The Convoy Model and Later-Life Family Relationships

Does Social Support Play a Role in the Expression and Everyday Functioning Impact of Apathy in HIV Disease?

Clinically notable apathy occurs in approximately one-third of persons living with HIV (PLWH). Drawing from psychological theory, this cross-sectional study examined the interplay between apathy and social support in persons with (n = 143) and without (n = 61) HIV disease. Analyses were conducted using multiple regression and mediation procedures with 95th percentile bootstrap confidence intervals. Positive HIV serostatus and lower social support were associated with more frequent apathy, independent of other mood symptoms. Social support did not moderate apathy's associations with everyday functioning among PLWH, but post hoc analyses revealed that apathy mediated the relationship between social support and everyday functioning among PLWH. Stronger social support may provide a buffer against the frequency of apathy symptoms in persons with and without HIV disease. The relationship between lower social support and poorer everyday functioning in HIV might be partly explained by apathy. Longitudinal research is needed to examine the mechanisms of these relationships.

A Visualization Tool to Study Dyadic Caregiving Health Profiles

OBJECTIVES

Guided by a life course perspective and fundamental cause theory, this study aims to visualize co-trajectories of health between partners and examine how changes in one spouse's cognitive status can cohesively impact the health of the other spouse along three dimensions (functional, mental, and cognitive).

METHODS

Drawing longitudinal data from the Health and Retirement Study 2000-2016 (N = 3582), we measure women's health profiles by functional limitation (physical health), depression (mental health), and cognitive function (cognitive health). We use multivariate linear mixed models to summarize these paths in the same visual representation.

RESULTS

The approach provides a visualization tool that depicts data and model in the same spatial representation allowing assessment of model fit and comparison. This study advances the traditional life course studies by representing underlying processes as a multidimensional time vector of health outcomes.

DISCUSSION

The described approach provides a blueprint for studying complex health profiles or trajectories.

Daily Rumination-Affect Associations in Dyads During the COVID-19 Pandemic

OBJECTIVES

Negative and repetitive self-oriented thinking (rumination) is associated with lower well-being and health. The social context of rumination remains underexplored and mostly centers on marital relationships. To embrace the diversity of older adult relationships, this study includes a range of different relationships (e.g., spouses, siblings, friends, etc.) and examines the role of rumination by close others on individual well-being during the coronavirus disease 2019 pandemic.

METHODS

Using daily diary data from 140 Canadian older adults (M = 72.21 years, standard deviation [SD] = 5.39, range: 63-87 years, 47% women, 71% university educated) and a close other of their choice (M = 59.95 years, SD = 16.54, range: 18-83 years, 78% women, 81% university educated), this project builds on past research examining daily life rumination dynamics from a dyadic perspective. For 10 days, both dyad members reported their daily rumination and affect quality in the evening.

RESULTS

Multilevel models replicate past work showing that individual rumination was associated with higher negative affect (within-person: b = 0.27, p < .001, between-person: b = 0.57, p < .001) and lower positive affect (within-person: b = -0.18, p < .001, between-person: b = -0.29, p < .001). Importantly, we additionally observed that partner rumination was associated with higher negative affect (b = 0.03, p = .038) and lower positive affect (b = -0.04, p = .023), highlighting the social context of rumination.

DISCUSSION

Findings illustrate the significance of rumination for the self and others and underline the merit of taking a dyadic perspective on what is typically viewed as an individual-level phenomenon.

How is intergenerational emotional cohesion linked to depression among older internal migrants in China: the mediating roles of loneliness and perceived stress

BACKGROUND

Late-life internal migration is frequently associated with a higher risk of depression in older parents. This research delves into the impact of intergenerational emotional cohesion (IEC) on depression in older internal migrants and the underlying mechanisms within the contemporary Chinese context.

METHODS

Obtained from a cross-sectional survey in Nanjing, China, the research involved 654 older internal migrants (66.97% female; mean age = 66.05 years; SD = 4.67). Variables were assessed using the Intergenerational Solidarity Inventory, 3-item R-UCLA Loneliness Scale, Perceived Stress Scale, and 9-item Patient Health Questionnaire (PHQ-9). For mediation exploration, a serial mediation model was utilized, and the Bootstrap method was employed to test the signifcance of these mediation effects.

RESULTS

IEC demonstrates a negative correlation with depression. Through IEC, three significant mediation pathways were identified that directly affect depression: (1) loneliness (β=-0.06; Ratio=17.14%), (2) perceived stress (β=-0.09; Ratio=25.71%), and (3) loneliness and perceived stress (β=-0.03; Ratio=8.57%).

CONCLUSIONS

IEC can impact the depression of older internal migrants by mitigating negative psychological emotions during the migration process. This finding provides valuable theoretical insights for the prevention of mental health problems among this demographic.

The relationship between social frailty and loneliness in community-dwelling older adults: a cross-sectional study

BACKGROUND

Social frailty (SF) is associated with multiple adverse health outcomes, yet there has been an inadequate focus on social frailty. The convoy model portrays the social networks through the perspective of the life course, thus providing a framework to explain the occurrence of social frailty. This study aimd to figure out the prevalence of social frailty and loneliness among community-dwelling older adults and to explore their correlations based on convoy model.

METHODS

This was a cross-sectional study, and 295 older adults from 10 communities of Zhengzhou in Henan Province participated in the study. Social frailty and loneliness were assessed separately with the Social Frailty Scale and University of California at Los Angeles-Loneliness Scale. The scores of social frailty of the older adults in different characteristic communities were compared by independent sample t-test and single factor analysis of variance. The influencing factors of social frailty were analysed by multiple stepwise linear regression and the structural equation model. The correlation between social frailty and loneliness was analysed by Pearson correlation analysis.

RESULTS

The total scores of social frailty and loneliness of the older adults in the community were (2.09 ± 1.53) and (43.19 ± 8.91), respectively. There was a moderate positive correlation between social frailty and loneliness (r = 0.621, P < 0.01). The results of multiple stepwise linear regression analysis showed that age, living styles, balance of payments, and loneliness were the main influencing factors of the social frailty of older adults in the community (F = 27.180, P < 0.001). The structural equation model of social frailty fitted well (χ2 = 47.292, df = 26, χ2/df = 1.819, P = 0.007; RMSEA = 0.053, 95%CI (0.028, 0.076), P = 0.359; GFI = 0.971; AGFI = 0.939; NFI = 0.904; IFI = 0.955; TLI = 0.918; CFI = 0.953; SRMR = 0.0466).

