Effects of socially stimulating group intervention on lonely, older people's cognition: a randomized, controlled trial

The WE-RISE™ multi-domain intervention: a feasibility study for the potential reversal of cognitive frailty in Malaysian older persons of lower socioeconomic status

BACKGROUND

Cognitive frailty (CF) is an emerging concern among older persons, particularly within lower socioeconomic statuses (SES) populations. Currently, there is limited evidence on the potential reversibility of CF through multi-domain interventions within this demographic. This study aimed to investigate the effectiveness of the WE-RISE™ multi-domain intervention in addressing the potential reversibility of CF among community-dwelling older persons of lower SES, the intervention effects on multiple health dimensions, and to determine if WE-RISE™ is of low cost.

METHODS

This 24-week randomised controlled trial included 55 community-dwelling older persons of lower SES with CF, who were randomised into either the WE-RISE™ intervention group (n = 27), or the control group receiving usual care (n = 28). The WE-RISE™ intervention comprised of 12 weeks of instructor led, community-based intervention, followed by 12 weeks of WE-RISE™@Home. CF status, cognitive and physical function, nutrition, disability, health-related quality of life, exercise self-efficacy and depression were assessed at baseline, 12th and 24th weeks. Changes in CF status was analysed descriptively, while intervention effects were analyzed with split plot ANOVA. The cost of the WE-RISE™ intervention was calculated using activity-based costing.

RESULTS

At baseline, all participants in both the intervention and control groups (100%) were classified as CF. Following 12 weeks of the WE-RISE™ intervention, 74.1% of participants in the experimental group no longer met the criteria for cognitive frailty, with 63% maintaining this improvement at 24 weeks. In contrast, the CF status of participants in the control group remained largely unchanged, with only 10.7% showing improvement at 12 weeks and falling to 3.6% at 24 weeks. Significant intervention effects were observed for cognition, physical function, body composition, disability, health-related quality of life and self-perceived exercise self-efficacy (p < 0.05) following participation in WE-RISE™. The cost per intervention session was RM4.06 (≈ RM3.88), and the cost per subject for 48 sessions was RM194.74 (≈ RM187.01).

CONCLUSION

The WE-RISE™ multi-domain intervention has demonstrated potential in reversing CF among older persons of lower SES, leading to significant improvements across multiple health dimensions at a low cost. WE-RISE™ shows promise to enrich the well-being of ageing societies, contribute to societal health, and ensure equitable access to healthcare, supporting broader implementation by enhancing equitable access to health programs and addressing the needs of older persons, WE-RISE™.

TRIAL REGISTRATION

This trial was registered in the Australian New Zealand Clinical Trials Registry (ACTRN12619001055190) on the 29th of July 2019 - retrospectively registered.

The Effects of Social Interaction Intervention on Cognitive Functions Among Older Adults Without Dementia: A Systematic Review and Meta-Analysis

Background and Objectives

Previous systemic reviews, predominantly including observational studies, have shown that participation in social activities is a protective factor against cognitive decline. However, this association is subject to potential reverse causality, creating a knowledge gap in our understanding of the effect of social interaction interventions on cognitive function. Therefore, this study aims to conduct a systematic review and meta-analysis of randomized controlled trials to examine the effects of social interaction interventions on cognitive decline among older adults without dementia.

Research Design and Methods

This systematic review, registered in PROSPERO (CRD42022367828), systematically searched 6 databases from inception to May 6, 2022, to identify relevant articles on the effects of activities with social interaction components on cognitive function in community-dwelling older adults without dementia aged above 60. Two independent reviewers conducted study selection, data extraction, and bias assessment, with RevMan5.3 used for meta-analysis. Subgroup analysis was conducted to assess variation in intervention effects among subgroups.

Results

We included 11 studies for qualitative analysis and 8 studies for the meta-analysis. The results showed that social interaction intervention had a significant effect on executive function (standardized mean difference [SMD] = 1.60; 95% CI, 0.50 to 2.70; p = .004), but not attention and memory. The subgroup analysis showed a greater cognitive benefit for healthy older adults, but not those with mild cognitive impairment. Moreover, in-person social interaction positively affected global cognition, whereas online interaction did not.

Discussion and Implications

Social interaction interventions have a limited impact on cognitive function in older adults without dementia but showed potential effects on executive function. This finding offers insights for implementing social intervention in the community.

Cooperation across healthcare service levels for medication reviews in older people with polypharmacy admitted to a municipal in-patient acute care unit (The COOP II Study): study protocol for a randomized controlled trial

BACKGROUND

Polypharmacy and inappropriate drug use are associated with adverse health outcomes in older people. Collaborative interventions between geriatricians and general practitioners have demonstrated effectiveness in improving clinical outcomes for complex medication regimens in home-dwelling patients. Since 2012, Norwegian municipalities have established municipal in-patient acute care (MipAC) units, designed to contribute towards reducing the number of hospital admissions. These units predominantly serve older people who typically benefit from multidisciplinary approaches. The primary objective of this study is to evaluate the effect of cooperative medication reviews conducted by MipAC physicians, supervised by geriatricians, and in collaboration with general practitioners, on health-related quality of life and clinical outcomes in MipAC patients ≥ 70 years with polypharmacy. Additionally, the study aims to assess the carbon footprint of the intervention.

METHODS

This is a randomized, single-blind, controlled superiority trial with 16 weeks follow-up. Participants will be randomly assigned to either the control group, receiving usual care at the MipAC unit, or to the intervention group which in addition receive clinical medication reviews that go beyond what is considered usual care. The medication reviews will evaluate medication appropriateness using a structured but individualized framework, and the physicians will receive supervision from geriatricians. Following the clinical medication reviews, the MipAC physicians will arrange telephone meetings with the participants' general practitioners to combine their assessments in a joint medication review. The primary outcome is health-related quality of life as measured by the 15D instrument. Secondary outcomes include physical and cognitive functioning, oral health, falls, admissions to healthcare facilities, and mortality.

DISCUSSION

This study aims to identify potential clinical benefits of collaborative, clinical medication reviews within community-level MipAC units for older patients with polypharmacy. The results may offer valuable insights into optimizing patient care in comparable municipal healthcare settings.

TRIAL REGISTRATION

The study was registered prospectively on ClinicalTrials.gov 30.08.2023 with identifier NCT06020391.

The effect of social isolation on the cognitive ability of the oldest old in Chinese nursing homes in post-COVID-19: a moderated chain mediation model

Background

Both pre-or post-COVID-19, older adults residing in nursing homes are at significant risk for social isolation, which is negatively associated with cognitive ability. Currently, the elderly aged 80 years and older are the fastest-growing age group globally. The extent of social isolation within this group post-COVID-19 and its impact on cognitive abilities remain inadequately explored.

Objective

This research aimed to evaluate the prevalence of social isolation among the oldest old in Chinese nursing homes post-COVID-19 and to investigate the mediating and moderating roles of basic activities of daily living (BADL), depression, and subjective socioeconomic status in the relationship between social isolation and cognitive ability.

Methods

This cross-sectional study included 453 participants aged 80 years and older from 11 nursing homes in Ningbo, Zhejiang Province, China. Social isolation was assessed using the Lubben Social Network Scale-6 (LSNS-6), cognitive ability using the Mini-Mental State Examination (MMSE), BADL using the Barthel Index (BI), and depression using the Patient Health Questionnaire-9 items (PHQ-9). Mediation and moderation effects were statistically analyzed using SPSS 23.0 and PROCESS 3.5.

Results

The mean age of the study sample was 87.1 ± 3.8 years, among whom 60.3% (n = 273) were female, and 56.1% experienced social isolation, with 41.1% and 63.1% being isolated from family and friends, respectively. Social isolation indirectly affected cognitive ability through BADL and depression, respectively, and through the chain mediation effect of BADL and depression. Subjective socioeconomic status moderated the relationships between social isolation and BADL and between social isolation and depression. However, no moderating effect of subjective socioeconomic status was found between social isolation and cognitive ability.

