1
|
Kotwal AA, Cenzer I, Hunt LJ, Ankuda C, Torres JM, Smith AK, Aldridge M, Harrison KL. Psychosocial distress among spouses of persons with dementia before and after their partner's death. J Am Geriatr Soc 2024; 72:2336-2346. [PMID: 38822746 PMCID: PMC11323186 DOI: 10.1111/jgs.19030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/12/2024] [Accepted: 05/04/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Spouses of persons living with dementia may face heightened psychosocial distress in the years immediately before and after their partner's death. We compared the psychosocial needs of spouses of partners with dementia with spouses of partners with non-impaired cognition nearing and after the end of life, focusing on loneliness, depression, life satisfaction, and social isolation. METHODS We used nationally representative Health and Retirement Study married couples data (2006-2018), restricting to spouses 50+ years old. We included 2098 spouses with data on loneliness and depressive symptoms 2 years before and after the partner's death. We additionally examined a subset of spouses (N = 1113) with available data on life satisfaction and social isolation 2 years before their partner's death. Cognitive status of partners was classified as non-impaired cognition, cognitive impairment not dementia (cognitive impairment), and dementia. We used multivariable logistic regression to determine: 1) the change in loneliness and depression for spouses pre- and post-partner's death, and 2) life satisfaction and social isolation 2 years before the partner's death. RESULTS Spouses were on average 73 years old (SD: 10), 66% women, 7% Black, 7% Hispanic non-White, 24% married to persons with cognitive impairment, and 19% married to partners with dementia. Before their partner's death, spouses married to partners with dementia experienced more loneliness (non-impaired cognition: 8%, cognitive impairment: 16%, dementia: 21%, p-value = 0.002) and depressive symptoms (non-impaired cognition: 20%, cognitive impairment: 27%, dementia: 31%, p-value < 0.001), and after death a similar prevalence of loneliness and depression across cognitive status. Before their partner's death, spouses of partners with dementia reported less life satisfaction (non-impaired cognition: 74%, cognitive impairment: 68%; dementia: 64%, p-value = 0.02) but were not more socially isolated. CONCLUSION Results emphasize a need for clinical and policy approaches to expand support for the psychosocial needs of spouses of partners with dementia in the years before their partner's death rather than only bereavement.
Collapse
Affiliation(s)
- Ashwin A Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Irena Cenzer
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Lauren J Hunt
- Department of Physiological Nursing, University of California San Francisco, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Claire Ankuda
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Jacqueline M Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Melissa Aldridge
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Krista L Harrison
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
2
|
Gärtner HS, Shabnam J, Aagesen M, Guldin MB, Vind AB, Marsaa K, Bergenholtz HM, Graven V, Sampedro Pilegaard M, Thuesen J. Combined rehabilitation and palliative care interventions for patients with life-threatening diseases - PREGOAL. A scoping review of intervention programme goals. Disabil Rehabil 2024; 46:2989-2998. [PMID: 37580981 DOI: 10.1080/09638288.2023.2246373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/14/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE WHO recommends integrating rehabilitation into palliative care when providing services for people with life-threatening conditions. Recently, there has been increasing interest in exploring how rehabilitation and palliative care approaches could be combined. The aim of this study was to map and discuss the goals of intervention programmes that combine rehabilitation and palliative care. METHODS A scoping review was performed. The electronic databases MEDLINE, EMBASE, and CINAHL were searched for papers published between January 2014 and September 2022. Papers were considered eligible if the participants in question had a life-threatening disease and if interventions included both rehabilitation and palliative care. All study types were included. RESULTS Ten papers describing five interventions were included. Qualitative goals were narratively described, and quantitative goals were analysed according to the International Classification of Functioning, Disability and Health, and the Total Pain framework. Findings showed an overall focus on functioning and quality of life. Further analysis indicated an emphasis on physical and psychological dimensions. Social participation, and the social and spiritual dimensions were rarely evaluated. CONCLUSION This review indicates that goals relative to social participation, the social and spiritual dimensions, and the patient's own goals may well be overlooked as points of orientation for interventions.
Collapse
Affiliation(s)
- Henriette Søby Gärtner
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Jahan Shabnam
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Maria Aagesen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Occupational Science, User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mai-Britt Guldin
- Research Unit for General Practice, Public Health, Aarhus University, Aarhus, Denmark
| | - Ane Bonnerup Vind
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kristoffer Marsaa
- North Zealand Hospital, University of Copenhagen, Kobenhavn, Denmark
| | - Heidi Maria Bergenholtz
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Zealand University Hospital, Research Support Unit, Koge, Denmark
| | - Vibeke Graven
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marc Sampedro Pilegaard
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Regional Hospital Gødstrup, Herning, Denmark
| | - Jette Thuesen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Occupational Science, User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
3
|
Mansfield R, Henderson M, Richards M, Ploubidis GB, Patalay P. Lifecourse trajectories and cross-generational trends in social isolation: Findings from five successive British birth cohort studies. ADVANCES IN LIFE COURSE RESEARCH 2024; 60:100613. [PMID: 38608375 DOI: 10.1016/j.alcr.2024.100613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/05/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024]
Abstract
Despite growing concerns in the UK about social isolation, there remains a lack of data on the extent and time trends of social isolation from longitudinal, population-based studies. There is also little research that assesses the multiple domains of social isolation across the lifecourse and between generations in a holistic way accounting for different contexts. By applying a multi-context, multi-domain framework of social isolation to 5 successive British birth cohorts, we provide conceptual and empirical understanding of social isolation trajectories across the lifecourse and identify potential generational and sex differences in trends. Where data were available, comparable social isolation indicators were generated to enable lifecourse trajectories and cross-generational trends to be explored. Information on isolation was available across the following relational contexts: household i.e., living alone; partnership, family and friends outside the household; education and employment networks; and community engagement. Trajectories were modelled stratified by sex using a multilevel growth curve framework. Data were analysed from 73,847 individuals (48.5% female), in 5 successive cohorts born in 1946 (N = 5,362), 1958 (N = 16,742), 1970 (N = 16,950), 1989-90 (N = 15,562), and 2000-01 (N = 19,231). Exploring a range of social isolation indicators across several contexts provided a nuanced picture of social isolation across the lifecourse and between generations in the UK, with no consistent pattern of increased or decreased isolation over time. For example, more people are living alone, less women are out of education and employment in midlife, more people are volunteering, but fewer people regularly engage in religious activity. It therefore highlights the need to focus on a range of social isolation indicators across contexts to understand how people compensate for specific types of isolation, and to understand structural differences in social configurations in the UK, which may not only define the timing and sequencing of life transitions but also social isolation.
Collapse
Affiliation(s)
- Rosie Mansfield
- Centre for Longitudinal Studies, University College London, UK.
| | - Morag Henderson
- Centre for Longitudinal Studies, University College London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing, University College London, UK
| | | | - Praveetha Patalay
- Centre for Longitudinal Studies, University College London, UK; MRC Unit for Lifelong Health and Ageing, University College London, UK
| |
Collapse
|
4
|
Saito H, Maeda D, Kagiyama N, Sunayama T, Dotare T, Fujimoto Y, Jujo K, Saito K, Uchida S, Hamazaki N, Kamiya K, Ogasahara Y, Maekawa E, Konishi M, Kitai T, Iwata K, Wada H, Kasai T, Nagamatsu H, Ako J, Momomura SI, Matsue Y. Prognostic Value of Objective Social Isolation and Loneliness in Older Patients With Heart Failure: Subanalysis of FRAGILE-HF and Kitasato Cohort. J Am Heart Assoc 2024; 13:e032716. [PMID: 38726923 PMCID: PMC11179817 DOI: 10.1161/jaha.123.032716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 04/15/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Social factors encompass a broad spectrum of nonmedical factors, including objective (social isolation [SI]) and perceived (loneliness) conditions. Although social factors have attracted considerable research attention, information regarding their impact on patients with heart failure is scarce. We aimed to investigate the prognostic impact of objective SI and loneliness in older patients with heart failure. METHODS AND RESULTS This study was conducted using the FRAGILE-HF (Prevalence and Prognostic Value of Physical and Social Frailty in Geriatric Patients Hospitalized for Heart Failure; derivation cohort) and Kitasato cohorts (validation cohort), which included hospitalized patients with heart failure aged ≥65 years. Objective SI and loneliness were defined using the Japanese version of Lubben Social Network Scale-6 and diagnosed when the total score for objective and perceived questions on the Lubben Social Network Scale-6 was below the median in the FRAGILE-HF. The primary outcome was 1-year death. Overall, 1232 and 405 patients in the FRAGILE-HF and Kitasato cohorts, respectively, were analyzed. Objective SI and loneliness were observed in 57.8% and 51.4% of patients in the FRAGILE-HF and 55.4% and 46.2% of those in the Kitasato cohort, respectively. During the 1-year follow-up, 149 and 31 patients died in the FRAGILE-HF and Kitasato cohorts, respectively. Cox proportional hazard analysis revealed that objective SI, but not loneliness, was significantly associated with 1-year death after adjustment for conventional risk factors in the FRAGILE-HF. These findings were consistent with the validation cohort. CONCLUSIONS Objective SI assessed using the Lubben Social Network Scale-6 may be a prognostic indicator in older patients with heart failure. Given the lack of established SI assessment methods in this population, further research is required to refine such methods.
Collapse
Affiliation(s)
- Hiroshi Saito
- Department of Rehabilitation Kameda Medical Centre Kamogawa Japan
| | - Daichi Maeda
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Nobuyuki Kagiyama
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
- Department of Digital Health and Telemedicine R&D Juntendo University Tokyo Japan
- Department of Cardiology The Sakakibara Heart Institute of Okayama Okayama Japan
| | - Tsutomu Sunayama
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Taishi Dotare
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Yudai Fujimoto
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Kentaro Jujo
- Department of Cardiology Nishiarai Heart Centre Hospital Tokyo Japan
| | - Kazuya Saito
- Department of Rehabilitation The Sakakibara Heart Institute of Okayama Okayama Japan
| | - Shota Uchida
- Department of Rehabilitation, School of Allied Health Sciences Kitasato University Sagamihara Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation Kitasato University Hospital Sagamihara Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences Kitasato University Sagamihara Japan
| | - Yuki Ogasahara
- Department of Nursing The Sakakibara Heart Institute of Okayama Okayama Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine Kitasato University School of Medicine Sagamihara Japan
| | - Masaaki Konishi
- Division of Cardiology Yokohama City University Medical Centre Yokohama Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine National Cerebral and Cardiovascular Centre Osaka Japan
| | - Kentaro Iwata
- Department of Rehabilitation Kobe City Medical Centre General Hospital Kobe Japan
| | - Hiroshi Wada
- Department of Cardiovascular Medicine, Saitama Medical Centre Jichii Medical University Saitama Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
- Cardiovascular Respiratory Sleep Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Hirofumi Nagamatsu
- Department of Cardiology Tokai University School of Medicine Isehara Japan
| | - Junya Ako
- Department of Cardiovascular Medicine Kitasato University School of Medicine Sagamihara Japan
| | - Shin-Ichi Momomura
- Department of Internal Medicine Saitama Citizens Medical Centre Saitama Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| |
Collapse
|
5
|
Kuang L, Hu H, Xiang S, Zhang H, Liu G, Tai R, Wang L, Sheng Y. Social network and related factors in older people with sensory impairment in the community: Using principal component analysis. Geriatr Nurs 2024; 57:109-116. [PMID: 38621312 DOI: 10.1016/j.gerinurse.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/03/2024] [Accepted: 04/03/2024] [Indexed: 04/17/2024]
Abstract
AIM Older people with sensory impairment are more likely to have smaller and weaker social network due to their reduced ability, which lowers their quality of life. However, there is little research on the social network in older people with sensory impairment, especially the related factors. The aim of the study was to explore the related factors of social network and to provide evidence for the improvement of social network to promote successful aging in older people with sensory impairment. METHODS A cross-sectional study was conducted among 374 participants for hearing and vision assessment and questionnaire survey in a community, Beijing. Data were collected and analyzed by principal component analysis (PCA) and multiple logistic regression using IBM SPSS 25.0 software. RESULTS PCA showed that there were six risk factors whose eigenvalues >1 were extracted, with a total variance of 56.555%. Multiple logistic regression analysis of principal component indicated that five factors including physical health factor, social interaction factor, psychological status factor, lifestyle factor, and family condition factor, were statistically significant (p < 0.05). CONCLUSIONS The social network of older people with sensory impairment is relatively poor. Physical health factor, social interaction factor, psychological status factor, lifestyle factor, and family condition factor may be related factors. Medical staff should pay attention to physical, psychological and social characteristics of older people, especially with sensory impairment, to carry out necessary measures to improve social network and avoid social isolation.