CONCLUSIONS

The convoy model had certain applicability in explanation of the relationship between loneliness and social frailty among older adults in community. The incidence of social frailty among the older adults in the community was high, and loneliness was at a medium level. It is necessary to strengthen the intervention of social frailty and loneliness of the older adults in the community, improve the quality of life of the older adults, and promote the development of healthy aging.

Aging with my family: a grounded theory approach on the role of family when aging as foreign-born

BACKGROUND

Research indicates that it is the quality of the closest relationships in the mixture of social relations that matters most for older adults. For older foreign-born, especially those who migrate late in life, the family is often the only socioeconomical resource they can lean on. This study aims to explore how older foreign-born perceive the role of family as they age.

METHODS

The study design has a grounded theory approach. Data consist of individual open-ended interviews with 15 foreign-born informants aged between 60 and 85 years old who migrated to Sweden as adults from various parts of the world.

RESULTS

The findings demonstrate that family was an essential part of the informants' lives as they lived for their families and their families lived for them. Family solidarity was described as a cultural heritage they took over from their original families and a cultural heritage they wished to pass on to their future generations. They found that this was what separated them as foreign-born from native-born. Memories of their parents reminded them of their biological, social, and cultural heritages. The intimate relationship with their spouses in a life course had served as a source of validation of their individual identities and promoted personal growth and self-esteem. The role as a loving and caring parent entailed a sense of accomplishment and satisfaction for the life lived. And now as grandparents, the role as a link between the family's historical heritage and the future generation entailed not only a sense of coherence as they aged but also hope and meaning beyond their own lives.

CONCLUSIONS

The older foreign-born experienced life satisfaction as they aged with their families. Family meant community and solidarity. It was in the family that they found their distinct roles that had defined them. Family was an indispensable part of their social identity. The findings highlight the importance of older foreign-born being studied from a family and lifetime perspective.

The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology

Although dysregulated stress biology is becoming increasingly recognized as a key driver of lifelong disparities in chronic disease, we presently have no validated biomarkers of toxic stress physiology; no biological, behavioral, or cognitive treatments specifically focused on normalizing toxic stress processes; and no agreed-upon guidelines for treating stress in the clinic or evaluating the efficacy of interventions that seek to reduce toxic stress and improve human functioning. We address these critical issues by (a) systematically describing key systems and mechanisms that are dysregulated by stress; (b) summarizing indicators, biomarkers, and instruments for assessing stress response systems; and (c) highlighting therapeutic approaches that can be used to normalize stress-related biopsychosocial functioning. We also present a novel multidisciplinary Stress Phenotyping Framework that can bring stress researchers and clinicians one step closer to realizing the goal of using precision medicine-based approaches to prevent and treat stress-associated health problems.

Family Ties and Older Adult Well-Being: Incorporating Social Networks and Proximity

OBJECTIVES

This paper examines the family ties of older adults in the United States and how they are associated with mental health and social activity. We compare older adults with 4 types of family ties: adults "close" to family in proximity and social network, "kinless" older adults without a partner or children, "distanced" adults who live far from close kin, and "disconnected" older adults who do not report kin in their social network or do not report a location for some kin.

METHODS

Using pooled data from the National Health and Aging Trends Study 2015-2019 for older adults aged 70 and older (N = 24,818 person-waves), we examine how family ties are associated with mental health and social activity, and whether lacking family is tied to poor well-being because older adults' needs are not being met.

RESULTS

Kinless older adults and disconnected older adults have poorer outcomes (lower mental health scores and less social activity), compared to those close to their family. These findings suggest that both the presence and quality of the connection, as measured here via both location and social network, are critical for understanding which older adults are "at risk." Older adults who were not geographically proximate to their close kin (i.e., distanced) were not disadvantaged relative to those close to their families. Unmet needs do not help explain these patterns.

DISCUSSION

Our results highlight that family ties are important for older adults well-being, not just through their existence but also their quality and strength.

Community engagement and loneliness in older adults in China: mediation effects of social support in the wake of COVID-19

Introduction

Loneliness is a key indicator of well-being in older adults. Drawing from the ecological model of aging, the active aging perspective, and the convoy model of social relations, this study investigates the extent community engagement influences loneliness and whether the relationship is mediated by social support during the COVID-19 pandemic.

Methods

Data was collected from 1,067 retired older adults in a cross-sectional design in Chengdu, China in 2022. Structural equation modeling was conducted to examine the direct and indirect effects of community engagement on loneliness through the hypothesized mediator of social support.

Results

The results show community engagement was positively associated with social support (β = 0.26, p < 0.001) and social support was negatively related to loneliness (β = -0.41, p < 0.001). Social support fully mediated the relationship between community engagement and loneliness. Additionally, community engagement had an indirect effect on loneliness via social support (β = -0.11, p < 0.001).

Discussion

The findings from the moderation analysis suggests community engagement and social support are likely to have large effects on loneliness for older adults over the age of 70 and who have low educational attainment. The findings suggest community engagement could be an important factor for improving social support and reducing loneliness amongst retired, older adults in China, especially in the wake of the COVID-19 pandemic where millions of individuals were isolated for extended periods of time.

A systematic review of reviews on the psychometric properties of measures of older persons' ability to build and maintain social relationships

BACKGROUND

Within the scope of the World Health Organisation's (WHO) world report on ageing and health and how healthy ageing was conceptualised, the WHO has been working with academia towards producing reviews of the psychometric properties of instruments that measure different domains of functional ability. This study aimed to conduct a review of reviews to examine existing and validated instruments measuring the ability of older persons to build and maintain social relationships and to evaluate the psychometric properties of these instruments.

METHODS

We searched for studies published in the English, Spanish and Portuguese languages. No restrictions were placed on the year of publication. The following databases were searched: PubMed, Embase, Psyinfo and Cumulated Index to Nursing and Allied Health Literature. Titles and abstracts were screened and selected articles were screened and reviewed independently by two reviewers.

RESULTS

A total of 3,879 records were retrieved, of which 39 records were retrieved for full-text analysis. None of the reviews met the inclusion criteria, thus resulting in an empty review.

CONCLUSIONS

Considering the current definition of older persons' functional ability to build and maintain social relationships, this review did not identify instruments that can measure both constructs simultaneously. We suggest the development of an instrument that simultaneously assesses the ability of older persons to build and maintain relationships.

The Risks of Experiencing Severe Loneliness Across Middle and Late Adulthood

OBJECTIVES

From a theoretical point of view, older adults may not necessarily face a greater risk of becoming lonely than middle-aged adults but are more likely at a disadvantage in fighting loneliness. Therefore, in this study, we differentiate between the risk of becoming lonely and the risk of remaining lonely.