Conclusion

This study deepens our understanding of the current state of social isolation and its mechanisms of action in the oldest old post-COVID-19 and provides a new basis for future public health policy development and related research.

Addressing loneliness in older adults: predictors, protective factors, and implications for social work practice

Loneliness significantly impacts the mental well-being of older adults, prompting an examination of psychological predictors and buffering factors associated with it in this demographic. A cross-sectional study involving 246 community-dwelling older adults was conducted. The UCLA Loneliness Scale identified predictors of loneliness, including negative mood, hopelessness (negative future expectations and loss of motivation), and despair. Buffering factors included ego-integrity, personal growth, and purpose in life. Regression analysis revealed that negative mood, negative future expectations, and despair increased loneliness, with negative mood showing a strong association. Conversely, ego-integrity, personal growth, and purpose in life reduced loneliness. The study underscores the complex interplay of psychological factors shaping loneliness in older adults, highlighting the importance of addressing both risk and protective factors. Social work practitioners in healthcare settings can play a pivotal role in addressing loneliness among older adults by leveraging these factors.

Evaluating the cognitive effects of interventions to reduce social isolation and loneliness in older adults: a systematic review

OBJECTIVES

Social isolation and loneliness among older adults present serious public health challenges linked to increased dementia risk. This systematic review analyzes interventions addressing social isolation and loneliness in older adults and their cognitive effects to inform future dementia prevention programs.

METHOD

We systematically searched databases (PUBMED, PsycINFO, SCOPUS, EBSCO, and SAGE Journals) from February to May 2023 and updated from August to November 2023 using terms like social isolation, loneliness, intervention, and cognitive outcome. We included studies that assessed cognitive outcomes (such as global cognition or specific domains) and non-cognitive outcomes (including depression, well-being, and functionality). Study quality was assessed using Cochrane's RoB 2, ROBINS-I, and other appraisal tools, with results synthesized narratively.

RESULTS

Nine studies (1025 participants) were included, with a high risk of bias in most randomized trials (except one) and a low-to-moderate risk in non-randomized studies. Six studies showed improved cognitive function post-intervention, five of which involved technology. Two studies demonstrated reduced loneliness and improved cognition.

CONCLUSION

Technological interventions promise to reduce social isolation and loneliness, positively impacting cognitive function. Despite this, these interventions did not directly impact social isolation, which requires future and larger studies to understand more in-depth the role of these approaches for individuals with social isolation. The interventions promoting social interactions could lead to higher social identification, well-being, and interest in life. Multidomain interventions, including technology, are effective. Limitations include study scarcity and heterogeneity, highlighting the need for more robust research on interventions to alleviate social isolation and loneliness and enhance cognitive function.Systematic Review Registration PROSPERO CRD42023460933.

Long-Term Effects of the Multicomponent Program BrainProtect® on Cognitive Function: One-Year Follow-Up in Healthy Adults

Background

Age-related neuronal changes impact cognitive integrity, which is a major contributor to health and quality of life. The best strategy to prevent cognitive decline and Alzheimer's disease is still debated.

Objective

To investigate the long-term effects of the eight-week multicomponent training program BrainProtect® on cognitive abilities compared to general health counseling (GHC) in cognitively healthy adults in Germany.

Methods

Healthy adults (age ≥50 years) previously randomized to either GHC (n = 72) or BrainProtect (intervention group, IG, n = 60) for eight-weeks (once weekly, 90 minutes, group-based) underwent a comprehensive neuropsychological test battery and health-related quality of life (HRQoL) evaluation 3- and 12-months after intervention end.

Results

Dropout rates were n = 8 after 3 months and n = 19 after 12 months. No significant long-term effect of BrainProtect was observed for the primary endpoint Consortium to Establish a Registry for Alzheimer's Disease (CERAD-Plus) total score. Logical reasoning was significantly improved (p = 0.024) 12 months after completion of the training program in IG participants compared to the GHC group independent of sex, age, education, diet, and physical activity. In IG participants, thinking flexibility (p = 0.019) and confrontational naming (p = 0.010) were improved 3 months after completing the intervention compared to the GHC group, however, after conservative Bonferroni adjustment, significance was lost.

Conclusions

BrainProtect® independently improved logical reasoning compared to GHC up to 12 months after cognitive training's end in healthy adults. To uncover the long-term clinical significance of multicomponent cognitive training in healthy adults, studies with larger sample size and frequent follow up visits are necessary.

Social activities in multidomain dementia prevention interventions: insights from practice and a blueprint for the future

Introduction

Social activities are important for health and act as a driver of cognitive reserve during aging. In this perspective paper, we describe challenges and outline future (research) endeavors to establish better operationalization of social activities in multidomain interventions to prevent dementia.

Body

We first address the lack of conceptual clarity, which makes it difficult to measure engagement in social activities. Second, drawing from our experience with the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), we discuss social activities in multidomain dementia prevention interventions. Using qualitative data from the Multimodal Preventive Trial for Alzheimer's Disease (MIND-ADmini), we reflect on participant experiences with social activities. Third, we address the potential and challenges of digital solutions in promoting social activities in interventions for dementia prevention. Finally, we share insights from a workshop on digital technology, where we consulted with individuals with and without cognitive impairment who have been involved in three European projects (i.e., EU-FINGERS, Multi-MeMo, and LETHE).

Discussion

Based on these insights, we advocate for research that strengthens and accelerates the integration of social activities into multidomain interventions for dementia prevention. We propose several ways to achieve this: (a) by conducting mixed methods research to formulate a broadly accepted definition and instructions to measure social activities; (b) by focusing on promoting engagement in social activities beyond the intervention setting; and (c) by exploring the needs and preferences of older adults towards digitally-supported interventions and co-design of new technologies that enrich in-person social activities.

Exploring the Relationship of Leisure Travel with Loneliness, Depression, and Cognitive Function in Older Adults

Loneliness, depression, and cognitive decline are pressing concerns among older adults. This study examines the association between leisure travel participation and these health outcomes in older adults, aiming to provide further evidence of the benefits of leisure travel. Using nationally representative historical data from the 2006 household survey of the Health and Retirement Study, this study conducted a series of regression analyses to investigate the relationship between traveling and the three health outcomes, adjusting for age, sex, race, marital status, education, total wealth, annual income, and difficulty with daily activities. The results reveal that travel patterns in terms of distance are significantly associated with loneliness, depression, and cognitive function. Long-distance travel is positively related to higher cognitive function and a reduction in depressive symptoms, along with lower levels of loneliness, reinforcing the notion that leisure travel can potentially act as a catalyst for improved cognitive and mental health by offering opportunities for enhancing social connections and forming new relationships. The findings on the relationships between participation in leisure travel and mental and cognitive health contribute to the body of evidence supporting the therapeutic value of leisure travel in promoting healthy aging and enhancing the overall well-being in older adults.

Mechanisms through which befriending services may impact the health of older adults: A dyadic qualitative investigation

Befriending services are often delivered to older adults with a view to improving social connectedness, but they may also lead to improved health. The objective of the current study was to explore potential mechanisms through which befriending services might impact the health of older adults. Data were collected from 13 befriendee-befriender dyads (n = 26), using a constructivist grounded theory and dyadic analytic approach. Potential mechanisms were described, using a realist evaluative framework of mechanistic processes in a complex intervention context. Five mechanisms of action triggered by the intervention were identified: supporting health behaviours; providing emotional support; improving mood; getting cognitive stimulation and novelty; and providing opportunities for socialising. We identified five potential mechanisms through which befriending services might impact health for older people. Our results suggest potential mechanisms through which befriending might positively impact the health of older people, and which should be evaluated empirically in future research.

