'invisible enemies'. They affect older people's health and quality of life and have significant impact on aged care resources. While in-person screening tools for SI and loneliness exist, staff shortages and psycho-social challenges fed by stereotypes are significant barriers to their implementation in routine care. Autonomous sensor-based approaches can be used to overcome these challenges by enabling unobtrusive and privacy-preserving assessments of SI and loneliness. This paper presents a comprehensive overview of sensor-based tools to assess social isolation and loneliness through a structured critical review of the relevant literature. The aim of this survey is to identify, categorise, and synthesise studies in which sensing technologies have been used to measure activity and behavioural markers of SI and loneliness in older adults. This survey identified a number of feasibility studies using ambient sensors for measuring SI and loneliness activity markers. Time spent out of home and time spent in different parts of the home were found to show strong associations with SI and loneliness scores derived from standard instruments. This survey found a lack of long-term, in-depth studies in this area with older populations. Specifically, research gaps on the use of wearable and smart phone sensors in this population were identified, including the need for co-design that is important for effective adoption and practical implementation of sensor-based SI and loneliness assessment in older adults.

Eight-Year Trajectories of Late-Life Loneliness and Incident Dementia: A Nationally Representative Cohort Study

OBJECTIVE

Some older adults with loneliness might have transient loneliness, followed by full remission, while others might have persistent loneliness. Such different courses might differ in predicting the risk of dementia, but most previous studies assessed short-term loneliness at a single time point, ignoring the long-term changes of loneliness. This study aimed to explore the association between 8-year trajectories of late-life loneliness and incident dementia.

METHODS

Data were from the English Longitudinal Study of Ageing (waves 2-9). This study included 6,722 older adults measured for loneliness greater than or equal to three times from wave 2 (2004-2005) to wave 6 (2012-2013) and free from dementia in wave 6. Loneliness was assessed using the short 1980 version of the University of California, Los Angeles Loneliness Scale. Group-based trajectory modeling was used to explore loneliness trajectories during waves 2-6. Cox proportional hazard models were used to investigate the association of loneliness trajectories with incident dementia during waves 6-9.

RESULTS

Five distinct loneliness trajectories were identified: long-term low, persistently decreasing, persistently increasing, long-term moderate, and long-term high. Compared with long-term low loneliness, the HRs (95% confidence intervals) for persistently decreasing, persistently increasing, long-term moderate, and long-term high loneliness were 1.29 (0.83-2.00), 1.55 (1.04-2.31), 1.56 (1.03-2.38), and 3.35 (1.89-5.91), respectively.

CONCLUSION

The elderly show distinct patterns of loneliness over time, which cannot be captured by a single assessment of loneliness. The elderly with long-term loneliness and persistently increasing loneliness might be the high-risk group for dementia. Further studies are needed to determine whether reducing loneliness can prevent dementia.

Multidimensional Environmental Factors and Sleep Health for Aging Adults: A Focused Narrative Review

The timing, amount, and quality of sleep are critical for an individual's health and quality of life. This paper provides a focused narrative review of the existing literature around multidimensional environments and sleep health for aging adults. Five electronic databases, Scopus, Web of Science, PubMed/Medline; EBSCOhost, PsycINFO (ProQuest), and Google Scholar yielded 54,502 total records. After removing duplicates, non-peer reviewed academic articles, and nonrelevant articles, 70 were included for review. We were able to categorize environmental factors into housing security, home environment, and neighborhood environment, and, within each environmental category, specific elements/aspects are discussed. This paper provides a comprehensive map connecting identified levels of influence (individual, home/house, and neighborhood-level) in which subfactors are listed under each level of influence/category with the related literature list. Our review highlights that multidimensional environmental factors can affect aging adults' sleep health and eventually their physical, mental, and cognitive health and that sleep disparities exist in racial minorities in socioeconomically disadvantaged communities in which cumulative environmental stressors coexist. Based on this focused narrative review on the multidimensional sleep environments for aging adults, knowledge gaps are identified, and future research directions are suggested.

The contribution of social isolation and loneliness to sleep disturbances among older adults: a systematic review

A large number of older people encounter both objective and subjective types of social isolation and sleep disorders. Social isolation increases a person's risk of a wide range of adverse health outcomes and premature death. Social isolation can cause poor sleep quality that has been proposed as one of the possible mechanisms by which social isolation affects people's health and quality of life. The present study was conducted to determine the relationship between objective and subjective social isolation with sleep difficulties among older adults. All articles in PubMed, Web of Science, Scopus, Embase, PsycInfo, and Social care online databases published by December 2020 were systematically searched for relevant published articles. Two authors separately checked the acceptability and quality of the studies using the Newcastle Ottawa checklist. Any disagreement was resolved by consulting the third author. According to the inclusion criteria, 11 studies were systematically reviewed, of which five were cross-sectional, and six were longitudinal studies. No meta-analysis was performed due to the high heterogeneity of the studies. Based on the present study results, both objective and subjective social isolation are related to sleep disturbance in older people. This systematic review showed that objective and subjective social isolation are associated with low sleep quality. It is recommended to investigate the causal relationships and possible pathways that affect the studied variables in future studies.

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.