METHODS

A large longitudinal data set representative of the German noninstitutionalized population from 40 to 85 years of age (N = 15,408; 49% female participants) was used in the analysis. Lagged logistic regression models were estimated to investigate the effect of earlier experiences of severe loneliness on the risk of being lonely after three years across middle age and late adulthood. Individual differences in health, views on aging, and social activities were taken into account to explore their role in age differences in the risk of remaining lonely.

RESULTS

The analysis revealed marginal age differences in the risk of becoming lonely but a marked age gradient regarding the risk of remaining lonely. Lonely older adults who were older than 75 years of age were more likely to remain lonely after three years than lonely middle-aged adults. Controlling for individual differences in health, views on aging as social loss, and social activities accounted for this age difference.

DISCUSSION

Interventions against loneliness may prioritize older age groups because losses in capacities, shifts in motivations, and a degraded opportunity structure render it increasingly less likely that older adults leave a state of loneliness on their own accord.

Social networks and the mental health among Chinese older adults: the mediating role of loneliness and moderating role of Internet use

Background

Although a large body of research suggests that social networks from family and friends are important factors in protecting the mental health of older adults, we know little about the mediating and moderating mechanisms behind this relationship. Using China as an example, this study aims to investigate a comprehensive model that includes social networks, loneliness, Internet use, and mental health outcomes in the older population.

Methods

We analyzed data from 7,648 Chinese older people over 60 using the 2018 CLASS survey. We studied how various social networks affect their mental health. Using SPSS's PROCESS macro, we first employed descriptive statistics to examine the characteristics of the participants and calculate the correlations of core variables. Then, we assessed whether loneliness mediated this relationship and tested the moderated mediation effect of Internet use. Our findings shed light on these complex dynamics.

Results

The statistics indicate a positive correlation between social networks and mental health. Furthermore, mediation models revealed that loneliness moderates the relationship between social networks and mental health. In addition, moderated mediation models revealed that Internet use played a distinct function in the family networks model compared to the friend networks model. Internet use moderates explicitly the effects of family networks on loneliness and friend networks on mental health.

Conclusion

The findings emphasize the importance of differentiating the types of social networks to understand their impact on older adults well-being, encouraging policymakers, medical professionals, and families to adopt more targeted approaches when devising policy interventions and medical strategies, especially for older individuals with insufficient social support. Additionally, we urge governments to recognize the varying types of social networks among older populations and harness the protective effects of Internet technology on their well-being within a digital society.

Age-related social selectivity: An adaptive lens on a later life social phenotype

Age-related social selectivity is a process in which older humans reduce their number of social partners to a subset of positive and emotionally fulfilling relationships. Although selectivity has been attributed to humans' unique perceptions of time horizons, recent evidence demonstrates that these social patterns and processes occur in other non-human primates, suggesting an evolutionarily wider phenomenon. Here, we develop the hypothesis that selective social behavior is an adaptive strategy that allows social animals to balance the costs and benefits of navigating social environments in the face of age-related functional declines. We first aim to distinguish social selectivity from the non-adaptive social consequences of aging. We then outline multiple mechanisms by which social selectivity in old age may enhance fitness and healthspan. Our goal is to lay out a research agenda to identify selective strategies and their potential benefits. Given the importance of social support for health across primates, understanding why aging individuals lose social connections and how they can remain resilient has vital applications to public health research.

Social support and subjective well-being of noncustodial grandparent caregivers in urban China: The mediating roles of generative acts

While social support is generally beneficial, it remains unclear how it directly and indirectly affects subjective well-being among grandparents via generative acts. Multi-stage cluster random sampling was employed in a city in Eastern China, reaching 1013 noncustodial grandparent caregivers of kindergarten children (mean age = 58.3, range: 40-93, female = 71.9%, non-local = 508). Data were analyzed using structural equation modeling (SEM). The results reveal that social support positively affected three indicators of subjective well-being among noncustodial grandparent caregivers. Also, social support worked through agentic generative acts to positively affect life satisfaction and positive affect, while not through domestic generative acts. The present study contributes to grandparent caregiving research in urban China by advancing an integrated framework that considers the mechanism of generative acts. Policy and practice implications are also discussed.

Dyadic Associations Between Grandparent-Grandchild Familial Values and Successful Aging: Mediating Role of Quality of Life

The current study aimed to determine the reciprocal associations between the familial values and successful aging of grandparents and grandchildren and the extent to which quality of life accounts for these reciprocal associations. Data was collected from 270 grandparent-grandchild pairs living together. Actor-Partner Independence Model indicated that familial values of both grandparents and grandchildren showed significant associations with their own successful aging (actor effects), whereas familial values of grandchildren showed significant associations with the successful aging of grandparents (partner effects). Grandchildren's quality of life mediated the actor and partner effects of familial values on the successful aging of grandchildren; whereas grandparents' quality of life only mediated the actor effect of familial values on the successful aging of grandparents. These findings showed the interdependence of grandparents and grandchildren while emphasizing the importance of grandparents-grandchildren familial values and quality of life in enhancing successful aging.

No Substitute for In-Person Interaction: Changing Modes of Social Contact during the Coronavirus Pandemic and Effects on the Mental Health of Adults in the UK

Life-course theories on how social relationships affect mental health are limited in causal claims. The restrictions in social contact during the coronavirus pandemic provided a natural experiment that modified the frequency of in-person contact and allowed us to estimate the effect of changes in in-person social contact frequency on mental health in four large nationally representative age-cohorts of adults living in the UK. There was consistent evidence of a small but statistically significant effect of less frequent social contact on anxiety-depression. Online modes of social contact did not compensate for the restrictions in in-person social contact during the pandemic. Young adults who increased their online social media frequency during the pandemic experienced a deterioration in mental health. Life-course theories cannot ignore the importance of the mode of social contact for social relationships, especially during young adulthood.

Widowhood, social networks, and mental health among Chinese older adults: The moderating effects of gender

Objectives

This study aimed to examine the three-way interaction between widowhood, social ties, and gender and its effects on older adults’ mental health, including depressive symptoms and life satisfaction, in the context of China.

Methods

Participants were 7,601 Chinese older adults. Their social network was divided between family and friendship ties, and their mental health was measured by depressive symptoms and life satisfaction. Linear regression was employed to analyze the associations between widowhood, social networks, and mental health, as well as to explore the moderating effect of gender.

Results

Widowhood is associated with more depressive symptoms, but not with life satisfaction, while family and friendship ties are associated with less depressive symptoms and greater life satisfaction. Furthermore, the lack of family ties is associated with more depressive symptoms for widowed men compared to married older men, while it is associated with lower life satisfaction for widowed women compared to married older women.

Conclusion

Family ties are the most important social support resource for Chinese older adults, especially for the widowed group. The vulnerability of older widowed men who lack family ties in China deserves public concern and attention.