Loneliness in older primary care patients and its relationship to physical and mental health-related quality of life

BACKGROUND

Loneliness is a significant public health challenge in the United States, especially among older adults. The epidemiology of loneliness among older adults in primary care is lacking, and specific research is needed on how loneliness impacts older primary patients' physical, mental, and cognitive health. A large sample of older primary care patients were recruited for a trial during the COVID-19 pandemic to measure the relationship between loneliness and physical and mental quality of life (QOL).

METHODS

Baseline data come from the Caregiver Outcomes of Alzheimer's Disease Screening (COADS) study, an ongoing randomized controlled trial evaluating benefits and risks of Alzheimer's disease and related dementias screening among primary care patients ages 65 and older, collected April 2020 to September 2021. Loneliness was measured with the 5-item, Loneliness Fixed Form Ages 18+ from The NIH Toolbox Emotion Battery, physical and mental health-related QOL was measured with the SF-36v2, and depression and anxiety severity were measured with the PHQ-9 and GAD-7, respectively.

RESULTS

Spearman correlation analyses revealed that loneliness was moderately correlated with mental health QOL (r[601] = -0.43, p < 0.001), anxiety severity (r[601] = 0.44, p < 0.001), and depression severity (r[601] = 0.42, p < 0.001), while weakly correlated with physical health QOL (r[601] = -0.15, p < 0.001). After conducting unadjusted and adjusted linear regression models, we found that loneliness was significantly associated with both lower mental (p < 0.001) and physical (p < 0.001) QOL. Furthermore, loneliness remained significantly associated with worse mental QOL after adjusting for age, gender, race, ethnicity, educational level, perceived income status, neighborhood disadvantage, severity of comorbidities, and comorbid depression and anxiety.

CONCLUSION

Primary care providers should discuss loneliness with their older adult patients and provide resources to help patients develop and maintain meaningful social relationships.

Association of social integration with cognitive function trajectories among Chinese older adults: evidence from the China health and retirement longitudinal study (CHARLS)

Background

The prevalence of cognitive impairment among older adults remains high. It has been proven that social integration is related to cognitive function. However, limited research has examined the association of social integration and its different dimensions with cognitive function trajectories of older adults.

Methods

The data were from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2013 (T1) to 2018 (T3). A total of 3,977 older adults were included in the final analysis. Cognitive function was measured with items from an adapted Chinese version of the Mini-Mini-Mental Mental State Examination (MMSE), while the measurement of social integration included three dimensions: economic integration, relational integration and community integration. A group-based trajectory model (GBTM) was used to identify cognitive trajectory groups among participants and an unordered multinomial logistic regression was employed to explore the association of baseline social integration and its three dimensions with cognitive function trajectories.

Result

Three cognitive function trajectory groups were identified: low-decline group (24.1%), medium-decline group (44.2%) and high-stable group (31.7%). Comparing to the medium-decline trajectory group, older adults with higher social integration scores were more likely to be in the high-stable trajectory group (OR = 1.087, 95%CI: 1.007 ~ 1.174), while less likely to be in the low-decline group (OR = 0.806, 95%CI: 0.736 ~ 0.882). Among the different dimensions of social integration, older adults with higher community integration scores were more likely to be in the high-stable trajectory group (OR = 1.222, 95%CI: 1.026 ~ 1.456); Older adults with higher relational integration scores were less likely to be in the low-decline trajectory group (OR = 0.816, 95%CI: 0.734 ~ 0.906). The economic integration was not found to correlate with the cognitive function trajectories. Stratified analyses revealed that the association between community integration and cognitive trajectories was only significant among older adults aged 60 to 69, and the association between relational integration and cognitive trajectories was only significant among older adults who was agricultural household registration.

Conclusion

The developmental trajectories of cognitive function among Chinese older adults are heterogeneous. Social integration is significantly related to the trajectories of cognitive function in Chinese older adults. Measures should be taken to promote social integration of Chinese older adults to reduce the decline of cognitive function.

Current Trends and Future Directions in Urban Social Prescribing

PURPOSE OF REVIEW

Social prescribing (SP) is defined as a non-medical community referral program to support well-being and health. This review explores the current evidence about the effectiveness of SP.

RECENT FINDINGS

This review examined existing SP models that have been or are being tested to connect people to these opportunities through direct and indirect referral schemes. The review identified a fifth model that facilitates a group-based approach used to mental well-being and resilience. While the development of SP largely originates from the UK, the global interest in SP has increased, with over 31 nations reporting elements of SP. The main goal of SP is to better integrate care between the traditional medical setting and resources available in the community and voluntary sectors. Although this review found widespread optimism around SP, there remain concerns about its effectiveness and demands for high-quality evaluations to strengthen the evidence base for SP.

Association Between Frequency of Social Contact and Brain Atrophy in Community-Dwelling Older People Without Dementia: The JPSC-AD Study

BACKGROUND AND OBJECTIVES

Epidemiologic evidence has shown that social isolation, a low frequency of social contact with others, is associated with the risk of dementia and late-life depressive symptoms. Therefore, we hypothesized that low frequency of social contact may be involved in brain atrophy, and depressive symptoms may play some role in this relationship. We aimed to evaluate the association between low frequency of social contact and the volumes of various brain regions and to assess the extent to which depressive symptoms mediate these relationships from a large population-based multisite cohort study.

METHODS

Dementia-free community-dwelling Japanese aged 65 years or older underwent brain MRI scans and a comprehensive health examination. Frequency of contact with noncohabiting relatives and friends was determined by asking a single question with 4 categories: everyday, several times a week, several times a month, and seldom. Total and regional brain volumes, intracranial volume (ICV), and white matter lesion volume were estimated using FreeSurfer software. The associations between frequency of social contact and brain volumes per ICV were examined using analyses of covariance. Mediation analyses were conducted to calculate the proportion of the associations explained by depressive symptoms.

RESULTS

We included 8,896 participants. The multivariable-adjusted mean of the total brain volume in the group with the lowest frequency of social contact was significantly lower compared with that in the group with the highest frequency of social contact (67.3% vs 67.8%), with a significant increasing trend across the groups (p value for trend <0.001). The white matter lesion volume increased significantly with lower frequency of social contact (0.30% in the lowest frequency group vs 0.26% in the highest frequency group, p value for trend <0.001). Lower frequency of social contact was associated with smaller volumes in the temporal lobe, occipital lobe, cingulum, hippocampus, and amygdala (all q values of false discovery rate correction <0.05). The relationships seemed to be partly mediated by depressive symptoms, which accounted for 15%-29% of the observed associations.

DISCUSSION

Lower frequency of social contact was associated with decreased total and cognitive function-related regional brain volumes. In addition, depressive symptoms partially explained the association in community-dwelling older people without dementia in Japan.

Positive impact of social relationships fostered by physical and/or cognitive group activity on older people's quality of life: PRISMA systematic review

Introduction

This review identified and examined the research literature on the effect of participating in physical and/or cognitive activities on older people's quality of life, to establish whether the social relationships fostered by these activities can be a vector of better physical, mental and social quality of life.

Method

A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched four databases (MEDLINE, APA PsycArticles/PsycInfo, PubMed, and Web of Science) for articles published between 1975 and 2022 using search terms related to psychosocial, population, and intervention topics. Studies were eligible if they involved older adults, participation in at least one activity (physical or cognitive), and at least one quality of life related outcome measure.

Results

We selected 20 articles published between 1990 and 2021, the majority concerning studies conducted in English-speaking countries. Ten studies were interventional (introduction of program of activities), and 10 studies were observational (60% quantitative, 40% qualitative). Overall, results revealed a positive impact of the activities on every aspect of quality of life (i.e., cognitive, physical, social, psychological, and quality of life in general).

Conclusion

The present review confirmed the beneficial impact of practicing physical and/or cognitive group activities on older people's quality of life, but the contribution of social factors and social relationships remains underestimated and not well defined in researches.