Collapse
Affiliation(s)
- Li Kuang
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hanyu Hu
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shule Xiang
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hui Zhang
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Guangnan Liu
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Rui Tai
- Department of Nursing, Shanghai General Hospital, Shanghai, China
| | - Lingyun Wang
- Beijing Desheng Community Health Service Center, Beijing, China
| | - Yu Sheng
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| |
Collapse
|
6
|
Pivodic L, Van den Block L, Pivodic F. Social connection and end-of-life outcomes among older people in 19 countries: a population-based longitudinal study. THE LANCET. HEALTHY LONGEVITY 2024; 5:e264-e275. [PMID: 38490235 PMCID: PMC10978496 DOI: 10.1016/s2666-7568(24)00011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Social connection is a key determinant of health, but its role in shaping end-of-life outcomes is poorly understood. We examined changes in structure, function, and quality components of social connection in older people's last years of life, and the extent to which social connection predicts end-of-life outcomes (ie, symptoms, health-care utilisation, and place of death). METHODS This study used longitudinal data of representative samples from across 18 European countries and Israel in the Survey of Health, Ageing, and Retirement in Europe (SHARE), the largest European cohort study of people aged 50 years or older. We included deceased participants of waves 4 and 6 (which contained social network modules) for whom a proxy provided an end-of-life interview. We did paired sample t-tests (for continuous variables), Wilcoxon signed-rank tests (for ordinal variables), and McNemar's tests (for non-ordinal categorical variables) to assess changes in structure, function, and quality components of social connection between waves 4 and 6. To examine social connection as a predictor of end-of-life outcomes, we used social connection data from wave 6 core interviews and end-of-life interviews from wave 7, conducted with a proxy respondent covering the deceased participant's last year of life. End-of-life outcomes included symptoms (pain, breathlessness, and anxiety or sadness) in the last month of life, health-care utilisation in the last year of life, and place of death. We conducted a mixed-effects logistic regression analysis per social connection measure, for each end-of-life outcome. FINDINGS Data were collected in 2011-12 for wave 4, 2015-16 for wave 6, and 2017-18 for wave 7. We studied 3356 individuals (mean age at death was 79·7 years [SD 10·2]), with interviews conducted, on average, 4·6 (1·2) years (wave 4) and 1·1 (0·7) years (wave 6) before death. From wave 4 to wave 6, the following changes in social connection were observed: proportion of married or partnered participants (from 1406 [60·9%] of 2310 to 1438 [57·1%] of 2518; p<0·0001), receiving personal care or practical help (from 781 [37·2%] of 2099 to 1334 [53·1%] of 2512; p<0·0001), loneliness (from mean 1·4 [SD 0·5] to 1·5 [0·6]; p<0·0001; scale 1-3), satisfaction with social network (from 8·8 [1·67] to 8·7 [1·7]; p=0·037; scale 0-10), and emotional closeness to social network (eg, from 1883 [88·8%] of 2121 to 1710 [91·3%] of 1872 participants who indicated being either very close or extremely close to social network members; p<0·0001). Higher levels of loneliness at wave 6 predicted a greater likelihood of experiencing symptoms in the last month of life (odds ratio range across symptoms: 1·29 [95% CI 1·08-1·55] to 1·58 [1·32-1·89]). Being married (1·32 [1·03-1·68]) or receiving personal care or practical help (1·25 [1·04-1·49]) predicted death in hospital. INTERPRETATION Social connection undergoes multifaceted changes towards older people's end of life, countering prevalent ideas of generally declining social trajectories. Loneliness in the final months of life might be a risk factor for end-of-life symptoms. Further research is needed to substantiate a causal relationship and to identify underpinning mechanisms, which could inform screening and prevention measures. FUNDING Research Foundation-Flanders and European Union.
Collapse
Affiliation(s)
- Lara Pivodic
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-Life Care Research Group, Brussels, Belgium; Vrije Universiteit Brussel (VUB), Department of Family Medicine & Chronic Care, Brussels, Belgium.
| | - Lieve Van den Block
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-Life Care Research Group, Brussels, Belgium; Vrije Universiteit Brussel (VUB), Department of Family Medicine & Chronic Care, Brussels, Belgium
| | - Fedja Pivodic
- World Bank, Health, Nutrition and Population Division; Washington DC, USA
| |
Collapse
|
7
|
Cohen-Mekelburg S, Jordan A, Kenney B, Burgess HJ, Chang JW, Hu HM, Tapper E, Langa KM, Levine DA, Waljee AK. Loneliness and Depressive Symptoms Are High Among Older Adults With Digestive Disease and Associated With Lower Perceived Health. Clin Gastroenterol Hepatol 2024; 22:621-629.e2. [PMID: 37689253 DOI: 10.1016/j.cgh.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/09/2023] [Accepted: 08/15/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND & AIMS Current approaches to managing digestive disease in older adults fail to consider the psychosocial factors contributing to a person's health. We aimed to compare the frequency of loneliness, depression, and social isolation in older adults with and without a digestive disease and to quantify their association with poor health. METHODS We conducted an analysis of Health and Retirement Study data from 2008 to 2016, a nationally representative panel study of participants 50 years and older and their spouses. Bivariate analyses examined differences in loneliness, depression, and social isolation among patients with and without a digestive disease. We also examined the relationship between these factors and health. RESULTS We identified 3979 (56.0%) respondents with and 3131 (44.0%) without a digestive disease. Overall, 60.4% and 55.6% of respondents with and without a digestive disease reported loneliness (P < .001), 12.7% and 7.5% reported severe depression (P < .001), and 8.9% and 8.7% reported social isolation (P = NS), respectively. After adjusting for covariates, those with a digestive disease were more likely to report poor or fair health than those without a digestive disease (odds ratio [OR], 1.25; 95% CI, 1.11-1.41). Among patients with a digestive disease, loneliness (OR, 1.43; 95% CI, 1.22-1.69) and moderate and severe depression (OR, 2.93; 95% CI, 2.48-3.47; and OR, 8.96; 95% CI, 6.91-11.63, respectively) were associated with greater odds of poor or fair health. CONCLUSIONS Older adults with a digestive disease were more likely than those without a digestive disease to endorse loneliness and moderate to severe depression and these conditions are associated with poor or fair health. Gastroenterologists should feel empowered to screen patients for depression and loneliness symptoms and establish care pathways for mental health treatment.
Collapse
Affiliation(s)
- Shirley Cohen-Mekelburg
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan; Veterans Affairs Center for Clinical Management Research, US Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
| | - Ariel Jordan
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Brooke Kenney
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Helen J Burgess
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Joy W Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Hsou Mei Hu
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Elliot Tapper
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Kenneth M Langa
- Division of General Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Deborah A Levine
- Division of General Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Akbar K Waljee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan; Veterans Affairs Center for Clinical Management Research, US Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| |
Collapse
|
8
|
He Y, Jiang W, Hua Y, Zheng X, Huang C, Liu Q, Liu Y, Guo L. Dynamic associations between vision and hearing impairment and depressive symptoms among older Chinese adults. Arch Gerontol Geriatr 2024; 116:105217. [PMID: 37793304 DOI: 10.1016/j.archger.2023.105217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/29/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Whether the impact of vision impairment (VI)/hearing impairment (HI) on depressive symptoms changes over time has not been investigated. This study aimed to examine the complex dynamic associations between VI/HI and depressive symptoms to design effective prevention strategies for older Chinese adults. METHODS Data were from the China Health and Retirement Longitudinal Study (CHARLS). The study identified self-reported VI, HI, depressive symptoms, and other covariates (including social isolation). Logistic regression models were used to analyze the dynamic associations across three waves, with the assessment of multiplicative and additive interactions. RESULTS Of the 8519 participants in wave 1 (mean [SD] age, 62.0 [8.0] years, 49.5 % male), 38.5 % had depressive symptoms. After adjusting for covariates including social isolation, VI and HI were significantly associated with depressive symptoms across all three waves. Specifically, the adjusted odds ratio (AOR) of VI increased from 2.08 (95 % CI: 1.89 to 2.29) in wave 1 to 2.15 (95 % CI: 1.90 to 2.44) in wave 3; while the AOR of HI increased from 1.80 (95 % CI: 1.58 to 2.04) in wave 1 to 2.11 (95 % CI: 1.75 to 2.51) in wave 3. The additive interactions between VI and HI on depressive symptoms in each wave (e.g., RERI [95 % CI]: 7.90 [2.51 to 12.30] in wave 1) were significant without adjusting for social isolation. CONCLUSION The study suggests that VI and HI are consistently associated with depressive symptoms among older adults in China over a four-year period, and their influences on mental health deserve more attention.
Collapse
Affiliation(s)
- Yitong He
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Weiqing Jiang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yilin Hua
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xinyu Zheng
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Cuihong Huang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qianyu Liu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuan Liu
- Liwan District Center for Disease Control and Prevention, Guangzhou, China.
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
| |
Collapse
|
9
|
Morikawa M, Lee S, Makino K, Harada K, Katayama O, Tomida K, Yamaguchi R, Nishijima C, Fujii K, Misu Y, Shimada H. Social isolation and risk of disability in older adults: Effect modification of metabolic syndrome. Arch Gerontol Geriatr 2024; 116:105209. [PMID: 37782966 DOI: 10.1016/j.archger.2023.105209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE Delaying the onset of disabilities is a social challenge, especially in an aging society. Social isolation (SI) and metabolic syndrome (MetS) can coexist and pose the risks of disability onset. However, their interaction is not proven in older adults. Therefore, this study investigated whether SI combined with MetS exacerbates disability onset in older adults. MATERIALS AND METHODS A total of 3,738 community-dwelling older adults underwent a health check-up. After baseline assessments, we followed them up to assess disability incidence for five years. SI was defined as a condition in which two or more of the following measures were met: domestic isolation, less social contact, and social disengagement. MetS was defined according to the criteria of the International Diabetes Federation. We used Cox proportional hazard regression used to identify the interaction effect of SI and MetS on the risk of disability onset after adjusting for potential confounding factors. RESULTS Multivariate Cox proportional hazard regression showed a significant interaction effect of SI and MetS on disability onset. In the subgroup analysis stratified by MetS status, SI was identified as a risk factor for disability onset only in the MetS group, but not in the non-MetS group. CONCLUSIONS This five-year longitudinal study showed that the co-occurrence of SI and MetS increased the risk of disability onset in older adults. This indicates that the assessment of MetS in socially isolated older adults is important for healthcare providers to delay the onset of disabilities.
Collapse
Affiliation(s)
- Masanori Morikawa
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan.
| | - Sangyoon Lee
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan
| | - Keitaro Makino
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan
| | - Kenji Harada
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan
| | - Osamu Katayama
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan
| | - Kouki Tomida
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan
| | - Ryo Yamaguchi
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan
| | - Chiharu Nishijima
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan
| | - Kazuya Fujii
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan
| | - Yuka Misu
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan
| | - Hiroyuki Shimada
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi 474-8511, Japan
| |
Collapse
|
10
|
Giotakis AI, Mariolis L, Koulentis I, Mpoutris C, Giotakis EI, Apostolopoulou A, Papaefstathiou E. The Benefit of Air Conduction Pure-Tone Audiometry as a Screening Method for Hearing Loss over the VAS Score. Diagnostics (Basel) 2023; 14:79. [PMID: 38201388 PMCID: PMC10802147 DOI: 10.3390/diagnostics14010079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/15/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Hearing loss is commonly encountered by general practitioners. We aimed to evaluate the screening benefit of air conduction pure-tone audiometry over visual analogue scale (VAS) scores for hearing loss. Moreover, we intended to perform the first cross-sectional study in Greece to assess hearing loss with pure-tone audiometry in young adults of the general population. We evaluated Greeks between 15 and 40 years old in a high school in Karditsa, Greece, and a primary health care unit in a nearby community. Subjects filled out a VAS score sheet and underwent pure-tone audiometry in a room without sound isolation, with air conduction only. We named the latter procedure modified pure-tone audiometry (mPTA). Subjects with pathologic results were examined via otoscopy and standardized pure-tone audiometry (sPTA). Of the 286 subjects evaluated, the VAS score revealed 5 subjects (1.7%) with hearing loss. mPTA (100 s duration) doubled this percentage (in total 3.8%; Pearson Chi-Square test; p < 0.001). Based on sPTA, the sensitivity and positive predictive value of the VAS score were 40% and 13%, respectively. For mPTA, they were 100% and 37%, respectively. mPTA filtered out pathologic cases in a proper, rapid, cheap and simple way and may be considered a proper screening method for hearing loss in primary health care.
