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Sherman DW, Alfano AR, Alfonso F, Duque CR, Eiroa D, Marrero Y, Muñecas T, Radcliffe-Henry E, Rodriguez A, Sommer CL. A Systematic Review of the Relationship between Social Isolation and Physical Health in Adults. Healthcare (Basel) 2024; 12:1135. [PMID: 38891210 PMCID: PMC11171827 DOI: 10.3390/healthcare12111135] [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: 04/01/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Background: According to the World Health Organization, social isolation, particularly of older adults, is a public health issue endangering the well-being of individuals, families, and communities. Social isolation affects health through biological, behavioral, and psychological pathways and is associated with physical and psychological/emotional well-being, increases morbidity and mortality rates, and lowers quality of life. Purpose: This systematic review examined the relationship between social isolation and physical health, including subjective and objective dimensions, and factors that influence this relationship in adults. Methods: This systematic review examined six electronic databases covering the field of health and human services and included results from 1 January 2017 to 10 March 2023 with key terms including adult social connection or social isolation coupled with health, physical, psychological, emotional, mental, or behavioral. The initial search yielded 925 research articles across all databases and was narrowed to 710 when the decision was made to focus on social isolation and physical health. Covidence was used throughout the retrieval and appraisal process, as provided in a PRISMA flow diagram. Twenty-four studies that scored 90 or above in the appraisal process were included in the systematic review. Results: The studies represented included seven studies conducted in the United States and seventeen studies conducted internationally. Regarding study design, twenty-three studies were quantitative, one was qualitative, and one was mixed methods. The majority of quantitative studies were correlational in design with nine being longitudinal. The majority of studies were based on large national data sets representing in total 298,653 participants aged 50 and older. The results indicate that social isolation is related to increases in inflammatory biomarkers associated with diseases, all-cause mortality, lower expectations of longevity, and frailty. In addition, social isolation was associated with cognitive decline and disruptions in sleep. Poor oral health increased social isolation. The results further indicated that decreased physical performance/function and a decline in physical activity were associated with social isolation, as well as decreased overall physical health, poor health behaviors, and self-care, and decreased health-related quality of life. Further research is warranted to examine the possible bidirectionality of these relationships and possible mediating, moderating, or confounding variables. Implications: Future research is needed to explore the biological and behavioral pathways in which social isolation negatively impacts physical health. Going forward, studies are needed that move beyond descriptive, exploratory methods and integrate data from qualitative and mixed-method designs that will inform the development and testing of a conceptual framework related to social isolation and health. By advancing the science behind social isolation, comprehensive interventions can be identified and tested with implications at the individual, family, community, and societal levels to reduce social isolation, particularly among adults, and improve health and quality of life.
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Affiliation(s)
- Deborah Witt Sherman
- Department of Graduate Nursing, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA
| | - Alliete Rodriguez Alfano
- Department of Communication and Science Disorders, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA; (A.R.A.); (C.L.S.)
| | - Fernando Alfonso
- Department of Nurse Anesthesiology, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA;
| | - Carmen R. Duque
- Department of Undergraduate Nursing, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA;
| | - Daniella Eiroa
- Department of Athletic Training Services, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA;
| | - Yamile Marrero
- Department of Health Services Administration, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA;
| | - Teresa Muñecas
- Department of Clinical Education, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA;
| | - Erica Radcliffe-Henry
- Department of Physical Assistant, Hubert Wertheim College of Medicine, Miami, FL 33199, USA;
| | - Ana Rodriguez
- Department of Occupational Therapy, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA;
| | - Chelsea L. Sommer
- Department of Communication and Science Disorders, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL 33199, USA; (A.R.A.); (C.L.S.)