Social participation and risk of developing dementia

The increasing number of people with dementia globally illustrates the urgent need to reduce dementia's scale and impact. Lifetime social participation may affect dementia risk by increasing cognitive reserve, and through brain maintenance by reducing stress and improving cerebrovascular health. It may therefore have important implications for individual behavior and public health policy aimed at reducing dementia burden. Observational study evidence indicates that greater social participation in midlife and late life is associated with 30-50% lower subsequent dementia risk, although some of this may not be causal. Social participation interventions have led to improved cognition but, partly due to short follow-up and small numbers of participants, no reduction in risk of dementia. We summarize the evidence linking social participation with dementia, discuss potential mechanisms by which social participation is likely to reduce and mitigate the impact of neuropathology in the brain, and consider the implications for future clinical and policy dementia prevention interventions.

Associations Among Loneliness, Purpose in Life and Subjective Cognitive Decline in Ethnoracially Diverse Older Adults Living in the United States

Subjective cognitive decline (SCD), which precedes Mild Cognitive Impairment and dementia, may be affected by purpose in life (PiL) and loneliness in older adults. We investigated associations among PiL, loneliness, and SCD in US Latino (n = 126), Black (n = 74), Asian (n = 33), and White (n = 637) adults. Higher PiL predicted lower SCD in all groups (p-values < .012), except Black participants. Lower loneliness predicted lower SCD in Latino and White groups (p-values < .05), and PiL moderated this association in White adults. PiL and loneliness may play important roles in cognitive decline. Differential predictors of SCD suggest differential targets for preventing cognitive decline and dementia across ethnoracial groups.

Cultural differences in caring for people with dementia: a pilot study of concern about losing face and loneliness in Chinese American and European American caregivers

OBJECTIVES

Heavy demands upon dementia caregivers can lead to a number of poor health outcomes including declines in physical, mental, and brain health. Although dementia affects people from all backgrounds, research in the US has largely focused on European American caregivers. This has made providing culturally-competent care more difficult. This study begins to address this issue by empirically examining how culturally-shaped beliefs can influence loneliness in family caregivers of people with dementia.

METHODS

We conducted a preliminary questionnaire study with Chinese American and European American family caregivers of people with dementia (N = 72).

RESULTS

Chinese American caregivers were more concerned than European American caregivers about losing face, which in turn, was associated with greater loneliness. This pattern remained when accounting for caregiver gender, age, and relationship to the person with dementia.

CONCLUSIONS

These preliminary findings highlight the role that cultural beliefs can play in adverse caregiver outcomes, and suggest that addressing concerns about losing face may be an important way for healthcare providers to help reduce loneliness among Chinese American caregivers.

CLINICAL IMPLICATIONS

Understanding how cultural beliefs influence caregiver outcomes is critical as healthcare professionals work to provide culturally-competent care and design culturally-sensitive interventions.

Prison and the brain

Imprisonment is a common punishment in most countries. Goals of imprisonment are often not only retribution, but also prevention. Specific prevention aims to reduce the risk of reoffending of the imprisoned offender. The question is whether the goals of retribution and specific prevention contradict each other. Retribution is not only expressed in taking away ones freedom, but also in the prison environment itself. Prisoners live in a sober regime, with a minimal amount of autonomy. There are few cognitive challenges, meaningful social interaction is reduced significantly, and many prisoners are highly sedentary. In other words, prison can be viewed as an impoverished environment. In the last few decades, much knowledge has been gained on the influence of enriched versus impoverished environment on the brain. In this chapter, we discuss the influence of the impoverished prison environment on brain functions of prisoners, with an emphasis on self-regulation and executive functions, since these functions are (1) often impaired in offenders, (2) highly sensitive to environmental influences, and (3) crucial for successful resocialization. We conclude this chapter by discussing possibilities for and potential effects of enriching prison environments.

Effects of the Multicomponent Cognitive Training Program BrainProtect in Cognitively Healthy Adults: A Randomized Controlled Trial

BACKGROUND

Cognitive integrity is a fundamental driver of health. The exact structure of strategies against cognitive impairment is still under debate.

OBJECTIVE

To compare the short-term effects of a multicomponent cognitive training (BrainProtect) with those of general health counseling (GHC) on cognitive abilities and health-related quality of life (HRQoL) in healthy adults in Germany.

METHODS

In this parallel randomized controlled trial (RCT), 132 eligible cognitively healthy adults (age ≥50 years, Beck Depression Inventory ≤9/63; Montreal Cognitive Assessment ≥26/30) were randomized to either GHC (N = 72) or to intervention with BrainProtect (intervention group, IG; N = 60). IG participants received 8 weekly sessions of 90 min of the group-based BrainProtect program focusing on executive functions, concentration, learning, perception, and imagination, plus nutritional and physical exercise units. Before and after intervention, all participants underwent neuropsychological testing and HRQoL evaluation, blinded for pretest.

RESULTS

No significant training effect was observed for the primary endpoint of global cognition as assessed by CERAD-Plus-z Total Score (p = 0.113; ηp2 = 0.023). Improvements in several cognitive subtests were shown in the IG (N = 53) compared to the GHC (N = 62) without adverse events. Differences reached significance for verbal fluency (p = 0.021), visual memory (p = 0.013), visuo-constructive functions (p = 0.034), and HRQoL (p = 0.009). Significance was lost after adjustment, though several changes were clinically relevant.

CONCLUSION

BrainProtect did not significantly impact global cognition in this RCT. Nevertheless, the results of some outcomes indicate clinically meaningful changes, so that a strengthening of the cognitive performance by BrainProtect cannot be excluded. Further studies with larger sample size are needed to confirm these findings.

Loneliness in Posttraumatic Stress Disorder: A Neglected Factor in Accelerated Aging?

Prior research suggests that people with Posttraumatic Stress Disorder (PTSD) may experience a form of accelerated biological aging. In other populations, loneliness has been shown to elevate risk for many of the same components of accelerated biological aging, and other deleterious outcomes, as seen in people with PTSD. Although standard diagnostic criteria for PTSD include "feelings of detachment or estrangement from others", the relationship of such feelings to the concept of loneliness remains uncertain, in par potentially due to a failure to distinguish between loneliness versus objective social isolation. In order to catalyze wider research attention to loneliness in PTSD, and the potential contribution to accelerated biological aging, the present paper provides three components: (1) a conceptual overview of the relevant constructs and potential interrelationships, (2) a review of the limited extant empirical literature, and (3) suggested directions for future research. The existing empirical literature is too small to support many definitive conclusions, but there is evidence of an association between loneliness and symptoms of PTSD. The nature of this association may be complex, and the causal direction(s) uncertain. Guided by the conceptual overview and review of existing literature, we also highlight key areas for further research. The ultimate goal of this line of work is to elucidate mechanisms underlying any link between loneliness and accelerated aging in PTSD, and to develop, validate, and refine prevention and treatment efforts.

Creativity and art therapies to promote healthy aging: A scoping review

The purpose of this scoping review is to investigate the value of creative arts therapies in healthy older adults. This article aims to shed light on current knowledge concerning the effectiveness of art therapies (ATs) for the prevention of common age-related conditions using the definition of art therapy provided by the American Art Therapy Association (AATA), as well as Cohen’s conceptual framework for the psychological conceptualization of the relationship between the arts and health in later life. The objective is to carefully capture subthreshold situations of distress, which are often not taken into account and primarily involve psychological aspects that are crucial in the multidimensional perspective of healthy aging. Twelve articles were selected and examined following an initial electronic search on 3 databases. A thematic analysis of the results identified four major themes: improving cognitive performance and proprioception; enhancing self-identity and meaningful life; reducing feelings of loneliness and depressive symptoms; and the importance of socialization. All these aspects constitute the basis for preventing psychological distress and enhancing mental well-being for healthy aging.