Diversity in Social Communication and Support: Implications for Loneliness Among LGB Adults

BACKGROUND AND OBJECTIVES

Current research indicates that structural and functional social network attributes influence older adults' well-being. However, these linkages may vary by sexual orientation. This study examines how social communication diversity and support diversity are related to loneliness and differ between lesbian, gay, and bisexual (LGB) and heterosexual adults.

RESEARCH DESIGN AND METHODS

Using data from the American Association of Retired Persons Foundation's Loneliness and Social Connection Survey of adults 45+ (N = 3,009), including 10% who identified as LGB, we derive entropy scores, which capture the extent to which network size and quality of relationships are evenly distributed. A series of linear regressions were conducted to examine sexual orientation, social network indicators, and their interactions in predicting loneliness.

RESULTS

We found a positive association between social communication diversity and loneliness. This finding was qualified by the interaction with sexual orientation. In addition, we found a negative association between support diversity and loneliness, an effect that was stronger for LGB participants than for heterosexual participants. The effect of support diversity on loneliness was much stronger for LGB adults than heterosexual adults.

DISCUSSION AND IMPLICATIONS

While LGB adults tend to score higher on the loneliness scale overall, the findings suggest that communication and support diversity have uniquely different patterns of associations for sexual minority groups. This study highlights the importance of considering multiple dimensions of social networks and has implications for addressing loneliness for heterosexual and LGB adults.

The perceived relationship quality with migrant domestic workers is correlated with a lower level of loneliness among community-dwelling older adults: A cross-sectional study

PURPOSE

To explore older adults' perceived relationship quality with migrant domestic workers (MDWs) and examine the correlation between older adult/MDW (O-M) relationship quality and loneliness of community-dwelling older adults.

MATERIALS AND METHODS

In this cross-sectional study, older adults living with MDWs were conveniently recruited from neighbourhood elderly centers in Hong Kong. Loneliness and O-M relationship quality were assessed by the 6-item De Jong Gierveld Loneliness Scale and the mutuality scale, respectively. Older adults' demographic and functional characteristics, and MDW's nationality, spoken language and years of service in the dyad were also collected. Hierarchical multiple regression analyses were conducted to examine the contributions of 1) demographic variables and functional status, 2) MDW characteristics, 3) perceived social network and 4) perceived O-M relationship quality on loneliness.

RESULTS

The 178 participants [mean age 83.44 (SD 7.05 years); 155 (87.1%) women and 23 men (22.9%)] were socially lonely (1.07 ± 1.15) and close to being lonely overall (1.90 ± 1.68), and emotionally (0.84 ± 0.97). The mean O-M relationship quality was poor (1.42 ± 0.79), which was significantly correlated with overall (β= -0.33, 95% CI: -0.65 to -0.01, P value = 0.045), and social (β= -0.24, 95% CI: -0.46 to -0.01, P value = 0.04) loneliness, but not significantly correlated to emotional loneliness.

CONCLUSION

Better perceived O-M relationship quality is correlated with a lower level of loneliness among older adults. Strategies to improve O-M relationship quality may alleviate loneliness among older adults.

Till Death Do Us Part?: Exploring the Social Convoys of Conjugally Bereaved Women

OBJECTIVES

The hierarchical mapping technique (HMT) is used to study social convoys, peoples' support systems. Recent research integrating the HMT and the continuing bonds framework suggests that deceased persons may be influential convoy members. Extending this idea, the current study aimed to gain insight regarding how older conjugally bereaved women view the role of a deceased romantic partner in their convoy.

METHODS

The study utilized a qualitative descriptive approach. Twenty heterosexual women (mean age = 78 years, range = 65-93 years), recruited via social media and snowball sampling, participated in one 90-min interview. Each discussed their bereavement journey and completed an HMT diagram to comment on how, if at all, their deceased romantic partner was part of their social convoy and their place within it.

RESULTS

Fifteen of the 20 women placed the deceased in the innermost circle of the diagram, with them yet separate from other convoy members. Thematic analysis of transcripts revealed 5 major themes: "We're part of each other," "I think he supports me," "He would want me to be happy," "I just feel so grateful," and "I think about him every day but I don't talk about him every day."

DISCUSSION

Perceptions that deceased romantic partners continue to play a key role in conjugally bereaved older women's lives offer researchers the unique opportunity to examine how loss is carried into old age. Furthermore, this study may assist with the development of interventions that destigmatize continuing bond expressions for conjugally bereaved heterosexual women.

Recognition of social health: A conceptual framework in the context of dementia research

Objective

The recognition of dementia as a multifactorial disorder encourages the exploration of new pathways to understand its origins. Social health might play a role in cognitive decline and dementia, but conceptual clarity is lacking and this hinders investigation of associations and mechanisms. The objective is to develop a conceptual framework for social health to advance conceptual clarity in future studies.

Process

We use the following steps: underpinning for concept advancement, concept advancement by the development of a conceptual model, and exploration of its potential feasibility. An iterative consensus-based process was used within the international multidisciplinary SHARED project.

Conceptual framework

Underpinning of the concept drew from a synthesis of theoretical, conceptual and epidemiological work, and resulted in a definition of social health as wellbeing that relies on capacities both of the individual and the social environment. Consequently, domains in the conceptual framework are on both the individual (e.g., social participation) and the social environmental levels (e.g., social network). We hypothesize that social health acts as a driver for use of cognitive reserve which can then slow cognitive impairment or maintain cognitive functioning. The feasibility of the conceptual framework is demonstrated in its practical use in identifying and structuring of social health markers within the SHARED project.

Discussion

The conceptual framework provides guidance for future research and facilitates identification of modifiable risk and protective factors, which may in turn shape new avenues for preventive interventions. We highlight the paradigm of social health in dementia as a priority for dementia research.

A life-course perspective of sex trafficking among the bedia caste of India

Thousands of Indian women and girls enter the commercial sex industry (CSI) annually based solely on membership in particular castes (e.g., Bedia, Nat). CSI-involved females bear the burden of sustaining entire family units on money earned in the sex trade; it is a life-long responsibility with negligible social status or personal indemnity. Based on the life-course developmental theory (Elder, Jr. 1994, 1998) this investigation was intended to examine trafficked women's experiences within the commercial sex industry across time. Beyond the CSI, we were equally interested in experiences with factors that could promote well-being (i.e., social support) and normative developmental transitions including education attainment and motherhood. To that end, three questions were posed. First, to what extent do factors surrounding CSI entry and continued involvement differ through time among CSI-involved Bedia? Second, how do CSI-involved Bedia describe social network composition and perceived support through time? Finally, are differences detectable, through time, in CSI-involved Bedia women's experiences with normative developmental transitions including education attainment and motherhood? Interview data were collected from 31 Bedia females (age range 17 - 65 years) residing in rural Madhya Pradesh, India. To examine change through time, participants were divided into cohorts based on age and time involved in the commercial sex industry. Data were then analyzed within and across cohorts with particular attention to cohort-related experiential differences. Policy implications and suggestions for continued research are presented.