Collapse
Affiliation(s)
- Aris I. Giotakis
- First Department of Otorhinolaryngology Head and Neck Surgery, Metropolitan General, 15562 Athens, Greece
| | - Lambros Mariolis
- First Department of Otorhinolaryngology Head and Neck Surgery, Metropolitan General, 15562 Athens, Greece
| | - Ioannis Koulentis
- First Department of Otorhinolaryngology Head and Neck Surgery, Metropolitan General, 15562 Athens, Greece
| | - Christos Mpoutris
- First Department of Otorhinolaryngology Head and Neck Surgery, Metropolitan General, 15562 Athens, Greece
| | - Evangelos I. Giotakis
- First Department of Otorhinolaryngology, Hippocrateion General Hospital, 11527 Athens, Greece
| | - Aikaterini Apostolopoulou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Efstathios Papaefstathiou
- Second Department of Urology, Aristotle University of Thessaloniki, General Hospital ‘Papageorgiou’, 56403 Thessaloniki, Greece;
| |
Collapse
|
11
|
Lively CLP. Medical-Legal Partnerships and Prevention: Caring for Unrepresented Patients Through Early Identification and Intervention. HEC Forum 2023:10.1007/s10730-023-09518-x. [PMID: 38141153 DOI: 10.1007/s10730-023-09518-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/24/2023]
Abstract
Caring for unrepresented patients encompasses legal, ethical, and moral challenges regarding decision-making, consent, the patient's values, wishes, best interest, and the healthcare team's professional integrity and autonomy. In this article, I consider the impact of the aging population and the effects of the social determinants of health and suggest that without preventive intervention, the number of unrepresented patients will continue to increase. The health, social, and legal risk factors for becoming unrepresented require a multidisciplinary response. Medical-Legal Partnerships (MLPs) bring healthcare and legal professionals together to address risk factors and health-harming legal needs. The article discusses the role of MLPs in identifying at-risk individuals, providing preventive interventions, and providing support. I make recommendations and conclude that proactive MLPs offer a sustainable approach to the ethical challenges in caring for unrepresented patients by providing interventions to prevent individuals from becoming unrepresented.
Collapse
Affiliation(s)
- Cathy L Purvis Lively
- The University of Miami Institute for Bioethics and Health Policy, Miami, Florida, US.
- Associate in Professional Studies in the Bioethics Program, Columbia University, NY, Florida, US.
| |
Collapse
|
12
|
Bradley N, Dowrick C, Lloyd-Williams M. Explaining how and why social support groups in hospice day services benefit palliative care patients, for whom, and in what circumstances. Palliat Care Soc Pract 2023; 17:26323524231214549. [PMID: 38044931 PMCID: PMC10693225 DOI: 10.1177/26323524231214549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023] Open
Abstract
Background Palliative care aims to provide holistic support for people with life-limiting illness, responding to psychological, social and spiritual needs, as well as to clinical and physical. In the United Kingdom, hospice day services (including day care, group interventions, group activities, and social events for palliative care outpatients) aim to provide opportunities for patients to gain social support, which is thought to improve their quality of life. Objectives This research explored social support within hospice day services, to explain in detail how and why social support obtained within a hospice day service could be beneficial to palliative care patients. Design Qualitative research using observations of hospice day services and interviews with service providers. Methods Data collection involved nineteen interviews with hospice service providers (n = 19) and researcher observations of hospice day services. The findings detail how patient and hospice context interact to produce mechanisms that lead to outcomes beyond the hospice day service. Results Practical, clinical and social aspects of the hospice day service are important for patients feeling welcome and safe in the setting. The opportunity to connect with other people and work towards personal goals can boost self-confidence for patients who have lost access to meaningful activity. New friendships between patients encourages reciprocal support and feelings of belonging. It is beneficial to have permission to speak freely about topics deemed inappropriate elsewhere, because honest communication is helpful in accepting and adapting to their circumstances. Conclusion Hospice day services facilitate group settings for reciprocal social support. This research proposes an initial programme theory that can be further developed and tested. It explains how and why, in some contexts, social support increases personal and practical resources to cope with illness and death, leading to changes outside of the hospice (to mood, interpersonal interactions and behaviour) that could improve quality of life.
Collapse
Affiliation(s)
- Natasha Bradley
- School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT7 1NN, UK
- Centre for Health & Clinical Research, University of the West of England (UWE), Bristol BS16 1DD, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Mari Lloyd-Williams
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| |
Collapse
|
13
|
Pomeroy ML, Mehrabi F, Jenkins E, O'Sullivan R, Lubben J, Cudjoe TKM. Reflections on measures of social isolation among older adults. NATURE AGING 2023; 3:1463-1464. [PMID: 37640906 DOI: 10.1038/s43587-023-00472-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Mary Louise Pomeroy
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
- Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Fereshteh Mehrabi
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Emerald Jenkins
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Roger O'Sullivan
- Ageing Research and Development Division, Institute of Public Health, Dublin, Ireland
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Coleraine, UK
| | - James Lubben
- Luskin School of Public Affairs, University of California Los Angeles, Los Angeles, CA, USA
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Thomas K M Cudjoe
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
- Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
14
|
Newmark RL, Allison TA, Smith AK, Perissinotto CM, Tha SH, Kotwal AA. The Role of Digital Technologies in Facilitating Psychosocial Resilience to Sudden Social Isolation Among Older Adults: Lessons Learned from the COVID-19 Pandemic. J Appl Gerontol 2023; 42:2348-2359. [PMID: 37536316 PMCID: PMC11056268 DOI: 10.1177/07334648231190228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
This study investigated how older adults adopted new technologies in response to sudden social isolation caused by the COVID-19 pandemic and how this adoption was related to their long-term psychosocial well-being. The study involved a 6-month longitudinal survey of 151 older adults and two phone-based focus groups, which informed a semi-structured interview guide and purposive sampling of diverse community-dwelling older adults. We then conducted twenty qualitative interviews and thematic analysis and mapped themes to 6-month quantitative trajectories of psychosocial health. Three themes emerged: first, most participants adopted multiple technologies to maintain social connection and psychosocial well-being. Second, participants felt left behind by certain technologies due to complicated systems or ageist societal norms. Third, pandemic-related community resources promoted technology independence among isolated older adults and those wanting to avoid "burdening" family. Results challenge ageist stereotypes and provide a framework for encouraging access and comfort with multiple technologies to adapt to sudden health crises or disruptive events.
Collapse
Affiliation(s)
- Rebecca L Newmark
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
- School of Medicine, University of California, San Francisco, CA, USA
| | - Theresa A Allison
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Carla M Perissinotto
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
| | - Soe Han Tha
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
| | - Ashwin A Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| |
Collapse
|
15
|
Urbaniak A, Walsh K, Batista LG, Kafková MP, Sheridan C, Serrat R, Rothe F. Life-course transitions and exclusion from social relations in the lives of older men and women. J Aging Stud 2023; 67:101188. [PMID: 38012947 DOI: 10.1016/j.jaging.2023.101188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 10/08/2023] [Accepted: 10/13/2023] [Indexed: 11/29/2023]
Abstract
There is increasing interest across European contexts in promoting active social lives in older age, and counteracting pathways and outcomes related to social isolation and loneliness for men and women in later life. This is evidenced within national and European level policy, including the 2021 Green Paper on Ageing and its concern with understanding how risks can accrue for European ageing populations in the relational sphere. Research indicates that life-course transitions can function as a source of these risks, leading to a range of potentially exclusionary impacts for the social relations of older men and women. Findings presented in this paper are drawn from the qualitative component of a larger European mixed-methods study on exclusion from social relations (GENPATH: A life course perspective on the GENdered PATHways of social exclusion in later life, and its consequences for health and well-being). We use data from 119 in-depth interviews from four jurisdictions: Austria, Czechia, Ireland and Spain. This research employed an approach that focused on capturing lived experienced insights related to relational change across the life course, the implications of these changes for multifaceted forms of exclusion from social relations and the role of gender in patterning these changes and implications. We focused on transitions that commonly emerged across those jurisdictions for older people: onset of ill-health, bereavement, retirement and relocation. We found that these transitions translate into multidimensional experiences of exclusion from social relations in the lives of older men and women by constraining their social networks, support networks, social opportunities and intimate relationships.
Collapse
Affiliation(s)
- Anna Urbaniak
- University of Vienna, Sociology Department, Rooseveltplatz 2, 1090 Vienna, Austria; Uniwersytet Ekonomiczny w Krakowie, ul. Rakowicka 27, 31-510 Kraków, Poland.
| | - Kieran Walsh
- National University of Ireland, Galway, NUI Galway, Irish Centre for Social Gerontology, Institute for Lifecourse & Society, Corrib Village, Ireland.
| | - Lucie Galčanová Batista
- Masaryk University, Faculty of Social Studies, Office for Population Studies, Dpt. of Sociology, Jostova 10, 60200 Brno, Czechia.
| | - Marcela Petrová Kafková
- Masaryk University, Faculty of Social Studies: Brno, Czechia, Joštova 218, 602 00 Brno-střed, Czechia.
| | - Celia Sheridan
- National University of Ireland, Galway, NUI Galway, Irish Centre for Social Gerontology, Institute for Lifecourse & Society, Corrib Village, Ireland.
| | - Rodrigo Serrat
- University of Barcelona, Department of Cognition, Development and Educational Psychology, Barcelona, Spain.
| | - Franziska Rothe
- NOVA Norwegian Social Research, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, NO-0130 Oslo, Norway.
| |
Collapse
|
16
|
Fang F, Hughes TF, Weinstein A, Dodge HH, Jacobsen EP, Chang CCH, Snitz BE, Ganguli M. Social Isolation and Loneliness in a Population Study of Cognitive Impairment: The MYHAT Study. J Appl Gerontol 2023; 42:2313-2324. [PMID: 37518906 PMCID: PMC10825064 DOI: 10.1177/07334648231192053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
In this study, we examined associations of social isolation and loneliness with cognitive impairment among older adults from a Rust Belt region in Southwest Pennsylvania. We used data from the population-based Monongahela-Youghiogheny Healthy Aging Team (MYHAT) study. We found that (a) 11 items combined into two reliable composites of social isolation and loneliness; (b) unique to this study, providing unpaid help to others was an indicator of reduced social isolation; (c) social isolation and loneliness were positively associated with cognitive impairment; and (d) these associations were appreciably attenuated by general health and physical functional status and depressive symptoms, respectively. We concluded that social isolation and loneliness are differentially associated with older adults' cognitive health, and that their effects might operate through separate pathways. Approaches to address social isolation and loneliness should consider the community context and its implications for older adults' cognitive health.
Collapse
Affiliation(s)
- Fang Fang
- Research and Infrastructure Research Service (RISE) and Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Tiffany F. Hughes
- Department of Graduate Studies in Health and Rehabilitation Sciences, Bitonte College of Health and Human Services, Youngstown State University, Youngstown, OH, USA
| | - Andrea Weinstein
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hiroko H. Dodge
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Erin P. Jacobsen
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chung-Chou H. Chang
- Department of Medicine, and Department of Biostatistics, School of Medicine and School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beth E. Snitz
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Ganguli
- Departments of Psychiatry, Neurology, and Epidemiology, School of Medicine and School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
17
|
Suen AO, Iyer AS, Cenzer I, Farrand E, White DB, Singer J, Sudore R, Kotwal A. National Prevalence of Social Isolation and Loneliness in Adults with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2023; 20:1709-1717. [PMID: 37463307 PMCID: PMC10704233 DOI: 10.1513/annalsats.202304-288oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/17/2023] [Indexed: 07/20/2023] Open
Abstract
Rationale: Social isolation and loneliness are gaining recognition for their role in health outcomes, yet they have not been defined in people with chronic obstructive pulmonary disease (COPD). Objective: To determine the national prevalence of and characteristics associated with social isolation and loneliness in people with COPD. Methods: This is a cross-sectional study of community-dwelling adults aged ⩾50 years in the nationally representative HRS (Health and Retirement Study) (2016-2018). Participants self-reported COPD and supplemental oxygen use and were categorized into three groups: 1) no COPD; 2) COPD; and 3) COPD on oxygen. Social isolation was defined using a nine-item scale indicating minimal household contacts, social network interaction, and community engagement. Loneliness was measured using the 3-Item UCLA Loneliness Scale. Multivariable logistic regression defined prevalence and associated characteristics for both. Results: Participants (n = 10,384) were on average 68 years old (standard deviation, ±10.5), 54% female, 10% Black, 11% self-reported COPD, and 2% self-reported supplemental oxygen. Overall, 12% were socially isolated, 12% lonely, and 3% both socially isolated and lonely. People with COPD had a higher adjusted prevalence of social isolation (no COPD: 11%; COPD: 16%; COPD on oxygen: 20%; P < 0.05) and loneliness (no COPD: 11%; COPD: 18%; COPD on oxygen: 22%; P < 0.001). In those with COPD, characteristics associated with social isolation (P < 0.05) included sex (men: 22%; women: 13%), non-Hispanic White ethnicity (White: 19%; Black: 7%), low net worth (<$6,000: 32%; $81,001-$239,000: 10%), depression (depression: 24%; no depression: 14%), having difficulty with one or more activities of daily living (one or more difficulty: 22%; no difficulty: 14%), and current cigarette use (current: 24%; never: 13%). Characteristics associated with loneliness (P < 0.05) included younger age (50-64 yr: 22%; 75-84 yr: 12%), being single (single: 32%; married: 12%), depression (depression: 36%; no depression: 13%), having difficulty with one or more activities of daily living (one or more difficulty: 29%; no difficulty: 15%), diabetes (diabetes: 26%; no diabetes: 17%), and heart disease (heart disease 23%; no heart disease: 17%). Conclusions: Nearly one in six adults with COPD experience social isolation, and one in five experience loneliness, with almost twice the prevalence among those on supplemental oxygen compared with the general population. Demographic and clinical characteristics identify those at highest risk to guide clinical and policy interventions.