Motion, Relation, and Passion in Brain Physiological and Cognitive Aging

The aim of the current paper was to present important factors for keeping the basic structures of a person’s brain function, i.e., the grey and white matter, intact. Several lines of evidence have shown that motion, relation, and passion are central factors for preserving the neural system in the grey and white matter during ageing. An active lifestyle has shown to contribute to the development of the central nervous system and to contrast brain ageing. Interpersonal relationships, and interactions, have shown to contribute to complex biological factors that benefit the cognitive resilience to decline. Furthermore, the current scientific literature suggests that passion, strong interest, could be the driving factor motivating individuals to learn new things, thus influencing the development and maintenance of the neural functional network over time. The present theoretical perspective paper aims to convey several key messages: (1) brain development is critically affected by lifestyle; (2) physical training allows one to develop and maintain brain structures during ageing, and may be one of the keys for good quality of life as an older person; (3) diverse stimuli are a key factor in maintaining brain structures; (4) motion, relation, and passion are key elements for contrasting the loss of the grey and white matter of the brain.

Association of Low Emotional and Tangible Support With Risk of Dementia Among Adults 60 Years and Older in South Korea

IMPORTANCE

The association between social support and dementia risk has been debated. Most previous prospective studies have not differentiated the subtypes of social support.

OBJECTIVE

To examine whether the association between social support and risk of dementia differs by subtype of social support and by sex.

DESIGN, SETTING, AND PARTICIPANTS

This nationwide prospective cohort study included randomly sampled South Korean adults 60 years or older. The study was launched November 1, 2010, with follow-up every 2 years until November 30, 2020. The 5852 participants who completed the assessment for social support and were not diagnosed as having dementia, severe psychiatric disorders including major depressive disorder, or major neurological disorders at the baseline assessment were included in the analysis.

EXPOSURES

Geriatric psychiatrists administered the structured diagnostic interviews and physical examinations to every participant based on the Korean version of the Consortium to Establish a Registry for Alzheimer Disease (CERAD-K) Assessment Packet Clinical Assessment Battery.

MAIN OUTCOMES AND MEASURES

Baseline levels of emotional and tangible support using the Medical Outcomes Survey Social Support Survey.

RESULTS

Among the 5852 participants (mean [SD] age, 69.8 [6.6] years; 3315 women [56.6%]; mean [SD] follow-up duration, 5.9 [2.4] years), 237 (4.0%) had incident all-cause dementia and 160 (2.7%) had incident Alzheimer disease (AD) subtype of dementia. Compared with women who reported having emotional support, those with low emotional support had almost a 2-fold higher incidence of all-cause dementia (18.4 [95% CI, 13.6-23.2] vs 10.7 [95% CI, 9.0-12.5] per 1000 person-years) and AD (14.4 [95% CI, 10.2-18.6] vs 7.8 [95% CI, 6.3-9.3] per 1000 person-years). Adjusted Cox proportional hazard analysis revealed that low emotional support was associated with increased risk of all-cause dementia (hazard ratio, 1.61 [95% CI, 1.10-2.36]; P = .02) and AD (hazard ratio, 1.66 [95% CI, 1.07-2.57]; P = .02) only in women. Low tangible support was not associated with a risk of all-cause dementia or AD regardless of sex.

CONCLUSIONS AND RELEVANCE

The findings of this cohort study suggest that older women with low emotional support constitute a population at risk for dementia. The level of emotional support should be included in risk assessments of dementia.

Exposure to the troubles in Northern Ireland, memory functioning, and social activity engagement: results from NICOLA

We investigated the potential impact of a cohort traumatic exposure, the Troubles in Northern Ireland, on memory functioning in later life, and the potential moderating effect of social activity engagement. Using data from 6571 participants aged 60 + in the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) cohort, we used a structural equation modelling framework to explore associations between traumatic exposure during the Troubles and memory functioning. As expected, social activity engagement was positively associated with memory functioning, β = .102. Traumatic exposure was also positively associated with memory functioning, β = .053. This association was stronger at low levels of social activity engagement; among those with higher levels, there was little association, interaction β = - 0.054. The positive association between traumatic exposure during the Troubles and memory functioning was not moderated by the age at which the exposures occurred (based on analysis of a subsample with available data), interaction β = - 0.015. We conclude that superior memory functioning was associated with higher levels of traumatic exposure during the Troubles, particularly among those with lower levels of social activity engagement, and regardless of the age at which the exposures occurred. Future longitudinal analyses are required to build on these results, which potentially have implications for life-course epidemiology, in relation to critical periods for traumatising experiences.

Association Between Social Network and Cognitive Function: A Cross-Sectional Assessment From the Cardiovascular and Metabolic Diseases Etiology Research Center Cohort (2013-2018)

BACKGROUND

This study aimed to investigate how social networks are associated with cognitive function in the middle-aged and elderly Korean population.

METHODS

A total of 7,704 individuals over the age of 50 were included from the baseline recruitment of the Cardiovascular and Metabolic Diseases Etiology Research Center cohort from the years 2013 to 2018. Egocentric social network characteristics including network size, intimacy, and frequency of face-to-face meetings were measured as exposures, and the Korean version of Mini-Mental State Examination (K-MMSE) score was measured to reflect general cognitive function as an outcome. We also stratified the analysis by income level into tertiles, with income caps of 42,000 thousand won and 72,000 thousand won. A general linear regression model was used, adjusting for age, gender, socioeconomic factors, lifestyle factors, depressive symptoms, and study settings.

RESULTS

Social network properties were positively associated with cognitive function in both men and women. However, the specific estimates varied according to gender and income level. In men, frequency was most significantly associated with cognitive function (standardized β = 0.093, p-value <0 .0001). In women, the strength of the association with cognitive function was found in size (standardized β = 0.055, p-value = 0.001). The effect modification of income level could be seen in the association between frequency and cognitive function. The strongest association between frequency and cognitive function was found in the middle income group in men (standardized β = 0.114, p-value = 0.0063), and the low income group in women (standardized β = 0.076, p-value = 0.0039).

CONCLUSION

There were positive associations between social network properties (i.e., size, intimacy, and frequency of face-to-face meetings) and cognitive function. The degree of association varied according to social network properties, gender, and income level. Overall, among social network properties, social network size was an important factor in the cognition of women, whereas frequency was important in the cognition of men.

Effects of the multimodal intervention program including animal-assisted therapy on depression and self-esteem among university students

This study aimed to investigate the effects of the multimodal group intervention that combined animal-assisted therapy (AAT) and integrated play therapy (IPT) on depression and self-esteem in undergraduate university students. The subjects were 40 students attending animal-related and social welfare departments of universities located in a metropolitan city. The multimodal intervention program was conducted for eight sessions (twice a week, 60 min each) in the experimental group. Data analysis was conducted using the independent sample t-test, ANCOVA, and paired sample t-test for pre- and post-test. Therefore, the multimodal intervention program applying AAT and IPT showed positive effects on depression and self-esteem in university students. Based on these results, this study proposed the operation of multidisciplinary education and practical and policy utilization methods to reduce depression among university students and help improve their self-esteem.

Randomized Controlled Trials of a Psychosocial Intervention for Improving the Cognitive Function among Older Adults: A Scoping Review

Aim: The goal is to explore available evidence and provide greater clarity to what is described as psychosocial intervention to improve cognitive function among older population with MCI as well as identifying areas for future research. Methods: An electronic literature search of PubMed, Cochrane, Ebscohost, Medline, Scopus, and gray resource was conducted to find articles published in English language between 2010 and September 2020. This review focused on research undertaken using randomized clinical trials study design. We extracted information regarding the publication date, geographical location, study setting, intervention mechanism, type of cognitive measurement used, and outcome of the studies. References of this literature were also reviewed to ensure comprehensive search. Result: Out of 240 potential records found, a total of 27 articles were identified following the first round of screening and deletion of duplicates. Full-text article reviews and analysis in the second round of screening narrowed the selection down to four articles. Another three relevant articles obtained from references were also included making a total of seven articles in the final analysis. Findings: Psychosocial intervention strategies for improvement of cognitive function, done in various setting all over the globe, covered a range of approaches including art therapy, visual art therapy, therapeutic writing therapy, reminiscence activity, and cognitive behavioral approach. Most were conducted in weekly basis within 1-to-2-hour duration of session. Cognitive function of older adult in psychosocial intervention group was significantly improved in two studies. Three studies showed no significant improvement at all in the cognitive function, and another one reported success in improving cognitive function over time in the intervention group than in control group. One study did not describe the interaction effect. Different types of cognitive measurement also were used to quantify different domains of cognitive function in the reviewed studies. Conclusion: The idea of using psychosocial intervention for improving cognitive function has begun to increasingly accepted recently. Findings from the limited studies are encouraging, although the outcome of the cognitive function was mixed. Large-scale and longer duration of psychosocial intervention with bigger sample size is warranted for future studies.