Relationship of social isolation with mental distress among older Korean Americans: The moderating role of social cohesion

Social isolation has been associated with poor mental health outcomes, particularly for older immigrants who do not have a protective social environment. The purpose of this study was to investigate the relationship of social isolation (living alone, marginal family ties and marginal friend ties) with mental distress and to examine the moderating role of social cohesion (family cohesion and community cohesion). We hypothesised that social isolation and social cohesion would be directly associated with mental distress and that social cohesion would buffer the influence of social isolation on mental distress. Data were drawn from the Study of Older Korean Americans (SOKA), which included 2150 older Korean Americans aged 60 or over in multiple areas, collected during 2017-2018. A series of hierarchical regression models of mental distress examined the direct and interactive role of social isolation and social cohesion. Approximately one-third of the sample lived alone, 20% had marginal family ties and 27% had marginal friend ties. All three indicators of social isolation had a significant direct effect on mental health; however, living alone lost its statistical significance with the inclusion of social cohesion variables. Both indicators of family and community cohesion were significantly associated with lower levels of mental distress. In addition, family cohesion buffered the negative effects of marginal ties to family and friends on mental distress. The significant role of a positive social environment must be considered when addressing the needs of older immigrants who are socially isolated.

Source of perceived social support and cognitive change: an 8-year prospective cohort study

OBJECTIVES

This study explored the longitudinal association between overall and individual sources of social support and global cognitive function in older adults.Methods:Data were drawn from three waves (2006, 2010 and 2014) of the Health and Retirement Study (HRS). The analytic sample included participants aged 65 and above who were married and had at least one child (N = 1319). Global cognitive function was measured through a 35-point Telephone Interview Cognitive Screen (TICS). Perceived social support was measured via questions across four sources of support (spouse, child, other family members, and friends). Analyses were conducted using Hierarchical Linear Modeling (HLM) with the addition of a cross-lagged panel model (CLPM).

RESULTS

There was no significant association between perceived overall social support and global cognitive function over time (β=-0.02, p=0.19). However, changes in perceived support from children were positively associated with changes in global cognition (β=0.05,p<0.01). In contrast, changes in perceived support from other family members were negatively associated with changes in cognitive function (β=-0.07,p<0.01).

CONCLUSIONS

Our findings highlight the importance of examining perceived social support from specific elements of one's social networks, rather than in an aggregated variable. Although the positive effect of perceived support from children may be small to moderate, the findings could provide a target for interventions to protect the cognitive function of older adults.

The Impact of a Canadian Model of Aging in Place on Community Dwelling Older Adults' Experience of Physical Distancing during the COVID-19 Pandemic

Naturally occurring retirement communities (NORCs) are unplanned communities with a high proportion of residents aged 65 years and older. Oasis is a Canadian aging in place model that combines health and supportive community services for adults aged 65 years and older within NORCs. The aims of this study were to explore how physical distancing restrictions during the COVID-19 pandemic impacted older adults living in a NORC (Oasis members) and to investigate whether Oasis served as a context for social connection and well-being during the COVID-19 pandemic. An interpretive description methodology guided this study. Semi-structured interviews were conducted with nine Oasis members (aged 66-77 years) and two Oasis site coordinators. The Oasis members also completed a social network mapping activity guided by the hierarchical mapping technique. Three overarching themes related to the impact of physical distancing on Oasis members during the COVID-19 pandemic were identified: (1) unintended consequences of physical distancing restrictions on participants' wellbeing; (2) face-to-face interactions are important for social connection; and (3) family, friend, healthcare provider, and community support mitigated the impact of physical distancing restrictions during the COVID-19 pandemic. In addition, two of Oasis' core pillars were found to support participants: strengthening social connectivity and connection to pre-existing community services. Findings illustrate that community programs like Oasis acted as a source of resilience during the COVID-19 pandemic and advance our understanding of the impact of aging in place models on community dwelling older adults' experience of the COVID-19 pandemic.

Social Support for Improved ART Adherence and Retention in Care among Older People Living with HIV in Urban South Africa: A Complex Balance between Disclosure and Stigma

The number of older people living with HIV (OPLWH) (aged 50-plus) in South Africa is increasing as people age with HIV or are newly infected. OPLWH are potentially vulnerable because of the intersection of age-related and HIV stigmas, co-morbidities, and lack of social support. Evidence from younger populations suggests that social support can improve ART adherence and retention in care. Further, HIV status disclosure plays a role in mediating social support and may reduce stigma by facilitating access to social support. This paper draws on qualitative research with OPLWH to explore the complex associations between disclosure, social support, and HIV stigma among OPLWH in urban Western Cape. The findings demonstrate that OPLWH receive most of their support from their family and this support can facilitate adherence to ART and retention in care. However, social support is facilitated by participants' disclosure, thus, when perceived stigma limits disclosure, social support is less accessible. Gender, age, and pre-existing vulnerability also affect disclosure to and support from kin and community. Given that social support, particularly from family members, amplifies HIV care access and ART adherence, encouraging disclosure stimulating household HIV competency is likely to both address anticipated stigma and support improved OPLWH's health outcomes.

Social support, social strain and declines in verbal memory: sex-specific associations based on 16-year follow-up of the English Longitudinal Study of Ageing cohort

OBJECTIVES

Previous investigations of cognitive aging have mainly focused on structural aspects of social relations (e.g. network size and composition), thereby neglecting the role of qualitative aspects of social relations. The current longitudinal study examined sex-specific differences in verbal memory decline by measures of perceived relationship quality (social support/strain) by relationship type.

METHOD

In the English Longitudinal Study of Ageing (ELSA), 10,109 participants aged 50-89 years were assessed at wave 1 (baseline: 2002-03) and followed to wave 9 (2017-18). Verbal memory was assessed by immediate and delayed word-recall tasks. Social support/strain was measured by relationship type (spouse; children; family; friends). Random effects within-between (REWB) modelling was used to separate between- and within-person effects. We estimated associations between social support/strain and (1) baseline levels of memory (main effects), and (2) rate of decline in memory (interaction with time-since-baseline).