Collapse
Affiliation(s)
- Angela O. Suen
- Division of Pulmonary, Allergy, and Critical Care Medicine
| | - Anand S. Iyer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Center for Palliative and Supportive Care, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Irena Cenzer
- Division of Geriatrics, and
- Division of Palliative Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Erica Farrand
- Division of Pulmonary, Allergy, and Critical Care Medicine
| | - Douglas B. White
- Program on Ethics and Decision Making in Critical Illness, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Rebecca Sudore
- Division of Geriatrics, and
- Division of Palliative Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Ashwin Kotwal
- Division of Geriatrics, and
- Division of Palliative Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| |
Collapse
|
18
|
Pavlidou E, Papadopoulou SK, Antasouras G, Vorvolakos T, Alexatou O, Tsourouflis G, Angelakou EP, Serdari A, Grammatikopoulou MG, Psara E, Vadikolias K, Dakanalis A, Lefantzis N, Giaginis C. Association of COVID-19 Infection with Sociodemographic, Anthropometric and Lifestyle Factors: A Cross-Sectional Study in an Older Adults' Population Aged over 65 Years Old. Diseases 2023; 11:165. [PMID: 37987276 PMCID: PMC10660554 DOI: 10.3390/diseases11040165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to unfavorable disruptions to daily living routines by exerting deleterious effects on several aspects of human mental and physical health and quality of life worldwide. The purpose of the current survey is to explore the potential association of COVID-19 infection with multiple sociodemographic, anthropometric, and lifestyle factors of community-dwelling older adults. METHODS This is a cross-sectional survey including 5197 older adults aged over 65 years old from 10 geographically diverse regions of Greece. Relevant questionnaires were used to record study the population sociodemographic factor, while anthropometric parameters were also measured. Validated questionnaires were also applied to assess several lifestyle factors such as depression, anxiety, stress, cognitive status, sleep quality, health-related quality of life, physical activity levels, and Mediterranean diet (MD) adherence. RESULTS In multivariate regression analysis, COVID-19 infection was significantly, independently related with urban residence (p = 0.0107), regular smoking (p = 0.0218), overweight status and obesity (p = 0.0036), as well as abdominal obesity (p = 0.0008), higher risk of depression (p = 0.0027), anxiety (p = 0.0045), stress (p = 0.0038), inadequate sleep quality (p = 0.0108), lower physical activity levels (p = 0.0012), reduced MD compliance (p = 0.0009), and poor health-related quality of life (p = 0.0002). In univariate analysis, older adults' age (p = 0.0001), male gender (p = 0.0015), living alone (p = 0.0023), lower educational and economic level (p = 0.0175 and p = 0.0294, respectively), and cognition decline (p = 0.0032) were also related with the presence of COVID-19 infection; however, these associations were considerably attenuated at a non-significant level by adjustment for several confounders in multivariate analysis. CONCLUSIONS This is one of the few available studies supporting evidence that COVID-19 infection may be associated with diverse sociodemographic, anthropometric, and lifestyle factors in an older adults' population in Greece. This study highlights the strong demand to provide psychological and nutritional counselling and support to older adults diagnosed with COVID-19 infection in order to ameliorate disease symptoms and severity, emphasizing the adaptation of healthy dietary and lifestyle habits as preventing and supplementary therapeutic factors against COVID-19.
Collapse
Affiliation(s)
- Eleni Pavlidou
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Greece; (E.P.); (G.A.); (O.A.); (E.-P.A.); (E.P.); (C.G.)
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Georgios Antasouras
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Greece; (E.P.); (G.A.); (O.A.); (E.-P.A.); (E.P.); (C.G.)
| | - Theofanis Vorvolakos
- Department of Geriatric Psychiatry, University Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandoupoli, Greece;
| | - Olga Alexatou
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Greece; (E.P.); (G.A.); (O.A.); (E.-P.A.); (E.P.); (C.G.)
| | - Gerasimos Tsourouflis
- Second Department of Propedeutic Surgery, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Exakousti-Petroula Angelakou
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Greece; (E.P.); (G.A.); (O.A.); (E.-P.A.); (E.P.); (C.G.)
| | - Aspasia Serdari
- Department of Psychiatry and Child Psychiatry, University Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandroupoli, Greece;
| | - Maria G. Grammatikopoulou
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, School of Health Sciences, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
| | - Evmorfia Psara
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Greece; (E.P.); (G.A.); (O.A.); (E.-P.A.); (E.P.); (C.G.)
| | - Konstantinos Vadikolias
- Department of Neurology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupoli, Greece;
| | - Antonios Dakanalis
- Department of Mental Health and Addiction, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
- Department of Medicine and Surgery, University of Milan Bicocca, Via Cadore 38, 20900 Monza, Italy
| | - Nikolaos Lefantzis
- Department of Oral and Maxillofacial Surgery, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Chaidari, 12462 Athens, Greece;
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Greece; (E.P.); (G.A.); (O.A.); (E.-P.A.); (E.P.); (C.G.)
| |
Collapse
|
19
|
Katanga JA, Hamilton CA, Walker L, Attems J, Thomas AJ. Age-related hearing loss and dementia-related neuropathology: An analysis of the United Kingdom brains for dementia research cohort. Brain Pathol 2023; 33:e13188. [PMID: 37551936 PMCID: PMC10580004 DOI: 10.1111/bpa.13188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/26/2023] [Indexed: 08/09/2023] Open
Abstract
Age-related hearing loss frequently precedes or coexists with mild cognitive impairment and dementia. The role specific neuropathologies play in this association, as either a cause or a consequence, is unclear. We therefore aimed to investigate whether specific dementia related neuropathologies were associated with hearing impairment in later life. We analysed data on ante-mortem hearing impairment with post-mortem neuropathological data for 442 participants from the Brains for Dementia Research Cohort. Binary logistic regression models were used to estimate the association of hearing impairment with the presence of each dementia-related neuropathology overall, and with specific staged changes. All analyses adjusted for age and sex, and several sensitivity analyses were conducted to test the robustness of findings. Presence and density of neuritic plaques were associated with higher odds of hearing impairment ante-mortem (OR = 3.65, 95% CI 1.78-7.46 for frequent density of plaques). Presence of any LB disease was likewise associated with hearing impairment (OR = 2.10, 95% CI 1.27-3.48), but this did not increase with higher cortical pathology (OR = 1.53, 95% CI 0.75-3.11). Nonspecific amyloid deposition, neurofibrillary tangle staging, overall AD neuropathology level, and cerebrovascular disease were not clearly associated with increased risks of hearing impairment. Our results provide some support for an association between dementia-related neuropathology and hearing loss and suggest that hearing loss may be associated with a high neuritic plaque burden and more common in Lewy body disease.
Collapse
Affiliation(s)
- Jessica A. Katanga
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Calum A. Hamilton
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Lauren Walker
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Johannes Attems
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Alan J. Thomas
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| |
Collapse
|
20
|
Hsu KY, Cenzer I, Harrison KL, Ritchie CS, Waite L, Kotwal A. In sickness and in health: Loneliness, depression, and the role of marital quality among spouses of persons with dementia. J Am Geriatr Soc 2023; 71:3538-3545. [PMID: 37539784 PMCID: PMC10838362 DOI: 10.1111/jgs.18520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/06/2023] [Accepted: 07/01/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Older adults married to persons living with dementia (PLwD) may be at risk for loneliness and depression. We assessed the prevalence of loneliness and depressive symptoms among spouses of PLwD or cognitive impairment not dementia (CIND), and the role of marital quality in mediating these outcomes. METHODS We used a US population-based sample of 4071 couples enrolled in the Health and Retirement Study (2014 and 2016). We included older adults married to PLwD (N = 227), married to persons with CIND (N = 885), or married to persons with no cognitive impairment (NCI) (N = 2959). We determined the prevalence of loneliness (UCLA 3-item scale), depressive symptoms (CESD-8 scale), and both, using multivariable logistic regression adjusting for sociodemographic and health-related characteristics. We then tested for interaction terms between marital quality (4-item scale) and degree of spousal cognitive impairment for each outcome of loneliness and depressive symptoms. RESULTS The sample was 55% women and on average 67-years-old (range: 50-97). After adjustment, spouses of persons with cognitive impairment were more likely to be lonely (NCI: 20%, CIND: 23%, PLwD: 29%; p = 0.04), depressed (NCI: 8%, CIND: 15%, PLwD: 14%; p < 0.01), and both (NCI: 4%, CIND: 9%, PLwD: 7%; p < 0.01). The association between cognition and loneliness, but not depression, differed by marital quality (interaction p-value = 0.03). Among couples with high marital quality, spousal cognitive impairment was associated with higher likelihood of loneliness (p < 0.05). In contrast, no association existed between spousal cognition and loneliness among couples with lower marital quality (p = 0.37). CONCLUSIONS One in six spouses of persons with CIND or more advanced disease (PLwD) experienced depressive symptoms, and loneliness among spouses of PLwD was experienced at a twofold rate. By identifying and managing both, and facilitating interventions that promote high-quality social connection, clinical teams might improve the lives of older couples facing dementia.
Collapse
Affiliation(s)
- Kristie Y. Hsu
- Division of Internal Medicine, University of California, San Francisco, CA
| | - Irena Cenzer
- Division of Geriatrics, University of California, San Francisco, CA
| | - Krista L. Harrison
- Division of Geriatrics, University of California, San Francisco, CA
- Global Brain Health Institute, University of California, San Francisco, CA
| | - Christine S. Ritchie
- Massachusetts General Hospital Division of Palliative Care and Geriatric Medicine and Harvard Medical School, Boston, MA
- The Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA
| | - Linda Waite
- Department of Sociology, University of Chicago, Chicago, IL
| | - Ashwin Kotwal
- Division of Geriatrics, University of California, San Francisco, CA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs, San Francisco, CA
| |
Collapse
|
21
|
Ogliari G, Ryg J, Andersen-Ranberg K, Scheel-Hincke LL, Collins JT, Cowley A, Di Lorito C, Booth V, Smit RAJ, Akyea RK, Qureshi N, Walsh DA, Harwood RH, Masud T. Association between pain intensity and depressive symptoms in community-dwelling adults: longitudinal findings from the Survey of Health, Ageing and Retirement in Europe (SHARE). Eur Geriatr Med 2023; 14:1111-1124. [PMID: 37450107 PMCID: PMC10587243 DOI: 10.1007/s41999-023-00835-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To investigate the longitudinal associations between pain and depressive symptoms in adults. METHODS Prospective cohort study on data from 28,515 community-dwelling adults ≥ 50 years, free from depression at baseline (Wave 5), with follow-up in Wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE). Significant depressive symptoms were defined by a EURO-D score ≥ 4. The longitudinal association between baseline pain intensity and significant depressive symptoms at follow-up was analysed using logistic regression models; odds ratios (ORs) and confidence intervals (CI) were calculated, adjusting for socio-demographic and clinical factors, physical inactivity, loneliness, mobility and functional impairments. RESULTS Mean age was 65.4 years (standard deviation 9.0, range 50-99); 14,360 (50.4%) participants were women. Mean follow-up was 23.4 (standard deviation 3.4) months. At baseline, 2803 (9.8%) participants reported mild pain, 5253 (18.4%) moderate pain and 1431 (5.0%) severe pain. At follow-up, 3868 (13.6%) participants-1451 (10.3%) men and 2417 (16.8%) women-reported significant depressive symptoms. After adjustment, mild, moderate and severe baseline pain, versus no pain, were associated with an increased likelihood of significant depressive symptoms at follow-up: ORs (95% CI) were 1.20 (1.06-1.35), 1.32 (1.20-1.46) and 1.39 (1.19-1.63), respectively. These associations were more pronounced in men compared to women, and consistent in participants aged 50-64 years, those without mobility or functional impairment, and those without loneliness at baseline. CONCLUSION Higher baseline pain intensity was longitudinally associated with a greater risk of significant depressive symptoms at 2-year follow-up, in community-dwelling adults without baseline depression.