Expanding role of nurses in management of dementia in geriatrics: improving well-being of geriatric patients through quality nursing care

The potential nurses role to include the recognition and management of dementia has been acknowledged. Practice Nurses are well-positioned to provide comprehensive dementia information and support so that people living with dementia are better equipped to self-manage their health and live well with dementia. However, treatment of geriatric dementia has become difficult owing to co-morbidities and cognitive and physical deterioration of these patients. Thus, geriatric dementia patients require special attention during care in homes and clinical settings. In modern medical practice, the role of nurse has become dynamic, ranging from education and personal care. The profession of nursing is considered as critical to meets the needs of the elderly population with dementia and ensure the delivery of high-quality care. Since nurses play such an important role in caring for these individuals, comprehensive reviews lack on their role and experience in geriatric dementia treatment and issues. This review summarizes the expanding role of nurses in the management of geriatric dementia in terms of nurse's knowledge, role, communication, attitude and maintaining patient's quality of life through diverse activities. Furthermore, we also explain the future direction for improving the nursing care to treat dementia in elderly population.

How can dementia and disability be prevented in older adults: where are we today and where are we going?

Ageing of the population, together with population growth, has brought along an ample increase in the number of older individuals living with dementia and disabilities. Dementia is the main cause of disability in old age, and promoting healthy brain ageing is considered as a key element in diminishing the burden of age-related disabilities. The World Health Organization recently launched the first risk reduction guidelines for cognitive impairment and dementia. According to recent estimates, approximately 40% of dementia cases worldwide could be attributable to 12 modifiable risk factors: low education; midlife hypertension and obesity; diabetes, smoking, excessive alcohol use, physical inactivity, depression, low social contact, hearing loss, traumatic brain injury and air pollution indicating clear prevention potential. Dementia and physical disability are closely linked with shared risk factors and possible shared underlying mechanisms supporting the possibility of integrated preventive interventions. FINGER trial was the first large randomized controlled trial indicating that multidomain lifestyle-based intervention can prevent cognitive and functional decline amongst at-risk older adults from the general population. Within the World-Wide FINGERS network, the multidomain FINGER concept is now tested and adapted worldwide proving evidence and tools for effective and easily implementable preventive strategies. Close collaboration between researchers, policymakers and healthcare practitioners, involvement of older adults and utilization of new technologies to support self-management is needed to facilitate the implementation of the research findings. In this scoping review, we present the current scientific evidence in the field of dementia and disability prevention and discuss future directions in the field.

A socially-engaged lifestyle moderates the association between gait velocity and cognitive impairment

Objective: Cognitive status has been linked to impaired gait velocity, and diminished social and physical engagement. To date, the potential moderating influence of lifestyle engagement on gait-cognitive status associations has not been systematically explored. The present investigation examines whether a socially- or physically-engaged lifestyle moderates the association between diminished gait velocity and likelihood of amnestic mild cognitive impairment (a-MCI) classification.Methods: Participants (aged 65+, M_age=73 years) were classified as either healthy controls (n = 30) or a-MCI (n = 24), using neuropsychological test scores and clinical judgement. Gait velocity was indexed using a GAITRite computerized walkway, engaged lifestyle (social and physical subdomains) were measured using a well-validated self-report measure, the revised Activity Lifestyle Questionnaire.Results: Logistic regression, evaluating likelihood of a-MCI classification, yielded a significant interaction between a socially-engaged lifestyle and gait velocity (b=.01, SE=.003, p=.015). Follow-up simple effects were derived for two levels (+/-1SD) of social engagement; for individuals 1 SD below the mean, the association between gait velocity and increased likelihood of a-MCI classification was exacerbated (probability of a-MCI classification for those with slower gait velocity was 60% higher for individuals 1 SD below vs 1 SD above the mean of social engagement). Physically-engaged lifestyle did not significantly moderate the gait-cognitive status association.Conclusions: The significant moderating influence of social engagement has several implications, including the likelihood that distinct mechanisms underlie the relationships of social engagement and gait velocity to cognitive function, the value of social variables for well-being, and the potential utility of socially-based interventions that may prevent/delay a-MCI onset.

Intergenerational Programmes bringing together community dwelling non-familial older adults and children: A Systematic Review

BACKGROUND

Social isolation is associated with an increased risk of adverse health outcomes, including functional decline, cognitive decline, and dementia. Intergenerational engagement, i.e. structured or semi structured interactions between non-familial older adults and younger generations is emerging as a tool to reduce social isolation in older adults and to benefit children and adults alike. This has great potential for our communities, however, the strength and breadth of the evidence for this is unclear. We undertook a systematic review to summarise the existing evidence for intergenerational interventions with community dwelling non-familial older adults and children, to identify the gaps and to make recommendations for the next steps.

METHODS

Medline, Embase and PsychInfo were searched from inception to the 28^th Sept 2020. Articles were included if they reported research studies evaluating the use of non-familial intergenerational interaction in community dwelling older adults. PROSPERO registration number CRD42020175927 RESULTS: Twenty articles reporting on 16 studies were included. Although all studies reported positive effects in general, numerical outcomes were not recorded in some cases, and outcomes and assessment tools varied and were administered un-blinded. Caution is needed when making interpretations about the efficacy of intergenerational programmes for improving social, health and cognitive outcomes.

DISCUSSION

Overall, there is neither strong evidence for nor against community based intergenerational interventions. The increase in popularity of intergenerational programmes alongside the strong perception of potential benefit underscores the urgent need for evidence-based research.

Is Physical Activity Associated With Loneliness or Social Isolation in Older Adults? Results of a Longitudinal Analysis Using the Irish Longitudinal Study on Ageing

Social relationships are central to the health and well-being of older adults. Evidence exploring the association of physical activity (PA) with social isolation and loneliness is limited. This study uses a path analysis to investigate the longitudinal association between loneliness and social isolation with PA using the Irish Longitudinal Study on Ageing. Higher levels of social isolation measured using the Berkman-Syme Social Network Index were directly and indirectly associated with lower levels of walking, moderate PA, and vigorous PA over 6 years. Additionally, higher levels of walking were associated with lower levels of loneliness measured using a modified version of the University of California, Los Angeles loneliness scale over a 3-year period. Future interventions should target individuals who are more socially isolated and explore the effects of different types of PA on loneliness over time.

The National Health and Resilience in Veterans Study: A Narrative Review and Future Directions

United States (U.S.) veterans are substantially older than their non-veteran counterparts. However, nationally representative, population-based data on the unique health needs of this population are lacking. Such data are critical to informing the design of large-scale outreach initiatives, and to ensure the effectiveness of service care delivery both within and outside of the Veterans Affairs healthcare system. The National Health and Resilience in Veterans Study (NHRVS) is a contemporary, nationally representative, prospective study of two independent cohorts (n = 3,157 and n = 1,484) of U.S. veterans, which is examining longitudinal changes, and key risk and protective factors for several health outcomes. In this narrative review, we summarize the main findings of all NHRVS studies (n = 82) published as of June 2020, and discuss the clinical implications, limitations, and future directions of this study. Review of these articles was organized into six major topic areas: post-traumatic stress disorder, suicidality, aging, resilience and post-traumatic growth, special topics relevant to veterans, and genetics and epigenetics. Collectively, results of these studies suggest that while a significant minority of veterans screen positive for mental disorders, the majority are psychologically resilient. They further suggest that prevention and treatment efforts designed to promote protective psychosocial characteristics (i.e., resilience, gratitude, purpose in life), and social connectedness (i.e., secure attachment, community integration, social engagement) help mitigate risk for mental disorders, and promote psychological resilience and post-traumatic growth in this population.