RESULTS

Longitudinal associations were most prominent for men, specific to relationship type, and showed between- rather than within-person effects. Among men, higher spousal strain was associated with faster memory decline (β_{between-effect×time} = -0.043; 95% CI [-0.084, -0.002]; p = .039), whilst greater support from children was associated with slower decline (β_{between-effect×time} = 0.020; 95% CI [0.002, 0.039]; p = .033). Men with higher strain from friends showed lower baseline memory (β_{between-effect} = -0.382; 95% CI [-0.627, -0.137]; p=.002) and faster decline (β_{between-effect×time} = -0.047; 95% CI [-0.095, 0.000]; p = .051).

CONCLUSION

Between-person differences in social support/strain were modestly associated with memory decline, especially among men.

Loneliness, age at immigration, family relationships, and depression among older immigrants: A moderated relationship

Guided by a convoy model of social relations, this study explores the complex relationships between loneliness, age at immigration, familial relationships, and depressive symptoms among older immigrants. This study used 2010 Health and Retirement Study data from a sample of 575 immigrants (52% female, age range 65-99 years). Ordinary least squares regression models were estimated. The findings indicate that for older immigrants who came to the United States at age 45 or older, loneliness was significantly positively associated with depressive symptoms. Further, perceived negative strain and hours spent helping family moderated this relationship such that the effect of loneliness on depressive symptoms was stronger among respondents who perceived more negative family strain and spent fewer hours helping family. Familial relationships are crucial for the psychological well-being of older immigrants because they can be a source of either stress or support. The results have implications for how research and practices can support the immigrant families.

For better or worse: Relationship change in Thailand during COVID-19

Objective

Novel infectious diseases have the potential to both strengthen or weaken interpersonal relationships within a society. In a collectivist setting such as Thailand amplification of relationships may be particularly marked, but may be associated with individual factors, including personal values and perceived control over the virus.

Methods

A national on-street survey in Thailand (April 2020, N = 1,000), collected data from five regions across the country (response rate 82.6%). Participants reported demographics, anxiety, perceived control, and personal values of security and universalism, and indicated changes, from negative to positive, across four relationship types (relationship partners, family, friendships and neighbourhood).

Results

While relationship changes were small overall, there was an improvement in close relations (partners, family members) but not amongst friends and neighbours. Respondents who were married without children recorded less enhancement of partnerships, friendships and neighbourhood relations. Those with less perceived control over the infection reported relationship decline, while single people reported fewer positive changes in their partnership or family relations. Multiple regression analyses demonstrated the prioritisation of security was associated with a decline in each of the relationships, while universalism was positively associated with change in the family, in friendships and neighbourly relations.

Conclusions

Personal values and marital status may impact on relationship functioning during a national health crisis. These issues should be considered by clinicians and health practitioners when trying to assist those struggling with interpersonal relations during a pandemic.

Grandparenting, Social Relations, and Mortality in Old Age

Guided by a convoy model of social relations, this study investigates the relationships between grandparenting status, social relations, and mortality among community-dwelling grandparents age 65 and older who are caring for their grandchildren. The data were drawn from the 2008 and 2016 waves of the Health and Retirement Study (N = 564). Latent class analysis was used to identify the social network structure based on six indicators of interpersonal relationships and activities. A series of hierarchical Weibull hazard models estimated the associations between grandparent caregiving, social relations, and mortality risk. Results of survival analyses indicate that co-parenting and custodial grandparents had higher all-cause mortality risk than grandparents who babysat occasionally; however, for custodial grandparents, the association was not significant once social relation variables were added to the model. This study suggests that community-based support may be beneficial to older grandparents and improved relationship quality is integral to the well-being of older adults.

Evaluation of Family Characteristics and Multiple Hospitalizations at the End of Life: Evidence from the Utah Population Database

Background: Scant research has examined the relationship between family characteristics and end-of-life (EOL) outcomes despite the importance of family at the EOL. Objectives: This study examined factors associated with the size and composition of family relationships on multiple EOL hospitalizations. Design: Retrospective analysis of the Utah Population Database, a statewide population database using linked administrative records. Setting/subjects: We identified adults who died of natural causes in Utah, United States (n = 216,913) between 1998 and 2016 and identified adult first-degree family members (n = 743,874; spouses = 13.2%; parents = 3.6%; children = 51.7%; siblings = 31.5%). Measurements: We compared demographic, socioeconomic, and death characteristics of decedents with and without first-degree family. Using logistic regression models adjusting for sex, age, race/ethnicity, marital status, comorbidity, and causes of death, we examined the association of first-degree family size and composition, on multiple hospitalizations in the last six months of life. Results: Among decedents without documented first-degree family members in Utah (16.0%), 57.7% were female and 7 in 10 were older than 70 years. Nonmarried (aOR = 0.90, 95% CI = 0.88-0.92) decedents and decedents with children (aOR = 0.97, 95% CI = 0.94-0.99) were less likely to have multiple EOL hospitalizations. Family size was not associated with multiple EOL hospitalizations. Conclusions: First-degree family characteristics vary at the EOL. EOL care utilization may be influenced by family characteristics-in particular, presence of a spouse. Future studies should explore how the quality of family networks, as well as extended family, impacts other EOL characteristics such as hospice and palliative care use to better understand the EOL care experience.

Friendship Network Satisfaction: A multifaceted construct scored as a unidimensional scale

Although satisfying friendships are crucial for well-being throughout adulthood, measures of friendship satisfaction have been limited by: (1) item content relevant to children only, (2) a focus on single relationships rather than the friendship network, and (3) disagreement about the number of dimensions necessary to capture the construct. To overcome these limitations, we assembled an item pool from a number of existing measures, created additional items drawn from research on friendships, and then examined the structure and psychometric properties of those items in two online surveys of over 2000 respondents each. Factor analyses consistently identified two correlated factors-closeness and socializing-but bi-factor modeling revealed that scores on both subscales load strongly on a general factor, suggesting that the multifaceted content can be scored efficiently as a unidimensional composite. Analyses using item response theory (IRT) supported the creation of a reliable 14-item instrument that demonstrated adequate convergent and predictive validity. Thus, the Friendship Network Satisfaction (FNS) Scale is a psychometrically sound tool to advance research on friendships across the lifespan.

Narcissism, Social Experiences, and Mood in Late Life

OBJECTIVES

Social ties increase in importance in late life and narcissism may be deleterious to these ties. More narcissistic older adults may have more frequent social encounters than less narcissistic people and may prefer weak ties (e.g., acquaintances) over close ones (e.g., family, close friends). They may benefit more from these encounters due to their need for adulation. This study examined how daily social experiences and mood varied by narcissism among older adults.

METHODS

Older adults aged 65-92 years (N = 303) completed the Narcissistic Personality Inventory-16 and completed ecological momentary assessments in which they reported number, type, and quality of social contacts and positive and negative mood every 3 h for 5-6 days.