Collapse
Affiliation(s)
- Giulia Ogliari
- Department of Health Care of Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, Nottinghamshire, NG7 2UH, UK
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Karen Andersen-Ranberg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark
| | - Lasse Lybecker Scheel-Hincke
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark
| | - Jemima T Collins
- Department of Health Care of Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, Nottinghamshire, NG7 2UH, UK
- University of Nottingham, Nottingham, UK
| | - Alison Cowley
- University of Nottingham, Nottingham, UK
- Research & Innovation, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Claudio Di Lorito
- Division of Primary Care and Population Health, University College London, London, UK
| | - Vicky Booth
- University of Nottingham, Nottingham, UK
- Research & Innovation, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Roelof A J Smit
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Building 7 (Maersk Tower), 2200, Copenhagen, Denmark
| | - Ralph K Akyea
- Primary Care Stratified Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nadeem Qureshi
- Primary Care Stratified Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - David A Walsh
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
- Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, UK
| | - Rowan H Harwood
- Department of Health Care of Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, Nottinghamshire, NG7 2UH, UK.
- University of Nottingham, Nottingham, UK.
- NIHR Applied Research Collaboration-East Midlands, Nottingham, UK.
| | - Tahir Masud
- Department of Health Care of Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, Nottinghamshire, NG7 2UH, UK
- NIHR Applied Research Collaboration-East Midlands, Nottingham, UK
| |
Collapse
|
22
|
Liu J, Lin Z. Race/Ethnicity, Nativity, and Gender Disparities in Mental Health Trajectories from Mid- to Later-Life: A Life Course-Intersectional Approach. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01808-x. [PMID: 37755686 DOI: 10.1007/s40615-023-01808-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/29/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Numerous studies have highlighted mental health disparities based on race/ethnicity, nativity, and gender across different life stages. However, few have investigated how the intersectionality of these factors influences mental health trajectories during midlife to late life. This study fills this gap by adopting a life course-intersectional approach, viewing mental health trajectories as dynamic processes shaped by the combined influences of race/ethnicity, nativity, and gender. It explores social, psychological, and physiological pathways contributing to these disparities. DESIGN Using data from the Health and Retirement Study (2006-2018; N = 38,049 observations) and growth curve models, this study examines how intra-individual trends in depressive symptoms (measured as CES-D scale, 07) are influenced by the intersection of race/ethnicity, nativity, and gender. It also investigates the impact of objective and subjective social isolation and physical health on group disparities in mental health trajectories. RESULTS The findings reveal that, during mid- to early late-life, most Black and Hispanic Americans experience higher levels of depressive symptoms compared to their White counterparts (disparities ranging from 0.184 to 0.463 for men and 0.117 to 0.439 for women). However, this disadvantage diminishes for US-born Hispanic men and US-born Black women (0.014-0.031 faster decrease rates compared to US-born White), while it intensifies for Hispanic immigrants (0.017-0.018 slower decrease rates compared to US-born White) in advanced ages. Mediation analysis demonstrates that both social isolation and physical health contribute to these disparities, with physical health explaining a larger portion, particularly in differences between immigrant Hispanic women and US-born Whites. CONCLUSION This study underscores the importance of a life course-intersectional approach in understanding mental health disparities. It emphasizes the need for improved social welfare systems and community-level interventions targeting the specific challenges faced by older Hispanic immigrants, especially women who encounter multiple forms of oppression.
Collapse
Affiliation(s)
- Jingwen Liu
- Department of Sociology, University of Maryland, 3834 Campus Dr., Parren Mitchell Art-Sociology Building, College Park, MD, 20742, USA.
| | - Zhiyong Lin
- Department of Sociology, University of Texas at San Antonio, One UTSA Circle, MS 4.02.66, San Antonio, TX, 78249, USA
- Population Research Center, University of Texas at Austin, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712, USA
| |
Collapse
|
23
|
Solomonov N, Green J, Quintana A, Lin J, Ognyanova K, Santillana M, Druckman JN, Baum MA, Lazer D, Gunning FM, Perlis RH. A 50-state survey study of thoughts of suicide and social isolation among older adults in the United States. J Affect Disord 2023; 334:43-49. [PMID: 37086804 PMCID: PMC10751855 DOI: 10.1016/j.jad.2023.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/26/2023] [Accepted: 04/14/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND We aimed to characterize the prevalence of social disconnection and thoughts of suicide among older adults in the United States, and examine the association between them in a large naturalistic study. METHODS We analyzed data from 6 waves of a fifty-state non-probability survey among US adults conducted between February and December 2021. The internet-based survey collected the PHQ-9, as well as multiple measures of social connectedness. We applied multiple logistic regression to analyze the association between presence of thoughts of suicide and social disconnection. Exploratory analysis, using generalized random forests, examined heterogeneity of effects across sociodemographic groups. RESULTS Of 16,164 survey respondents age 65 and older, mean age was 70.9 (SD 5.0); the cohort was 61.4 % female and 29.6 % male; 2.0 % Asian, 6.7 % Black, 2.2 % Hispanic, and 86.8 % White. A total of 1144 (7.1 %) reported thoughts of suicide at least several days in the prior 2 week period. In models adjusted for sociodemographic features, households with 3 or more additional members (adjusted OR 1.73, 95 % CI 1.28-2.33) and lack of social supports, particularly emotional supports (adjusted OR 2.60, 95 % CI 2.09-3.23), were independently associated with greater likelihood of reporting such thoughts, as was greater reported loneliness (adjusted OR 1.75, 95 % CI 1.64-1.87). The effects of emotional support varied significantly across sociodemographic groups. CONCLUSIONS Thoughts of suicide are common among older adults in the US, and associated with lack of social support, but not with living alone. TRIAL REGISTRATION NA.
Collapse
Affiliation(s)
- Nili Solomonov
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, New York, NY, United States of America
| | - Jon Green
- Northeastern University, Boston, MA, United States of America
| | - Alexi Quintana
- Northeastern University, Boston, MA, United States of America
| | - Jennifer Lin
- Northwestern University, Evanston, IL, United States of America
| | | | - Mauricio Santillana
- Harvard Medical School, Boston, MA, United States of America; Boston Children's Hospital, Boston, MA, United States of America
| | | | - Matthew A Baum
- Massachusetts General Hospital, Boston, MA, United States of America
| | - David Lazer
- Northwestern University, Evanston, IL, United States of America
| | - Faith M Gunning
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, New York, NY, United States of America
| | - Roy H Perlis
- Harvard University, Cambridge, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Massachusetts General Hospital, Boston, MA, United States of America.
| |
Collapse
|
24
|
Ritchie CS, Kotwal AA. Loneliness and Social Isolation in Palliative Care: A Call to Action. J Palliat Med 2023; 26:1032-1034. [PMID: 37579234 PMCID: PMC11079500 DOI: 10.1089/jpm.2023.0425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Affiliation(s)
- Christine S. Ritchie
- Massachusetts General Hospital Division of Palliative Care and Geriatric Medicine and Harvard Medical School, Boston, Massachusetts, USA
- The Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ashwin A. Kotwal
- Division of Geriatrics, University of California, San Francisco, California, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs, San Francisco, California, USA
| |
Collapse
|
25
|
Kuang K, Huisingh-Scheetz M, Miller MJ, Waite L, Kotwal AA. The association of gait speed and self-reported difficulty walking with social isolation: A nationally-representative study. J Am Geriatr Soc 2023; 71:2549-2556. [PMID: 37000466 PMCID: PMC10524495 DOI: 10.1111/jgs.18348] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/21/2023] [Accepted: 03/07/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Mobility assessments are commonly used among older adults as risk stratification for falls, preoperative function, frailty, and mortality. We determined if gait speed and self-reported difficulty walking are similarly associated with social isolation and loneliness, which are key markers of social well-being and linked to health outcomes. METHODS We used 2015-2016 data from the National Social life Health and Aging Project (NSHAP), an in-person nationally-representative survey of 2640 community-dwelling adults ≥65 years old. We measured gait speed (timed 3-m walk: unable to walk, ≥5.7 s, and <5.7 s), and self-reported difficulty walking one block or across the room (unable, "much," "some," or "no" difficulty). Social measures included loneliness (3-item UCLA scale), social isolation (12-item scale), and individual social activities (frequency socializing, religious participation, community participation, and volunteering). We used logistic regression to determine the adjusted probability of each social measure by gait speed and difficulty walking, adjusting for sociodemographic and health characteristics, and tested for interaction terms with age. RESULTS Participants were on average 75 years old (SD = 7.1), 54% female, 9% Black/African American, and 6% Hispanic. Difficulty walking one block was associated with (p < 0.05): social isolation (much difficulty: 26% vs no difficulty: 18%), low socializing (33% vs 19%), low volunteering (67% vs 53%), low community participation (54% vs 43%), low religious participation (51% vs 46%), and loneliness (25% vs 14%). Difficulty walking across the room was similarly strongly associated with social isolation and individual activities. The association between self-reported difficulty walking and social isolation was stronger at older ages (p-value of interaction <0.001). CONCLUSIONS Self-reported mobility difficulty is a widely used clinical assessment that is strongly associated with loneliness and social isolation, particularly at older ages. Among persons with limited mobility, clinicians should consider a careful social history to identify social needs and interventions addressing mobility to enhance social connections.
Collapse
Affiliation(s)
- Kathy Kuang
- University of Arizona College of Medicine – Tucson, Tucson, AZ
| | - Megan Huisingh-Scheetz
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL
| | - Matthew J. Miller
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA, USA
| | - Linda Waite
- Department of Sociology, University of Chicago, Chicago, IL
| | - Ashwin A. Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center
| |
Collapse
|
26
|
Balki E, Hayes N, Holland C. Loneliness and older adults: psychological resilience and technology use during the COVID-19 pandemic-a cross sectional study. FRONTIERS IN AGING 2023; 4:1184386. [PMID: 37434741 PMCID: PMC10331608 DOI: 10.3389/fragi.2023.1184386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023]
Abstract
Introduction: This study investigated how psychological resilience influenced greater technology use among older adults, and whether they moderated the impact of social isolation on loneliness during the COVID-19 pandemic. We also explored whether technology mediates the impact of psychological resilience on loneliness. To explain the relationship between variables, the research drew upon the socio-emotional selective theory, which posits the notion that older adults are more focused on current and emotionally important relationships and goals concerning emotional regulation goals such as psychological well-being. Methods: Using a cross-sectional observational design, data were collected from 92 residents aged 65 to 89 in England from March 2020 to June 2021. Participants completed the Connor-Davidson Resilience Scale, Technology Experience Questionnaire, UCLA Loneliness Scale, and Lubben Social Network Index. Pearson correlation, mediation and moderation analyses were conducted to investigate the hypotheses. Results: Most participants experienced moderate to severe levels of loneliness, displaying higher levels than pre-pandemic. Psychological resilience predicted greater technology use, and lower levels of loneliness. Technology was found to mediate the relationship between psychological resilience and loneliness. Neither technology use, nor psychological resilience was found to moderate the impact of social isolation on loneliness. Discussion: Findings suggested that strategies directed towards screening older adults for psychological resilience levels and low technology experience may help identify those most at risk for adapting poorly when exposed to stressors in situations like the Covid-19 pandemic. Early interventions can be initiated to increase psychological resilience and technology use, including empirical interventions, that may help decrease loneliness, especially in times of elevated risks for loneliness.
Collapse
Affiliation(s)
- Eric Balki
- Centre for Ageing Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Niall Hayes
- The Directorate, Nottingham Trent University, Nottingham, United Kingdom
| | - Carol Holland
- Centre for Ageing Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| |
Collapse
|
27
|
Loh KP, McLaughlin EM, Krok-Schoen JL, Odejide OO, El-Jawahri A, Qi L, Shadyab AH, Johnson LG, Paskett ED. Correlates of common concerns in older cancer survivors of leukemia and lymphoma: results from the WHI LILAC study. J Cancer Surviv 2023; 17:769-780. [PMID: 35982359 PMCID: PMC9938088 DOI: 10.1007/s11764-022-01249-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Older survivors of leukemia and lymphoma often experience long-term effects of chemotherapy. We described common concerns related to their cancer and treatment in older survivors of leukemia and non-Hodgkin lymphoma (NHL) and assessed correlates of these concerns. METHODS We utilized data from the Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) study that recruited post-menopausal women aged 50-79. Participants diagnosed with leukemia and NHL were included (n = 420). They were asked about 14 areas of current concerns related to their cancer and treatment and to rate each from 0 (no concern) to 2 (major concern), with total scores ranging from 0 to 28. Linear regression was used to assess factors correlated with the concern score, and logistic regression for factors correlated with the three most common concerns. RESULTS Mean age at assessment was 81 years (range 69-99); 72% reported at least one concern, and median concern score among these survivors was 3.5 (Q1-Q3 2-5). Factors significantly correlated with concern scores were sadness, pain, distress, higher prior symptom count, and loneliness (all p < 0.05). Significant factors correlated with common concerns were (1) fatigue/sleep: sadness/depression, distress, higher prior symptom count, greater loneliness, and worse physical functioning; (2) physical functioning/activity: older age, public insurance, higher body mass index, pain, worse QoL, and higher treatment-related comorbidities; (3) memory/concentration: prior chemotherapy or radiation, worse QoL, higher prior symptom count, and greater loneliness (all p < 0.05). CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS Almost three-quarters of older survivors of leukemia and lymphoma reported at least one concern; a multifaceted intervention may be needed to address these concerns.