Early impact on sleep and mental health during the mandatory social isolation of COVID-19 outbreak: an obser vational cross-sectional study carried out in Argentina

Introduction

The mandatory social isolation (MSI) due to the pandemic caused by COVID-19 in the world produced many changes in sleep and different areas of mental health. Objectives: To evaluate the early effects of MSI on sleep, anxiety, and depression in Argentina.

Material and Methods

An anonymous observational cross-sectional web-based study was distributed throughout the country and was completed by 2,594 respondents to analyze demographic information, quality of sleep, REM sleep-related events, depressive, and anxiety symptoms.

Results

The study revealed that 53, 21, 22, 23, and 16% of people surveyed were poor sleepers, had dream-related behaviors, nightmares, depression, and anxiety symptoms, respectively. Multivariate logistic regression showed a positive correlation between anxiety, being a poor sleeper, and having nightmares.

Conclusion

We identified the early effects of MSI on sleep quality, dreaming activity, anxiety, and depression in Argentina during the COVID-19 outbreak. Our findings can be used to formulate sleep and psychological interventions to improve mental health during the pandemic and post-pandemic times.

Association between Social Frailty and Sleep Quality among Community-dwelling Older Adults: A Cross-sectional Study

OBJECTIVE

We examined the association between social frailty and subjective sleep quality among community-dwelling adults.

METHODS

This cross-sectional study recruited Japanese adults over the age of 60 years from health check-ups held in a public townhall in a suburban area between 2018 and 2019. Social frailty was evaluated using five criteria (living alone, not visiting friends sometimes, going out less frequently than the last year, not feeling helpful to friends or family, and not talking to someone every day) and categorized into three groups: non-frailty, pre-frailty, and frailty. Sleep quality was assessed according to the Pittsburgh Sleep Quality Index (PSQI) by giving participants a self-reported questionnaire. We performed multivariable linear regression analysis, denoting social frailty as an independent variable, and the global PSQI score as a dependent variable.

RESULTS

Data from 300 older adults were analyzed, 51.0% of whom were female. The participants' mean age was 73.0 years (standard deviation = 5.8). Multivariable analysis revealed the notable association between social frailty and a high global PSQI score (compared with non-frailty, frailty: β = 0.94, 95% CI = 0.08 to 1.80, p = 0.033). Of the five determiners of social frailty, not talking with someone every day was especially associated with a high global PSQI score (β = 1.57, 95% CI = 0.49 to 2.66, p = 0.005).

CONCLUSION

The present study suggests that social frailty is associated with poor sleep quality among community-dwelling older adults. Our findings indicate the importance of social frailty on sleep quality among older adults.

Association between loneliness, sleep behavior and quality: a propensity-score-matched case-control study

OBJECTIVE

To explore the influence of loneliness on sleep behavior and sleep quality based on propensity score-matched samples in Southwest China.

METHODS

Individual-level data were obtained from a Southwest China cohort study. Participants who felt lonely were matched with those who did not with propensity scores on the basis of age, gender, socioeconomic factors, physical exercise and social connection level. Sleep behavior (onset and offset timing), sleep quality (sleep latency, nocturnal awakenings and subjective sleep quality), and daytime function (daytime sleepiness and fatigue) were assessed with the Pittsburgh Sleep Index Scale (PSQI) and compared between the two groups. The data were collected between May 2019 and December 2019, and data analyses were completed in April 2021.

RESULTS

A total of 11,696 participants were included, and 824 out of 839 participants who felt loneliness were statistically matched with 824 participants who did not. Analyses of the matched samples showed that sleep onset and offset timing were similar between those who felt lonely and those who did not (p = 0.110 and p = 0.751, respectively). Sleep latency was longer in those who felt lonely (26.84 [0.9] vs. 35.52 [1.2] min, p < 0.001) than in those who did not. Furthermore, participants who felt lonely tended to have poor subjective sleep, a higher frequency of nocturnal awakenings, daytime sleepiness and fatigue (all p < 0.001).

CONCLUSIONS

Loneliness was associated with extended sleep latency, increased nocturnal awakenings, and reduced subjective sleep quality and daytime function but was not associated with sleep behavior, including sleep onset and offset timings.

The Long-Term Public Health Impact of Social Distancing on Brain Health: Topical Review

Social distancing has been a critical public health measure for the COVID-19 pandemic, yet a long history of research strongly suggests that loneliness and social isolation play a major role in several cognitive health issues. What is the true severity and extent of risks involved and what are potential approaches to balance these competing risks? This review aimed to summarize the neurological context of social isolation and loneliness in population health and the long-term effects of social distancing as it relates to neurocognitive aging, health, and Alzheimer's disease and related dementias. The full scope of the underlying causal mechanisms of social isolation and loneliness in humans remains unclear partly because its study is not amenable to randomized controlled trials; however, there are many detailed experimental and observational studies that may provide a hypothesis-generating theoretical framework to better understand the pathophysiology and underlying neurobiology. To address these challenges and inform future studies, we conducted a topical review of extant literature investigating associations of social isolation and loneliness with relevant biological, cognitive, and psychosocial outcomes, and provide recommendations on how to approach the need to fill key knowledge gaps in this important area of research.