Childhood Friendship Experiences and Cognitive Functioning in Later Life: The Mediating Roles of Adult Social Disconnectedness and Adult Loneliness

BACKGROUND AND OBJECTIVES

This study investigated the relationship between childhood friendships and cognitive functioning, as assessed with cognitive status and decline among adults aged 45 and older in China. We also examined the mediating effect of adult social disconnectedness and adult loneliness for this relationship.

RESEARCH DESIGN AND METHODS

This study was based on 3 waves of data from the China Health and Retirement Longitudinal Study (CHARLS; 2011, 2013, 2015; N = 13,959). Cognitive functioning was assessed with episodic memory. Childhood friendship measures were taken from the 2014 life history module of the CHARLS. Two dimensions of adult social isolation, loneliness and social disconnectedness, were included as mediators. Latent growth curve modeling was utilized to test the associations between childhood friendships, adult social isolation, and cognitive functioning.

RESULTS

Adverse childhood friendship experiences were found to be significantly associated with both lower initial cognitive status and the rate of decline in cognitive functioning. Our findings indicated that adult loneliness and social disconnectedness partly mediated the link between childhood friendship experiences and the initial level of cognitive functioning, but not cognitive decline later in life.

DISCUSSION AND IMPLICATIONS

The findings emphasized the enduring importance of childhood friendships for cognitive functioning later in life. Interventions that focus on improving social participation through fostering friendships in childhood may have long-term benefits for cognition later in life.

Social Isolation and Cognitive Function in Later Life: A Systematic Review and Meta-Analysis

BACKGROUND

There is some evidence to suggest that social isolation may be associated with poor cognitive function in later life. However, findings are inconsistent and there is wide variation in the measures used to assess social isolation.

OBJECTIVE

We conducted a systematic review and meta-analysis to investigate the association between social isolation and cognitive function in later life.

METHODS

A search for longitudinal studies assessing the relationship between aspects of social isolation (including social activity and social networks) and cognitive function (including global measures of cognition, memory, and executive function) was conducted in PsycInfo, CINAHL, PubMed, and AgeLine. A random effects meta-analysis was conducted to assess the overall association between measures of social isolation and cognitive function. Sub-analyses investigated the association between different aspects of social isolation and each of the measures of cognitive function.

RESULTS

Sixty-five articles were identified by the systematic review and 51 articles were included in the meta-analysis. Low levels of social isolation characterized by high engagement in social activity and large social networks were associated with better late-life cognitive function (r = 0.054, 95% CI: 0.043, 0.065). Sub-analyses suggested that the association between social isolation and measures of global cognitive function, memory, and executive function were similar and there was no difference according to gender or number of years follow-up.

CONCLUSIONS

Aspects of social isolation are associated with cognitive function in later life. There is wide variation in approaches to measuring social activity and social networks across studies which may contribute to inconsistencies in reported findings.

A Multi-Domain Intervention Protocol for the Potential Reversal of Cognitive Frailty: "WE-RISE" Randomized Controlled Trial

Following the rapid increase of the aging population, health promotion and prevention of physical disability and dementia in older persons are essential for healthy aging. For example, there may be a potential to prevent or reverse cognitive frailty, the co-existence of both physical frailty and cognitive impairment in older persons. However, evidence-based interventions targeting the prevention or potential reversibility of cognitive frailty among community dwelling older adults are scarce. In this paper, we described the rationale, development and delivery of a multi-domain intervention comprising multi-component physical exercise prescription, cognitive training, dietary counseling and promotion of psychosocial support, called the WE-RISE trial. The aim of WE-RISE intervention is to potentially reverse cognitive frailty. This is a two-armed, single blinded, randomized controlled trial conducted over a duration of 6 months, at senior citizen activity centers within the Klang Valley, Malaysia. Ambulating, community dwelling older adults aged 60 years and above with cognitive frailty are randomized into two groups; (1) intervention group: which receives an instructor based "WE-RISE" intervention for the first 3 months, and then a home-based "WE-RISE at Home" intervention for the following 3 months; (2) control group: usual care with no modifications to their daily routine. Primary outcome is cognitive frailty status and secondary outcome include physical function, cognitive performance, nutritional status, psychosocial status and quality of life which are obtained during baseline screening and subsequent follow ups at 3rd and 6th month. Description of the intervention is done using the template for intervention description and replication (TIDieR) checklist. This trial protocol has received approval from Research Ethics Committee of Universiti Kebangsaan Malaysia (UKM PPI/111/8/JEP-2018-558) and the Department of Social Welfare Malaysia (MyResearch Reference: JKMM 100/12/5/2: 2018/405). Trial registration number: ACTRN12619001055190.

Dual Trajectories of Social Isolation and Dementia in Older Adults: A Population-Based Longitudinal Study

Objectives: To identify the interrelations between the trajectories of social isolation and dementia in older adults. Methods: Data came from the National Health and Aging Trends Study 2011-2018 surveys. Group-based dual trajectory modeling was used to examine trajectories and their interrelations. Results: Four trajectories of social isolation-rarely isolated (62.2%), steady increase (13.5%), steady decrease (7.4%), and persistently isolated (16.9%) and dementia risk-persistently low risk (80.4%), increasing with early onset (3.9%), increasing with late onset (4.5%), and persistently high risk (11.2%) emerged. Two-thirds of the low-risk dementia group were in the rarely isolated group. The high-risk dementia group had the most overlap with the decreasing social isolation group (47%), followed by the persistently isolated group (28%). Conclusions: Social isolation and dementia mostly evolved in the same direction. However, the pattern of associations between these trajectories is intricate and may be reversed among long-term dementia survivors.

Is Sedentary Behavior or Physical Activity Associated With Loneliness in Older Adults? Results of the European-Wide SITLESS Study

Research has found that social relationships are central to the health and well-being of an aging population. Evidence exploring the association between physical activity (PA) and sedentary behavior (SB) with social isolation and loneliness is limited. This study uses objectively measured PA and SB (ActiGraph®) and self-reported measures of loneliness (the De Jong Gierveld Loneliness Scale) and social engagement (the Lubben Social Network Scale) from the SITLESS study, a European-wide study of community-dwelling older adults. Social isolation was associated with SB where higher levels of SB were associated with an increase in the level of social isolation, controlling for age, sex, living arrangements, employment status, body mass index, educational background, marital status, and self-reported general health. In contrast, PA was not associated with social isolation, and neither SB nor PA was a statistically significant predictor of loneliness. SB may be linked to social isolation in older adults, but PA and SB are not necessarily linked to loneliness in older community-dwelling adults.

Day centres for older people: a systematically conducted scoping review of literature about their benefits, purposes and how they are perceived

With a policy shift towards personalisation of adult social care in England, much attention has focused on individualised support for older people with care needs. This article reports the findings of a scoping review of United Kingdom (UK) and non-UK literature, published in English from 2005-2017, about day centres for older people without dementia and highlights the gaps in evidence. This review, undertaken to inform new empirical research, covered the perceptions, benefits and purposes of day centres. Searches, undertaken in October/November 2014 and updated in August 2017, of electronic databases, libraries, websites, research repositories and journals, identified seventy-seven relevant papers, mostly non-UK. Day centres were found to play a variety of roles for individuals and in care systems. The largest body of evidence concerned social and preventive outcomes. Centre attendance and participation in interventions within them impacted positively on older people's mental health, social contacts, physical function and quality of life. Evidence about outcomes is mainly non-UK. Day centres for older people without dementia are under-researched generally, particularly in the UK. In addition to not being studied as whole services, there are considerable evidence gaps about how day centres are perceived, their outcomes, what they offer, to whom and their wider stakeholders, including family carers, volunteers, staff and professionals who are funding, recommending or referring older people to them.