Collapse
Affiliation(s)
- Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA.
| | - Eric M McLaughlin
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Jessica L Krok-Schoen
- Division of Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Oreofe O Odejide
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Center for Lymphoma, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Areej El-Jawahri
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lihong Qi
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Lisa G Johnson
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Electra D Paskett
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
28
|
Kotwal AA, Cenzer IS, Yaffe K, Perissinotto C, Smith AK. End-of-life health care use among socially isolated and cognitively impaired older adults. J Am Geriatr Soc 2023; 71:880-887. [PMID: 36420540 PMCID: PMC10023302 DOI: 10.1111/jgs.18131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Social isolation is common in the last years of life, especially among individuals with cognitive impairment (CI), but it is unknown if social isolation is related to end-of-life health care use. METHODS We used nationally-representative 2006-2018 Health and Retirement Study (HRS) data linked to Medicare claims, including adults age ≥65 interviewed in the last 4 years of life (N = 2380). We used a validated social isolation scale and three social isolation subscales: (1) household contacts (marital status, household size, nearby children), (2) social network interaction (with children, family, and friends), and (3) community engagement. End-of-life health outcomes included 2+ emergency department (ED) visits in the last month of life, hospitalizations or ICU stays in the last 6 months of life, and any hospice use. CI was defined using the validated Langa-Weir methodology. We used logistic regression to test the association of each social isolation measure with each end-of-life outcome, adjusted for sociodemographic covariates, and tested for interaction terms with CI (p < 0.2). RESULTS The mean age of our sample of decedents was 81.2 (SD = 9.9), 53% were female, 8% Black, and 4% Hispanic. Overall, social isolation and the community engagement subscale were not associated with end-of-life health care use. Fewer household contacts were associated with lower hospice use (aOR = 0.74, p = 0.005). There were significant interaction terms between the social network interaction subscale and CI for ED use (p = 0.009) and hospitalizations (p = 0.04), and a trend for ICU stays (p = 0.15); individuals with both low social network interaction and CI had lower health care use across all three outcomes compared to other groups. CONCLUSIONS Individuals with fewer household contacts had lower hospice use, and cognitively impaired individuals with low social network interaction had fewer end-of-life ED visits, hospitalizations, and ICU stays. Clinicians should consider mobilizing external support services to ensure access to goal-concordant care for older adults with limited end-of-life social contact when needed.
Collapse
Affiliation(s)
- Ashwin A Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Health System, San Francisco, California, USA
| | - Irena S Cenzer
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Health System, San Francisco, California, USA
| | - Kristine Yaffe
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Health System, San Francisco, California, USA
- Departments of Psychiatry & Neurology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Carla Perissinotto
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Health System, San Francisco, California, USA
| |
Collapse
|
29
|
Factors Associated With Social Isolation in Older Adults: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2023; 24:322-330.e6. [PMID: 36549651 DOI: 10.1016/j.jamda.2022.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Social isolation is a global health issue that affects older adults throughout their lives. This study aimed to identify the factors associated with social isolation in older adults. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS Adults aged 60 years and older. METHODS We searched for observational studies without language restrictions in 11 databases from inception to August 2022. Pooled odds ratio (OR) and 95% CI were calculated using the R software (version 4.2.1). The modified Newcastle-Ottawa Scale was used to evaluate the risk of bias. RESULTS Eighteen factors were grouped into 5 themes. The following 13 factors were statistically significant: (1) demographics theme: aged 80 years and older (OR: 2.41; 95% CI: 1.20-4.85), less than or equal to a high school degree (OR: 1.68; 95% CI: 1.44-1.97), smoking (OR: 1.43; 95% CI: 1.18-1.73), and male (OR: 1.38; 95% CI: 1.01-1.89); (2) environment theme: low social support (OR: 7.77; 95% CI: 3.45-17.50) and no homeownership (OR: 1.38; 95% CI: 1.25-1.51); (3) role theme: no social participation (OR: 3.18; 95% CI: 1.30-7.80) and no spouse (OR: 2.61; 95% CI: 1.37-4.99); (4) physical health: hearing loss (OR: 2.78; 95% CI: 1.54-5.01), activities of daily living impairment (OR: 2.38; 95% CI: 1.57-3.61), and poor health status (OR: 1.52; 95% CI: 1.32-1.74); and (5) mental health: cognitive decline (OR: 1.85; 95% CI: 1.40-2.45) and depression (OR: 1.72; 95% CI: 1.21-2.44). CONCLUSIONS AND IMPLICATIONS Social isolation in older adults is associated with various factors. Hence, focused intervention should be adopted for older adults. In addition, further longitudinal studies are required to confirm a direct link between multiple factors and social isolation.
Collapse
|
30
|
Huang AR, Roth DL, Cidav T, Chung SE, Amjad H, Thorpe RJ, Boyd CM, Cudjoe TK. Social isolation and 9-year dementia risk in community-dwelling Medicare beneficiaries in the United States. J Am Geriatr Soc 2023; 71:765-773. [PMID: 36628523 PMCID: PMC10023331 DOI: 10.1111/jgs.18140] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/26/2022] [Accepted: 10/26/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Social isolation can influence whether older adults develop dementia. We examine the association between social isolation and incident dementia among older adults in a nationally representative sample of community dwelling older adults in the United States (U.S.). We also investigate whether this association varies by race and ethnicity. METHODS Data (N = 5022) come from the National Health and Aging Trends Study, a longitudinal and nationally representative cohort of older adults in the U.S. A composite measure of social isolation was used to classify older adults as socially isolated or not socially isolated at baseline. Demographic and health factors were measured at baseline via self-report. Dementia was measured at each round of data collection. Discrete-time proportional hazard time-to-event models were used to assess the association between social isolation and incident dementia over 9 years (2011-2020). RESULTS Of 5022 older adults, 1172 (23.3%) were socially isolated, and 3850 (76.7%) were not socially isolated. Adjusting for demographic and health factors, being socially isolated (vs. not socially isolated) was associated with a 1.28 (95% CI: 1.10-1.49) higher hazard of incident dementia over 9 years. There was no statistically significant difference by race and ethnicity. CONCLUSION Social isolation among older adults is associated with greater dementia risk. Elucidating the pathway by which social isolation impacts dementia may offer meaningful insights for the development of novel solutions to prevent or ameliorate dementia across diverse racial and ethnic groups.
Collapse
Affiliation(s)
- Alison R. Huang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David L. Roth
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tom Cidav
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shang-En Chung
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Halima Amjad
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roland J. Thorpe
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cynthia M. Boyd
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | |
Collapse
|
31
|
Sakurai R, Kawai H, Suzuki H, Ogawa S, Yanai S, Hirano H, Ito M, Ihara K, Obuchi S, Fujiwara Y. Cognitive, physical, and mental profiles of older adults with misplaced self-evaluation of hearing loss. Arch Gerontol Geriatr 2023; 104:104821. [PMID: 36116286 DOI: 10.1016/j.archger.2022.104821] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although inconsistency between objective and subjective hearing loss among older adults has been suggested, a systematic examination of the cognitive and physical functioning among such older adults is lacking. Our objective was to assess the cognitive, physical, and mental profiles associated with the discrepancy. METHODS The auditory acuity of 696 community-dwelling older adults was evaluated using a pure-tone average of hearing thresholds at 1.0 and 4.0 kHz in the better-hearing ear. Participants were then stratified as follows: normal hearing ≤ 25 dB, mild loss >25 dB and ≤40 dB, and moderate loss >40 dB and ≤70 dB. Global cognition, gait speed, and depressive symptoms were also assessed. RESULTS Among older adults, 63.5% of those with mild hearing loss and 22.2% of those with moderate hearing loss did not recognize hearing difficulties. Significantly lower cognition and gait performance were observed in those with moderate hearing loss without subjective hearing loss (i.e., overestimation of hearing acuity) than in those with subjective hearing loss. Furthermore, older adults with subjective hearing loss showed a higher tendency toward depression than those without subjective hearing loss, irrespective of objective hearing loss. CONCLUSIONS Our results suggest that failure to recognize a high level of age-related hearing loss may be related to impaired cognition and gait performance among older adults. Subjective hearing loss may indicate a tendency toward depression.
Collapse
Affiliation(s)
- Ryota Sakurai
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan.
| | - Hisashi Kawai
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Hiroyuki Suzuki
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Susumu Ogawa
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Shuichi Yanai
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Hirohiko Hirano
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Masayasu Ito
- Department of Removable Prosthodontics and Geriatric Oral Health, Nihon University School of Dentistry at Matusdo, 2-870-1 Sakae-cho-nishi, Matsudo city, Chiba 271-8587, Japan
| | - Kazushige Ihara
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori 036-8562, Japan
| | - Shuichi Obuchi
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Yoshinori Fujiwara
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| |
Collapse
|
32
|
Mavragani A, Eikey EV, De Leon C, Schueller SM, Schneider M, Stadnick NA, Zheng K, Wilson L, Caro D, Mukamel DB, Sorkin DH. Understanding the Role of Support in Digital Mental Health Programs With Older Adults: Users' Perspective and Mixed Methods Study. JMIR Form Res 2022; 6:e43192. [PMID: 36512387 PMCID: PMC9795392 DOI: 10.2196/43192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/08/2022] [Accepted: 11/18/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Digital mental health interventions have the potential to increase mental health support among isolated older adults. However, the older adult population can experience several barriers to accessing and using digital health resources and may need extra support to experience its benefits. OBJECTIVE This paper aimed to understand what older adults experience as an important aspect of support during engagement in a digital mental health program. The program entailed 3 months of staff support to participate in digital literacy training and engage with the digital mental health platform myStrength, which offers support for a range of mental health challenges, including depression and anxiety. METHODS A total of 30 older adults participated in surveys and interviews to assess their experience of participating in a digital mental health program provided by county mental health services. As part of the program, participants attended 4 classes of digital literacy training, had access to the digital mental health platform myStrength for 2 months with staff support (and 10 months after the program without support), and received support from program staff during the entire 3-month program. Survey data were analyzed using descriptive statistics, and interview data were analyzed using thematic analysis. RESULTS A thematic analysis of the interview data revealed that participants valued ongoing support in 3 main areas: technical support to assist them in using technology, guided support to remind them to use myStrength and practice skills they had learned, and social support to enable them to connect with others through the program. Furthermore, participants reported that social connections was the most important aspect of the program and that they were mainly motivated to participate in the program because it was recommended to them by trusted others such as a community partner or because they believed it could potentially help others. CONCLUSIONS Our findings can be used to inform the design of future digital mental health programs for older adults who may have unique support needs in terms of dedicated technical support and ongoing guided support to use technology and social support to increase social connectedness.
Collapse
Affiliation(s)
| | - Elizabeth V Eikey
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States.,The Design Lab, University of California, San Diego, La Jolla, CA, United States
| | - Cinthia De Leon
- Department of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Stephen M Schueller
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States.,Department of Informatics, University of California, Irvine, Irvine, CA, United States
| | - Margaret Schneider
- Department of Public Health, University of California, Irvine, Irvine, CA, United States
| | - Nicole A Stadnick
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla, CA, United States.,Child and Adolescent Services Research Center, San Diego, CA, United States
| | - Kai Zheng
- Department of Informatics, University of California, Irvine, Irvine, CA, United States
| | - Lorraine Wilson
- Department of Health and Human Services, County of Marin, San Rafael, CA, United States
| | - Damaris Caro
- Department of Health and Human Services, County of Marin, San Rafael, CA, United States
| | - Dana B Mukamel
- Department of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Dara H Sorkin
- Department of Medicine, University of California, Irvine, Irvine, CA, United States
| |
Collapse
|
33
|
Kotwal AA, Batio S, Wolf MS, Covinsky KE, Yoshino Benavente J, Perissinotto CM, O'Conor RM. Persistent loneliness due to COVID-19 over 18 months of the pandemic: A prospective cohort study. J Am Geriatr Soc 2022; 70:3469-3479. [PMID: 36054661 PMCID: PMC9539351 DOI: 10.1111/jgs.18010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/07/2022] [Accepted: 07/21/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Loneliness was common early in the COVID-19 pandemic due to physical distancing measures, but little is known about how loneliness persisted into later stages of the pandemic. We therefore examined longitudinal trajectories of loneliness over 18 months of the pandemic and subgroups at risk for persistent loneliness. METHODS We used data from the COVID-19 & Chronic Conditions study collected between March 27, 2020 to December 10, 2021, including 641 predominantly older adults with ≥1 chronic condition who completed six interviews at approximately 3 month intervals. Participants reported loneliness (defined as some, most, or all of the time) during the past week due to COVID-19. We used trajectory mixture models to identify clusters of individuals following similar trajectories of loneliness, then determined subgroups likely to be classified in different loneliness trajectories using multivariable regression models adjusted for sociodemographic and clinical covariates. RESULTS Participants were on average 63 years old, 61% female, 30% Black, 20% Latinx, and 29% were living below the poverty level. There was an overall reduction in loneliness over time (March to April/2020: 51% to September to December/2021: 31%, p = 0.01). Four distinct trajectory groups emerged: (1) "Persistent Loneliness" (n = 101, 16%); (2) "Adapted" (n = 141, 22%), individuals who were initially lonely, with feelings of loneliness decreasing over time; (3) "Occasional loneliness" (n = 189, 29%); and (4) "Never lonely" (n = 211, 33%). Subgroups at highest risk of the "Persistently Lonely" trajectory included those identifying as Latinx (aOR 2.5, 95% CI: 1.2, 5.2), or living in poverty (aOR 2.5; 95% CI: 1.4, 4.6). CONCLUSIONS Although loneliness declined for a majority of older adults during the pandemic in our sample, persistent loneliness attributed to the COVID-19 pandemic was common (1 in 6 adults), particularly among individuals identifying as Hispanic/Latinx or living in poverty. Interventions addressing loneliness can ease pandemic-related suffering, and may mitigate long-term mental and physical health consequences.