RESULTS

In multilevel models, narcissism did not predict the number or pleasantness of social encounters. But more narcissistic older adults reported a greater percentage of stressful discussions with weak ties. With regard to mood, more narcissistic people reported higher negative mood if they had more encounters with weak ties and when discussing something stressful with weak ties. Less narcissistic people reported lowered positive mood after they discussed something stressful with close ties.

DISCUSSION

The findings present a nuanced understanding of how the self-centeredness of narcissism may be manifest in late life. More narcissistic people may be less sensitive to close partner's (e.g., family, friends) distress, but their mood may be more susceptible to negative social events, especially with weak ties (e.g., acquaintances).

Professional Support After Partner Loss: Likelihood and Correlates of Help-Seeking Behavior

Intimate partner loss in later life can be one of the most stressful events in adulthood. Individuals who struggle to adapt to the new life conditions may need support from a mental health professional. However, less is known about the likelihood to seek professional help after separation, divorce, or bereavement in later life and associated factors. This study investigated professional help-seeking (PHS) for partner loss after a long-term marriage in separated, divorced, and bereaved individuals and examined the extent to which specific person and event-related variables, as well as depressive symptoms, increase its likelihood. The data were derived from the LIVES "Intimate Partner Loss Study." The self-administered questionnaires were completed by 388 adults. PHS was higher after separation (57%) and divorce (49%), compared to widowhood (18%). Higher likelihood of PHS was associated with separation and divorce, female gender, having someone to count on, loss unexpectedness, needing more time to overcome the loss, and more depressive symptoms. Informing individuals unlikely to seek help (e.g., males, bereaved, and individuals with no confidant) about PHS benefits may facilitate adaptation to partner loss.

Domestic Generative Acts and Life Satisfaction among Supplementary Grandparent Caregivers in Urban China: Mediated by Social Support and Moderated by Hukou Status

Urban China is witnessing a growth of migrant grandparents apart from the prevalent local grandparent caregiving. However, the health consequences and influencing factors of grandparent caregiving remain largely unknown among migrant and local grandparent caregivers. This study examined informal and formal social support's mediation roles between domestic generative acts and life satisfaction, as well as investigating Hukou's (household registration system) moderation effect. Our sample compromised 1013 grandparent caregivers (Migrant = 508, Local = 505) from 12 kindergartens with a multistage clustered random sampling from Eastern China. Migrant grandparent caregivers had significant lower informal social support (M = 4.000, L = 4.355, p < 0.001), formal social support (M = 1.787, L = 2.111, p < 0.001), and life satisfaction (M = 3.323, L = 3.574, p < 0.001) than local ones. Structural equation modeling results indicated that domestic generative acts positively associated with life satisfaction (b = 0.085, p < 0.05), informal (b = 0.223, p < 0.001) and formal social support (b = 0.080, p < 0.05); informal (b = 0.379, p < 0.001) and formal social support (b = 0.138, p < 0.001) positively associated with life satisfaction. In addition, both informal (β = 0.084, CI [0.039, 0.101], p < 0.001) and formal social support (β = 0.011, CI [0.001, 0.018], p < 0.05) mediated the relationship between domestic generative acts and life satisfaction. Furthermore, Hukou status moderated the indirect path from domestic generative acts to life satisfaction via informal social support (p < 0.01), but not formal social support (p > 0.05). Migrant grandparent caregivers, with limited formal social support resources, were found to be more dependent on informal social support than locals. The findings revealed social support and wellbeing disparities among migrant and local grandparent caregivers in urban China. Theoretical contributions and practical implications are also discussed.

Association between social network characteristics and prevalent and incident depression: The Maastricht Study

AIMS

Social network characteristics may provide a novel non-pharmaceutical target for the prevention of depression. We investigated the temporal association of a broad range of structural and functional social network characteristics with incident depressive symptoms over 5 years of follow-up.

METHODS

We used data from The Maastricht Study, a population-based prospective cohort study (n=2,465, mean age 59.8±8.1 years, 49.1% women, 11,585 person-years of follow-up). Social network characteristics were assessed through a name generator questionnaire. Clinically relevant depressive symptoms (9-item Patient Health Questionnaire score≥10) were assessed at baseline and annually. We used multivariable logistic and Cox regression analyses, adjusted for sociodemographic, lifestyle and cardiovascular risk factors.

RESULTS

In cross-sectional analyses less emotional support for discomfort and with important decisions, and less informational support were associated with prevalent depressive symptoms (OR[95%CI] 1.19 [1.01-1.40]; 1.22 [1.05-1.43], and 1.20 [1.04-1.39], respectively). Every fewer 10% of family members was associated with prevalent depressive symptoms (1.11 [1.01-1.23]). In longitudinal analyses, less emotional support on important decisions was also associated with higher risk of incident depressive symptoms (HR[95%CI] 1.13 [1.03-1.25]). In addition, every fewer 10% of the network that was a family member was associated with a higher hazard of incident depressive symptoms (1.07 [1.01-1.13]).

CONCLUSIONS

This study shows that less emotional support and fewer family members in the network were associated with higher risk of both prevalent and incident depression. The importance of emotional support and the role that family plays should be considered in treatment and prevention of depression.

Social integration after moving to a new city predicts lower systolic blood pressure

Residential mobility is linked to higher incidence of cardiovascular disease (CVD) and mortality. A mechanism by which residential relocation may impact health is through the disruption of social networks. To examine whether moving to a new city is associated with increased CVD risk and whether the extent to which movers rebuild their social network after relocating predicts improved CVD risk and psychosocial well-being, recent movers (n = 26), and age- and sex-matched nonmovers (n = 20) were followed over 3 months. Blood pressure, C-reactive protein/albumin ratio (CRP/ALB), social network size, and psychosocial well-being were measured at intake (within 6 weeks of residential relocation for movers) and 3 months later. Multiple regression indicated higher systolic blood pressure (SBP) for movers (M = 107.42, SD = 11.39), compared with nonmovers (M = 102.37, SD = 10.03) at intake, though this trend was not statistically significant. As predicted, increases in movers' social network size over 3 months predicted decreases in SBP, even after controlling for age, sex, and waist-to-hip ratio, b = -2.04 mmHg, 95% CI [-3.35, -.73]. Associations between increases in movers' social ties and decreases in depressive symptoms and stress were in the predicted direction but did not meet the traditional cutoff for statistical significance. Residential relocation and movers' social network size were not associated with CRP/ALB in this healthy sample. This study provides preliminary evidence for increased SBP among recent movers; furthermore, it suggests that this elevation in CVD risk may decrease as individuals successfully rebuild their social network.