Investigating associations between personality and the efficacy of interventions for cognitive ageing: A systematic review

The personal and societal impact of age-related cognitive decline supports the development of effective interventions. While some strategies, such as cognitive training, exercise or socio-intellectual engagement, appear beneficial, few studies have examined the association between personality and intervention efficacy. A systematic review was therefore conducted to summarise and synthesise the literature regarding the influence of personality traits on the effectiveness of non-pharmacological interventions for cognitive ageing. A systematic search of PubMed, PsycINFO and Web of Science was carried out. Of the 2100 papers identified by the search strategy, 10 studies were retained that met the relevant criteria (e.g., intervention studies with one or more cognitive outcomes and a measure of personality). Of these, two studies reported that higher levels of Openness to Experience were associated with greater improvement in memory performance after cognitive training interventions. Another found a positive association between Openness and improvement in divergent thinking following a novel group-based problem solving programme. One social intervention study reported positive moderating effects of Conscientiousness and Agreeableness, and mixed effects of Extraversion. Mixed evidence was also found regarding Need for Cognition, with one study reporting a positive association with memory improvement and another reporting less improvement in divergent thinking. Others found no evidence of personality influencing intervention outcomes. Due to the relatively small and heterogeneous sample of studies identified, any conclusions should currently be considered preliminary. These findings highlight the need for further research exploring the role of personality in intervention efficacy, so that interventions might be better tailored to individuals.

Effect of group integrated intervention program combined animal-assisted therapy and integrated elderly play therapy on live alone elderly

The purpose of this study is to identify the effects of a group integrated intervention program that simultaneously conducts cognitive activities, physical activities, emotional activities and social interactions by integrating animal-assisted therapy (AAT) and integrated elderly play therapy based on the cognitive functions and depression of the elderly who live alone. This study follows a pre-test post-test design with a nonequivalent control group, to verify the effectiveness of a group integrated intervention. It applies a group integrated intervention program to 20 elderly people who live alone, aged 65 and above (10 in the experimental group, 10 in the control group), once a week for 90 minutes across eight weeks. The study went through MMSE-K, TMT-A and GDSSF-A to assess cognitive functions and the level of depression. The group integrated intervention increased the cognitive functions of the experimental group and decreased levels of depression. Therefore, this study verified that a group integrated intervention program of AAT and integrated play therapy of the elderly, is an effective for increasing cognitive functions and decreasing depression levels of the elderly who live alone. Based on these findings, the study suggests that there is a need to continuously expand group integrated intervention programs and provide relevant political support.

Can cognitive leisure activity prevent cognitive decline in older adults? A systematic review of intervention studies

The aims of this systematic review were to investigate what kind of cognitive leisure activities have been used in intervention studies targeting older adults, and whether these activities improve cognitive function or inhibit cognitive decline. Based on the PRISMA declaration, we searched keywords using three electronic databases: PubMed, PsycINFO and PsycARTICLES. Intervention studies involving cognitive leisure activities with cognitive assessments set as outcomes were included. We regarded cognitive leisure activities as activities for enjoyment or well-being that cause intellectual stimulation (e.g. reading, playing board games). To investigate the influence of each activity on cognitive domains, multicomponent programs (e.g. combined music and art) were excluded. In total, 20 studies were included in the evaluation. Consequently, intervention studies related to arts, writing, board games, reading, handicrafts, a crossword puzzle and learning computer skills were identified. Of the 20 studies, 13 showed improvement in some cognitive domain. In 12 of these 13 studies, the intervention effects were not observed in a specific cognitive domain; rather, the intervention effects were observed across multiple cognitive domains and on working memory. The results of the present review suggest that cognitive function in older adults can be improved through cognitive leisure activity interventions. Activities related to learning new skills, that cause strong intellectual stimulation and that include communication elements were considered particularly effective tools. However, as the number of studies is small, more high-quality research needs to be accumulated. Geriatr Gerontol Int 2019; 19: 469-482.

The impact of marriage on the overall survival of prostate cancer patients: A Surveillance, Epidemiology, and End Results (SEER) analysis

INTRODUCTION

Marital status has long been associated with positive patient outcomes in several malignances; however, little is known about its influence on prostate cancer. We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database to evaluate whether married patients with prostate cancer had a better prognosis than unmarried patients.

METHODS

We identified 824 554 patients diagnosed with prostate cancer between 1973 and 2012 in the SEER database. Using the Cox proportional hazard models, we analyzed the impact of marital status (single, married, divorced/separated, and widowed) on survival after diagnosis with prostate cancer. Chi-square tests were used to analyze the association between marital status and other variables, and the Kaplan-Meier method was used to estimate survival curves.

RESULTS

Married men were more likely to be diagnosed with a lower Gleason score and undergo surgery than patients in the other groups (p<0.001). The married group had a lower risk of mortality caused by prostate cancer than the other groups. The five-year survival rate for married patients was higher than that for patients in the other groups.

CONCLUSIONS

Marital status is a prognostic factor for the survival of prostate cancer patients, as being married was associated with better outcomes.

Loneliness, Depressive Symptoms, and Cognitive Functioning Among U.S. Chinese Older Adults

Objective: Loneliness has been associated with cognitive functioning in the general older adult population. Previous studies further indicate that loneliness has a strong association with depressive symptoms and the two constructs can reinforce each other to diminish well-being. However, such relationships have not been examined in U.S. Chinese older adults. This study attempts to bridge this knowledge gap. Method: Data were drawn from a population-based study of 3,159 U.S. Chinese older adults in the Greater Chicago area. Stepwise multivariate regression analyses were conducted to examine the relationship between loneliness, depressive symptoms, and global cognitive functioning. Results: Loneliness was associated with poor global cognitive functioning in U.S. Chinese older adults, though the relationship became nonsignificant after adjustment for depressive symptoms. The interaction term between loneliness and cognitive functioning was statistically significant (p < .01). The findings further highlight the importance of age, education, number of children, number of people in household, and length of residence in the U.S. in cognitive functioning among U.S. Chinese older adults. Discussion: The study findings indicate that loneliness and depressive symptoms act together to influence cognitive functioning in U.S. Chinese older adults. Research and clinical implications of the findings are discussed.

The impact of social activities, social networks, social support and social relationships on the cognitive functioning of healthy older adults: a systematic review

BACKGROUND

Social relationships, which are contingent on access to social networks, promote engagement in social activities and provide access to social support. These social factors have been shown to positively impact health outcomes. In the current systematic review, we offer a comprehensive overview of the impact of social activities, social networks and social support on the cognitive functioning of healthy older adults (50+) and examine the differential effects of aspects of social relationships on various cognitive domains.

METHODS

We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, and collated data from randomised controlled trials (RCTs), genetic and observational studies. Independent variables of interest included subjective measures of social activities, social networks, and social support, and composite measures of social relationships (CMSR). The primary outcome of interest was cognitive function divided into domains of episodic memory, semantic memory, overall memory ability, working memory, verbal fluency, reasoning, attention, processing speed, visuospatial abilities, overall executive functioning and global cognition.

RESULTS

Thirty-nine studies were included in the review; three RCTs, 34 observational studies, and two genetic studies. Evidence suggests a relationship between (1) social activity and global cognition and overall executive functioning, working memory, visuospatial abilities and processing speed but not episodic memory, verbal fluency, reasoning or attention; (2) social networks and global cognition but not episodic memory, attention or processing speed; (3) social support and global cognition and episodic memory but not attention or processing speed; and (4) CMSR and episodic memory and verbal fluency but not global cognition.

CONCLUSIONS

The results support prior conclusions that there is an association between social relationships and cognitive function but the exact nature of this association remains unclear. Implications of the findings are discussed and suggestions for future research provided.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2012: CRD42012003248 .