Collapse
Affiliation(s)
- Ashwin A Kotwal
- Division of Geriatrics, Department of Medicine, University of California, California, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, California, USA
| | - Stephanie Batio
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Michael S Wolf
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Kenneth E Covinsky
- Division of Geriatrics, Department of Medicine, University of California, California, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, California, USA
| | - Julia Yoshino Benavente
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Carla M Perissinotto
- Division of Geriatrics, Department of Medicine, University of California, California, USA
| | - Rachel M O'Conor
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| |
Collapse
|
34
|
Ribaya DNF, Cunningham A, Hersh LR, Salzman B, Parks SM. Acceptability of Telemedicine in a Geriatric Outpatient Practice During the COVID-19 Pandemic. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- David Nathan F. Ribaya
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amy Cunningham
- Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lauren R. Hersh
- Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brooke Salzman
- Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Susan M. Parks
- Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
35
|
Wang Q, Zhang S, Wang Y, Zhao D, Zhou C. Dual Sensory Impairment as a Predictor of Loneliness and Isolation in Older Adults: National Cohort Study. JMIR Public Health Surveill 2022; 8:e39314. [PMID: 36374533 PMCID: PMC9706378 DOI: 10.2196/39314] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/28/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Loneliness and social isolation are global public health challenges. Sensory impairments (SIs) are highly prevalent among older adults but are often ignored as a part of normal aging. Identifying the role of SIs in loneliness and social isolation could provide insight into strategies for improving public health among older adults. OBJECTIVE This study aims to analyze the effects of SIs on loneliness and social isolation among older adults in rural and urban China. METHODS This cohort study of 3069 older adults (aged 60+) used data from 4 waves (2011, 2013, 2015, and 2018) of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey of adults aged 45 years or older. SIs include hearing impairment (HI), vision impairment (VI), and dual sensory impairment (DSI). DSI is defined as the co-occurrence of VI and HI. Participants with complete data on hearing, vision, social isolation, and loneliness were included in the analysis. Generalized estimating equation models adjusted for covariates were used to examine the relationships of DSI with loneliness and social isolation among older adults. RESULTS Older adults in rural areas have higher prevalence of DSI, loneliness, and social isolation than their urban counterparts. In rural areas, participants with VI only (odds ratio [OR] 1.34, 95% CI 1.12-1.62; P=.002), HI only (OR 1.32, 95% CI 1.02-1.71; P=.03), and DSI (OR 1.84, 95% CI 1.56-2.18; P<.001) were more likely to experience loneliness compared with participants without SIs. DSI showed a statistically significant association with loneliness compared with VI only (OR 1.37, 95% CI 1.22-1.54; P<.001) and HI only (OR 1.39, 95% CI 1.13-1.72; P=.002). In urban areas, participants with VI only (OR 2.44, 95% CI 1.57-3.80; P<.001), HI only (OR 2.47, 95% CI 1.41-4.32; P=.002), and DSI (OR 1.88, 95% CI 1.24-2.85; P=.003) were more likely to experience loneliness compared with participants without SIs. DSI was not associated with the increased likelihood of loneliness compared with HI only or VI only. SIs were not associated with social isolation among older adults in urban and rural areas. Until 2018, 86.97% (2669/3069) reported VI, but only 27.11% (832/3069) and 9.45% (290/3069) were treated with glasses and cataract surgery, respectively; besides, 75 individuals received both glasses and cataract surgery treatment. The prevalence of HI was 74.39% (2283/3069) in 2018, but only 0.72% (22/3069) were treated with a hearing aid. CONCLUSIONS SIs are associated with an increased risk of loneliness rather than social isolation. A compounded risk of DSI on loneliness exists in rural areas rather than in urban areas. These findings expand our knowledge about the effects of SIs on loneliness and social isolation in non-Western populations. Interventions targeting HI only and DSI might be particularly effective for mitigating loneliness of older adults in urban and rural areas, respectively. Considering the high prevalence and low treatment rate of SIs, measures should be taken to make treatment more accessible.
Collapse
Affiliation(s)
- Qiong Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission of China Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Shimin Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission of China Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Yi Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission of China Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Dan Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission of China Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission of China Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| |
Collapse
|
36
|
Perez FP, Perez CA, Chumbiauca MN. Insights into the Social Determinants of Health in Older Adults. JOURNAL OF BIOMEDICAL SCIENCE AND ENGINEERING 2022; 15:261-268. [PMID: 36419938 PMCID: PMC9681180 DOI: 10.4236/jbise.2022.1511023] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In this paper, we review the social determinants of health in older adults and their complex interrelationship with medical diseases. Also, we provide recommendations to address these determinants in the integrated healthcare plan. The social determinants in older adults and its influence in health outcomes have been studied for decades. There is solid evidence for the interrelationship between social factors and the health of individuals and populations; however, these studies are unable to define their complex interrelatedness. Health is quite variable and depends on multiple biological and social factors such as genetics, country of origin, migrant status, etc. On the other hand, health status can affect social factors such as job or education. Addressing social determinants of health in the integrated healthcare plan is important for improving health outcomes and decreasing existing disparities in older adult health. We recommend a person-centered approach in which individualized interventions should be adopted by organizations to improve the health status of older adults at the national and global level. Some of our practical recommendations to better address the social determinants of health in clinical practice are EHR documentation strategies, screening tools, and the development of linkages to the world outside of the clinic and health system, including social services, community activities, collaborative work, and roles for insurance companies.
Collapse
Affiliation(s)
- Felipe P. Perez
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Carmen A. Perez
- School of Social Work, Indiana University, Indianapolis, IN, USA
| | - Magali N. Chumbiauca
- Richard L. Roudebush Veterans Affairs Medical Center, Home Based Primary Care, Indianapolis, IN, USA
| |
Collapse
|
37
|
Older Women Who Practiced Physical Exercises before the COVID-19 Pandemic Present Metabolic Alterations and Worsened Functional Physical Capacity after One Year of Social Isolation. Healthcare (Basel) 2022; 10:healthcare10091736. [PMID: 36141348 PMCID: PMC9498301 DOI: 10.3390/healthcare10091736] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Because the consequences of the lifestyle changes in older adults associated with the social isolation imposed in response to the COVID-19 pandemic are not fully understood, here, we investigated the effects of one year of social isolation imposed by COVID-19 on the metabolic parameters and functional physical capacity of older women who regularly practiced physical exercises before the pandemic. Methods: Systemic lipid and protein profiles, estimated creatinine clearance (ECC), and functional physical capacity (FPC) were assessed before (January-February 2020) and 12 months after social isolation in 30 older women (mean age 73.77 ± 6.22) who were engaged in a combined-exercise training program for at least 3 years before the COVID-19 pandemic. Results: In this group, we observed increased plasma levels of triglycerides and creatinine, an increase in the time necessary to perform gait speed and time-up-and-go tests, and reduced muscle strength assessed by the handgrip test and ECC post-COVID-19 pandemic relative to values recorded pre-pandemic. In addition, we observed significant correlations (both negative and positive) between anthropometric, some metabolic parameters, and physical tests. Conclusion: One year of interruption of physical exercise practice imposed in response to the COVID-19 pandemic significantly altered some systemic metabolic parameters and worsened ECC and FPC in older women.
Collapse
|
38
|
Huang Y, Zhu X, Liu X, Li J. The effects of loneliness, social isolation, and associated gender differences on the risk of developing cognitive impairment for Chinese oldest old. Aging Ment Health 2022:1-8. [PMID: 36065623 DOI: 10.1080/13607863.2022.2116396] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To investigate whether loneliness and social isolation could independently predict subsequent risk of cognitive impairment in Chinese oldest old, and to examine possible gender differences. METHODS The sample included 2,732 older adults aged 80 years and above with intact cognitive function from the Chinese Longitudinal Healthy Longevity Survey 2002-2018 waves, with an average follow-up of 4.24 years. Loneliness was measured by a single-item question about how often the participant felt lonely. Social isolation was defined by marital status, frequent visits by family members, and social activity engagement. Cognitive impairment was defined based on Mini-Mental State Examination scores. RESULTS Cox regression showed that social isolation independently predicted a higher risk of developing cognitive impairment at follow-up (HR = 1.14, 95% CI [1.03, 1.27], p = 0.014). Importantly, although there was no main effect of loneliness, a significant interaction between gender and loneliness (p = 0.013) suggested that increased loneliness was associated with a higher risk of developing cognitive impairment for men but not for women. CONCLUSION To prevent cognitive impairment and promote healthy longevity, socially isolated adults in their oldest old age should receive more attention, and men who often feel lonely should be offered with more emotional support.
Collapse
Affiliation(s)
- Yan Huang
- Center on Aging Psychology, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xinyi Zhu
- Center on Aging Psychology, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiaomei Liu
- Center on Aging Psychology, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Juan Li
- Center on Aging Psychology, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| |
Collapse
|
39
|
Umberson D, Lin Z, Cha H. Gender and Social Isolation across the Life Course. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2022; 63:319-335. [PMID: 35856404 PMCID: PMC10409601 DOI: 10.1177/00221465221109634] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Social isolation has robust adverse effects on health, well-being, dementia risk, and longevity. Although most studies suggest similar effects of isolation on the health of men and women, there has been much less attention to gendered patterns of social isolation over the life course-despite decades of research suggesting gender differences in social ties. We build on theoretical frames of constrained choice and gender-as-relational to argue that gender differences in isolation are apparent but depend on timing in the life course and marital/partnership history. Results indicate that boys/men are more isolated than girls/women through most of the life course, and this gender difference is much greater for the never married and those with disrupted relationship histories. Strikingly, levels of social isolation steadily increase from adolescence through later life for both men and women.
Collapse
|
40
|
Gender and Psychosocial Differences in Psychological Resilience among a Community of Older Adults during the COVID-19 Pandemic. J Pers Med 2022; 12:jpm12091414. [PMID: 36143198 PMCID: PMC9504613 DOI: 10.3390/jpm12091414] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
The study aimed at exploring gender and additional sociodemographic differences in psychological resilience, as well as the association between resilience and psychological distress in older adults, during the first lockdown in Italy, due to the COVID-19 pandemic. Participants attended an online survey during the first lockdown in May 2020. Psychological distress was assessed through the Depression Anxiety Stress Scale-21, the Resilience Scale (RS) was administered to evaluate psychological resilience, and sociodemographic variables were also collected. The study involved 108 community older adults (mean age 70.02 ± 3.5 years). Comparisons revealed that women reported significantly lower total scores of RS (p = 0.027), as well as lower levels of resilience-related domains, namely Meaningfulness (p = 0.049), Self-Reliance (p = 0.011), Perseverance (p = 0.035), and Existential Aloneness (p = 0.014), compared to men. Significantly higher RS scores were found in older adults being involved in a relationship, compared to those not involved in relationships (p = 0.026), and in older adults with children (p = 0.015), compared to those without offspring, suggesting the importance for older adults of not dealing alone with such a dramatic and stressful event, such as the pandemic. Negative correlations were found between psychological resilience and stress, depression, and anxiety. Linear regressions revealed that lower RS total scores, as well as lower scores in the majority of the RS scales, were associated with greater levels of stress, greater levels of anxiety, and greater levels of depressive symptoms. This study suggested that older women might appear more vulnerable in facing the pandemic, compared to men; having not lived alone through the lockdown period might also be considered as a factor of resilience for older adults.