COVID-19, Inter-household Contact and Mental Well-Being Among Older Adults in the US and the UK

Interacting with family members and friends from other households is a key part of everyday life and is crucial to people's mental well-being. The COVID-19 pandemic severely curtailed face-to-face contact between households, particularly for older adults (aged 60 and above), due to their high risk of developing severe illness if infected by COVID-19. In-person contact, where possible, was largely replaced by virtual interaction during the pandemic. This article examines how inter-household contact in face-to-face and virtual forms, as well as combinations of the two forms of contact, related to older adults' mental well-being during the pandemic. Data from two national longitudinal surveys, collected from the same respondents before (2018-2019) and during (June 2020) the pandemic, were comparatively analysed: the Health and Retirement Study in the US and Understanding Society in the UK. The findings showed a notable increase in loneliness in the US and a decline in general mental well-being in the UK following the outbreak of COVID-19. In both countries, more frequent inter-household face-to-face contact during the pandemic was associated with better general mental well-being, but inter-household virtual contact, via means such as telephone and digital media, was not associated with general mental well-being in either the US or the UK. In the US, older adults who engaged more frequently in virtual contact were more likely to feel lonely during the pandemic, particularly if their face-to-face contact was limited. In both countries, the increase in loneliness following the outbreak of the pandemic was greater for older adults who reported more virtual contact. The findings suggest that household-centred crisis management during the COVID-19 pandemic had unintended mental health implications in both the US and the UK, despite contextual differences between the two countries. Although face-to-face contact between households helped to sustain older adults' mental well-being, virtual contact was not a qualitatively equivalent alternative. The findings also provide an important evidence base for informing policy developments and for supporting the mental health of older people during the COVID-19 pandemic and in the longer term.

Strength of social ties and perceived tangible support: distinct characteristics and gender differences of older adults' social circles

Social connections have been found to promote wellbeing among older adults. Studies note gender differences in older adults' social network characteristics and aspects of social support. The present study examined gender differences in the association of social network characteristics (number of strong social ties) and perceived tangible support among a sample of elders (n = 278). Older men reported higher levels of perceived tangible support, while older women had more strong social ties. The number of strong social ties was associated with older women's, but not men's, increased sense of tangible support. Implications for cultivating elders' wellbeing respective of gender particularities are discussed.

The role of social communication technologies in cognition and affect in older adults

Affect and cognition have both been associated with communication across one's social network during ageing. Thus, it is important to consider how communication varies by different aspects of one's social network, and by communication mode, including phone, email and social media. This study aimed to investigate the relationship between technology-mediated communication, depression and an executive function-related fluid-reasoning measure among older adults. Data were drawn from the Health and Retirement dataset's 2016 wave. Hierarchical regression analyses were conducted to examine the link between communication modes (phone, email and social media) with children, family and friends with a fluid-reasoning cognition measure and Center for Epidemiologic Studies Depression Scale, controlling for demographic covariates, among 3,798 older American adults. Phone and email communication, but not social media, were significantly related to depression and cognition. The model fit was considerably stronger for the analyses with cognition than depression. Curvilinear associations were found for communication via phone and email with cognition, suggesting moderate amounts of communication by phone and email across social groups were most closely linked with higher scores on fluid reasoning. For depression, curvilinear relationships were found for talking on the phone with family and friends, and emailing for children and family, indicating that moderate communication levels revealed the lowest depression levels. Implications for how older adults’ social support may contribute to depression and cognition status are discussed.

A Multi-Institutional Study of Older Hearing Aids Beginners-A Prospective Single-Arm Observation on Executive Function and Social Interaction

OBJECTIVES

To obtain new insights into research questions on how executive function and social interaction would be observed to change after the introduction of hearing aids (HAs) in older people with hearing impairment.

DESIGN

Multi-institutional prospective single-arm observational study.

SETTING AND PARTICIPANTS

Outpatients with complaints of hearing difficulty who visited HA clinics between October 18, 2017, and June 30, 2019, in 7 different university hospitals in Japan.

METHODS

The inclusion criteria of the study named Hearing-Aid Introduction for Hearing-Impaired Seniors to Realize a Productive Aging Society-A Study Focusing on Executive Function and Social Activities Study (HA-ProA study) were age ≥60 years and no history of HA use. A series of multi-institution common evaluations including audiometric measurements, the digit symbol substitution test to assess executive functions, convoy model as an index of social relations, and hearing handicap inventory for the elderly (HHIE) were performed before (pre-HA) and after 6 months of the HA introduction (post-HA).

RESULTS

Out of 127 enrollments, 94 participants completed a 6-month follow-up, with a mean age of 76.9 years. The digit symbol substitution test score improved significantly from 44.7 at baseline to 46.1 at 6 months (P = .0106). In the convoy model, the social network size indicated by the number of persons in each and whole circles were not significantly different between pre- and post-HA; however, the total count for kin was significantly increased (P = .0344). In the analyses of HHIE, the items regarding the family and relatives showed significant improvement.

CONCLUSIONS AND IMPLICATIONS

HA use could benefit older individuals beginning to use HAs in executive function and social interaction, though the results should be interpreted cautiously given methodological limitations such as a single-arm short 6 months observation. Reduction in daily hearing impairment would have a favorable effect on relationships with the family.

Longitudinal Implications of Social Integration for Age and Gender Differences in Late-Life Physical Functioning

Social integration has documented benefits for late-life health; yet, little is known about its impacts on trajectories of physical functioning. This study examines age and gender differences in the longitudinal associations between social integration and activities of daily living (ADLs) using a hierarchical linear model with three waves of survey data collected over 4 years from the Social Integration and Aging Study (N = 400; baseline mean age = 80.3). Findings indicated some interaction effects of age, gender, and/or social integration on ADL trajectories. Among those of more advanced age, women showed greater increases in ADL limitations than men, and individuals with lower social integration experienced greater increases in ADL limitations than those with higher social integration. Neither of these patterns were found among younger older adults. This study highlights the benefits of longitudinal research on social integration and the need to explore practical interventions for promoting social integration particularly among the oldest older adults.

Implications of relationships with family, friends, and neighbors for changes in women's well-being in late life

This study examined whether relationships with family, friends, and neighbors (both satisfaction and number in the social network) were associated with older women's well-being concurrently and over two years. Additionally, age differences among older women were explored. Women aged 60+ (N = 224, M_age = 80) were sampled from the Social Integration and Aging Study. Greater family and friend satisfaction were positively associated with well-being; number in network was not. Age-related effects for family and friend relationships suggested potential protective effects for the oldest women. Findings highlight unique facets of older women's relationships, suggesting future directions addressing age and support source.