Collapse
|
41
|
Clifton K, Gao F, Jabbari J, Van Aman M, Dulle P, Hanson J, Wildes TM. Loneliness, social isolation, and social support in older adults with active cancer during the COVID-19 pandemic. J Geriatr Oncol 2022; 13:1122-1131. [PMID: 36041993 PMCID: PMC9385725 DOI: 10.1016/j.jgo.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/09/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
Abstract
Introduction The COVID-19 pandemic has had a considerable impact on mental health. The social distancing and stay-at-home orders have likely also impacted loneliness, social isolation, and social support. Older adults, particularly those with comorbidities such as cancer, have a greater potential to be impacted. Here we assessed loneliness, social isolation, and social support in older adults undergoing active cancer treatment during the pandemic. Materials and methods A mixed methods study in which quantitative data and qualitative response items were collected in parallel was conducted in 100 older adults with cancer. Participants completed a survey by telephone with a series of validated questionnaires to assess the domains of loneliness, social isolation, and social support as well as several open-ended questions. Baseline demographics and geriatric assessments were summarized using descriptive statistics. Bivariate associations between social isolation and loneliness and social support and loneliness were described using Spearman correlation coefficients. Conventional content analysis was performed on the open-ended questions. Results In a population of older adults with cancer, 3% were noted to be severely lonely, although 27% percent screened positive as having at least one indicator of loneliness by the University of California, Los Angeles (UCLA) Three Item Loneliness Scale. There was a significant positive correlation between loneliness and social isolation (r = +0.52, p < 0.05) as well as significant negative correlation between loneliness and social support (r = −0.49, p < 0.05). There was also a significant negative correlation between loneliness and emotional support (r = −0.43, p < 0.05). There was no significant association between loneliness and markers of geriatric impairments, including comorbidities, G8 score or cognition. Discussion Reassuringly, in this cohort we found relatively low rates of loneliness and social isolation and high rates of social support. Consistent with prior studies, loneliness, social isolation, and social support were found to be interrelated domains; however, they were not significantly associated with markers of geriatric impairments. Future studies are needed to study if cancer diagnosis and treatment may mediate changes in loneliness, social isolation, and social support in the context of the pandemic as well as beyond.
Collapse
Affiliation(s)
- Katherine Clifton
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America.
| | - Feng Gao
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America
| | - JoAnn Jabbari
- Goldfarb School of Nursing at Barnes-Jewish College, Saint Louis, MO, United States of America
| | - Mary Van Aman
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America
| | - Patricia Dulle
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America
| | - Janice Hanson
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America
| | - Tanya M Wildes
- Division of Hematology/Oncology, University of Nebraska Medical Center/Nebraska Medicine, Omaha NE, United States of America
| |
Collapse
|
42
|
Assi L, Deal JA, Samuel L, Reed NS, Ehrlich JR, Swenor BK. Access to food and health care during the COVID-19 pandemic by disability status in the United States. Disabil Health J 2022; 15:101271. [PMID: 35151597 PMCID: PMC8767932 DOI: 10.1016/j.dhjo.2022.101271] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/03/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The COVID-19 pandemic has impacted people's access to food and health care. People with disabilities may be disproportionately affected by these outcomes due to structural and social barriers. OBJECTIVE/HYPOTHESIS To examine the relative prevalence of food insufficiency and unmet health care needs among the U.S. residents by vision, hearing, cognition, and mobility disability. METHODS We used data from the Household Pulse Survey wave conducted from April 14 to April 26, 2021, when questions about functional disability were first included. Participants were asked about difficulty seeing, hearing, remembering or concentrating, and walking or climbing stairs. The outcomes of interest were food insufficiency, delaying needed medical care and not getting needed medical care. Poisson regression models with robust variance adjusted for potential confounders were used to examine the prevalence ratio of each of these outcomes by disability status in separate models for each type of disability. RESULTS During April 14-26, 2021, 39.5% adults in the U.S. reported cognitive disability, 30.8% reported vision disability, 23.2% reported mobility disability, and 14.9% reported hearing disability. Adults with any type of disability were more likely than those without to experience food insufficiency (range of prevalence rate ratios [PRR]: 1.67-1.96), and delay (range of PRR: 1.48-1.87) or not get (range of PRR: 1.60-2.07) needed medical care. CONCLUSIONS These disparities suggest there is an urgent need to address the negative impact of the COVID-19 pandemic on people with disabilities. The prioritization of disability data collection is key in achieving that goal.
Collapse
Affiliation(s)
- Lama Assi
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; The Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer A Deal
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura Samuel
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Nicholas S Reed
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Bonnielin K Swenor
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA; The Disability Health Research Center, Johns Hopkins Bloomberg University, Baltimore, MD, USA.
| |
Collapse
|
43
|
Kotwal AA, Meier DE. A paradigm shift-Loneliness as a root cause of symptom distress among older adults. J Am Geriatr Soc 2022; 70:2201-2204. [PMID: 35607720 PMCID: PMC9378438 DOI: 10.1111/jgs.17880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 12/20/2022]
Affiliation(s)
- Ashwin A Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Diane E Meier
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
44
|
Prevalence of loneliness and social isolation among older adults during the COVID-19 pandemic: A systematic review and meta-analysis. Int Psychogeriatr 2022; 35:229-241. [PMID: 35357280 DOI: 10.1017/s1041610222000199] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Pandemics and their public health control measures have generally substantially increased the level of loneliness and social isolation in the general population. Because of the circumstances of aging, older adults are more likely to experience social isolation and loneliness during pandemics. However, no systematic review has been conducted or published on the prevalence of loneliness and/or social isolation among the older population. This systematic review and meta-analysis aims to provide up-to-date pooled estimates of the prevalence of social isolation and loneliness among older adults during the COVID-19 pandemic and other pandemics in the last two decades. DESIGN EMBASE, PsychoINFO, Medline, and Web of Science were searched for relevant studies from January 1, 2000 to November 31, 2021 published in a variety of languages. Only studies conducted during the COVID-19 pandemic were selected in the review. RESULTS A total of 30 studies including 28,050 participants met the inclusion criteria. Overall, the pooled period prevalence of loneliness among older adults was 28.6% (95% CI: 22.9-35.0%) and 31.2% for social isolation (95% CI: 20.2-44.9%). Prevalence estimates were significantly higher for those studies conducted post 3-month from the start of the COVID-19 pandemic compared to those conducted within the first 3 months of the pandemic. CONCLUSIONS This review identifies the need for good quality longitudinal studies to examine the long-term impact of pandemics on loneliness and social isolation among older populations. Health policymaking and healthcare systems should proactively address the rising demand for appropriate psychological services among older adults.
Collapse
|
45
|
Holaday LW, Oladele CR, Miller SM, Dueñas MI, Roy B, Ross JS. Loneliness, sadness, and feelings of social disconnection in older adults during the COVID-19 pandemic. J Am Geriatr Soc 2022; 70:329-340. [PMID: 34850379 PMCID: PMC8896574 DOI: 10.1111/jgs.17599] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Public health measures to control the COVID-19 pandemic have led to feelings of loneliness among older adults, which, prior to COVID, has been associated with subsequent morbidity and mortality. We sought to identify differences in feelings of loneliness, sadness, and social disconnection early in the pandemic across racial groups, and possible mitigating factors. METHODS We performed a cross-sectional analysis using the weighted nationally-representative Medicare Current Beneficiaries Survey COVID-19 supplement, collected summer 2020. We included all Medicare beneficiaries aged 65 years and older who did not respond by proxy. We examined changes in loneliness, sadness, or feelings of social disconnection. Multivariable logistic regression models accounted for sociodemographic variables, access to primary care and the internet, and history of depression or dementia. RESULTS Among 8125 beneficiaries, representative of 43.7 million Medicare beneficiaries, 22.6% reported loneliness or sadness, and 37.1% feeling socially disconnected. In fully-adjusted models, Hispanic/Latinx beneficiaries were most likely to report loneliness or sadness (OR = 1.3, CI: 1.02-1.65; p = 0.02) and Black beneficiaries were least likely to report feeling socially disconnected (OR = 0.55; CI: 0.42-0.73; p < 0.001). Internet access was associated with increased odds of both (OR = 1.29, 95 CI: 1.07-1.56; p = 0.009; and OR = 1.42, 95 CI: 1.24-1.63; p < 0.001, respectively). Access to primary care was associated with lower odds of both (OR = 0.77, 95 CI: 0.61-0.96; p = 0.02; and OR = 0.72, 95 CI: 0.61-0.87; p < 0.001). CONCLUSIONS Loneliness, sadness, and feelings of social disconnection were common among older Medicare beneficiaries early in the COVID-19 pandemic. Differences by race/ethnicity may be driven by different living structures and social networks, and warrant further study. Policy makers and clinicians should consider facilitating connection by phone or in person, as internet access did not diminish feelings of loneliness, particularly for those living alone. Access to primary care, and tools for clinicians to address loneliness should be prioritized.
Collapse
Affiliation(s)
- Louisa W. Holaday
- Division of General Internal Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, NY,National Clinician Scholars Program, Yale School of Medicine, New Haven, CT,VA Connecticut Healthcare System - West Haven Campus, West Haven, CT
| | - Carol R. Oladele
- Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT,Equity Research and Innovation Center (ERIC), Yale School of Medicine, Yale University, New Haven, CT
| | - Samuel M. Miller
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT,Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Maria I. Dueñas
- Division of General Internal Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, NY,Division of Geriatrics, Department of Internal Medicine, UCLA Medical School, Los Angeles, CA
| | - Brita Roy
- Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Joseph S. Ross
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT,Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT,Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut,Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| |
Collapse
|
46
|
Affective Neuroscience of Loneliness: Potential Mechanisms underlying the Association between Perceived Social Isolation, Health, and Well-Being. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2022; 7:e220011. [PMID: 36778655 PMCID: PMC9910279 DOI: 10.20900/jpbs.20220011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Loneliness, or the subjective feeling of social isolation, is an important social determinant of health. Loneliness is associated with poor physical health, including higher rates of cardiovascular disease and dementia, faster cognitive decline, and increased risk of mortality, as well as disruptions in mental health, including higher levels of depression, anxiety, and negative affect. Theoretical accounts suggest loneliness is a complex cognitive and emotional state characterized by increased levels of inflammation and affective disruptions. This review examines affective neuroscience research on social isolation in animals and loneliness in humans to better understand the relationship between perceptions of social isolation and the brain. Loneliness associated increases in inflammation and neural changes consistent with increased sensitivity to social threat and disrupted emotion regulation suggest interventions targeting maladaptive social cognitions may be especially effective. Work in animal models suggests the neural changes associated with social isolation may be reversible. Therefore, ameliorating loneliness may be an actionable social determinant of health target. However, more research is needed to understand how loneliness impacts healthy aging, explore the role of inflammation as a potential mechanism in humans, and determine the best time to deliver interventions to improve physical health, mental health, and well-being across a diverse array of populations.
Collapse
|
47
|
Yang M, Pajewski N, Espeland M, Easterling D, Williamson JD. Modifiable risk factors for homebound progression among those with and without dementia in a longitudinal survey of community-dwelling older adults. BMC Geriatr 2021; 21:561. [PMID: 34663232 PMCID: PMC8522162 DOI: 10.1186/s12877-021-02506-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Being homebound is independently associated with increased mortality but the homebound population is heterogeneous. In order to improve precision medicine, we analyzed potentially modifiable factors that contribute to homebound progression (from independent to needing assistance, to homebound), stratified by dementia status. METHODS Using National Aging and Trends Survey (NHATS), a nationally-representative, longitudinal annual survey from 2011 to 2017 (n = 11,528), we categorized homebound progression if one transitioned from independent or needing assistance to homebound, including competing risks of institutionalization or death between 2011 and last year of data available for each unique respondent. Using proportional hazards regression, we calculated hazard ratios of potentially modifiable risk factors on homebound progression. RESULTS Depressive symptoms, mobility impairment, and pain increased risk of homebound progression regardless of dementia status. Social isolation increased risk of homebound progression only among those without dementia at baseline. CONCLUSION Future clinical care and research should focus on the treatment of depressive symptoms, mobility, and pain to potentially delay progression to homebound status.
Collapse
Affiliation(s)
- Mia Yang
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, 1Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | - Nicholas Pajewski
- Department of Biostatistics and Data Science, School of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mark Espeland
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, 1Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Douglas Easterling
- Department of Social Sciences and Health Policy, School of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeff D Williamson
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, 1Medical Center Blvd, Winston-Salem, NC, 27157, USA
| |
Collapse
|
48
|
Meier DE, Morrison RS. All you need is love: Yet another social determinant of health. J Am Geriatr Soc 2021; 69:3020-3022. [PMID: 34409585 DOI: 10.1111/jgs.17421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Diane E Meier
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, Center to Advance Palliative Care, New York, New York, USA.,Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - R Sean Morrison
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|