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Dogra S, Dunstan DW, Sugiyama T, Stathi A, Gardiner PA, Owen N. Active Aging and Public Health: Evidence, Implications, and Opportunities. Annu Rev Public Health 2021; 43:439-459. [PMID: 34910580 DOI: 10.1146/annurev-publhealth-052620-091107] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
By 2050, 20% of the world's population will be over the age of 65 years, with projections that 80% of older adults will be living in low- to middle-income countries. Physical inactivity and sedentary time are particularly high in older adults, presenting unique public health challenges. In this article, we first review evidence that points to multiple beneficial outcomes of active aging, including better physical function, cognitive function, mental health, social health, and sleep and suggest the need to shift the research focus from chronic disease outcomes to more relevant outcomes that affect independence and quality of life. Second, we review the critical role of age-friendly environments in facilitating active aging equitably across different countries and cultures. Finally, we consider emerging opportunities related to social engagement and technology-enabled mobility that can facilitate active aging. In all these contexts, it is a priority to understand and address diversity within the global aging population. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Shilpa Dogra
- Faculty of Health Sciences (Kinesiology), University of Ontario Institute of Technology, Ontario, Canada;
| | - David W Dunstan
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne 3004, Victoria, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Takemi Sugiyama
- Centre for Urban Transitions, Swinburne University of Technology, Hawthorn, Victoria, Australia.,Behavioural Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne 3004, Victoria, Australia
| | - Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Paul A Gardiner
- School of Health and Wellbeing, University of Southern Queensland, Ipswich, Queensland, Australia.,School of Kinesiology, The University of Western Ontario, London, Canada.,Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Neville Owen
- Centre for Urban Transitions, Swinburne University of Technology, Hawthorn, Victoria, Australia.,Behavioural Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne 3004, Victoria, Australia
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Ning H, Zhao Y, Liao L, Chen H, Tao Z, Chen X, Feng H. Impact of Pain and Psychosocial Factors on Frailty Among Older Adults With Physical Functional Limitations: A Cross-Sectional Study. Pain Manag Nurs 2021; 23:338-344. [PMID: 33994304 DOI: 10.1016/j.pmn.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/04/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
AIMS The objective of this study was to determine the prevalence of frailty and pain among older adults with physical functional limitations in China. We also assessed the impact of pain and psychosocial determinants on frailty among this vulnerable population. DESIGN This study was a cross-sectional study. SETTING AND PARTICIPANTS Totally, 2,323 Chinese elders with physical functional limitation were enrolled. METHODS Physical functioning was assessed by the Barthel Index, participants who reported "often troubled with pain" were further asked about the intensity of their pain using a 1-10 numeric rating scale, and frailty was assessed by the Assessment of frailty FRAIL scale. The impact of pain and psychosocial factors on frailty was assessed by multivariable binary logistic regression. RESULTS The prevalence of frailty and pain were 30.9% and 46.1%, respectively. Compared with subjects who reported no pain, those who reported mild (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.21-2.31), moderate (OR = 2.10, 95% CI = 1.53-2.82), or severe pain (OR = 2.31, 95% CI = 1.56-3.40) tended to be more vulnerable to frailty. Furthermore, compared with participants with positive psychosocial determinants, those with negative psychosocial determinants seemed more likely to be frail. CONCLUSIONS These findings suggest that the incidence of pain, negative psychosocial status, and frailty were prevalent, and the presence of pain and negative psychosocial factors increased the risk of frailty among older adults with physical functional limitation.
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Affiliation(s)
- Hongting Ning
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yinan Zhao
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Lulu Liao
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Huijing Chen
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Zirong Tao
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University.
| | - Xujiao Chen
- Department of Geriatrics, Zhejiang Hospital, Hongzhou, Zhejiang, China
| | - Hui Feng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China; Xiangya-Oceanwide Health Management Research Institute, Central South University, Changsha, Hunan, China.
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Merchant RA, Liu SG, Lim JY, Fu X, Chan YH. Factors associated with social isolation in community-dwelling older adults: a cross-sectional study. Qual Life Res 2020; 29:2375-2381. [PMID: 32253669 DOI: 10.1007/s11136-020-02493-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Social isolation in older adults is a major public health problem and associated with increased morbidity and mortality. There are limited data on the association between social isolation and physical function including gait speed. Hence, this study is to determine the prevalence of social isolation and its association with gait speed, frailty, cognition, depression and comorbidities amongst community-dwelling older adults. METHODS Social isolation, depression, frailty and perceived general health were assessed using 6-item Lubben Social Network Scale (LSNS-6), Geriatric Depression Scale (GDS), FRAIL scale and EuroQol EQ-5D-5L questionnaire which includes EQ Visual Analogue Scale (EQ-VAS), respectively. Cognition was assessed using the Chinese Mini Mental State Examination (cMMSE), while physical performance test included gait speed and short physical performance battery test. Binary logistic regression was performed to determine the influence of socio-demographic, medical, functional and cognitive variables on social isolation. RESULTS Out of 202 participants, 27.7% were robust, 66.8% of participants were pre-frail, and 5.4% of participants were frail. Almost half (45.5%, n = 92) of the participants were found to be at risk of social isolation. A poor social network was negatively associated with mean gait speed (OR = 0.674, CI 0.464-0.979, p = 0.039), EQ-VAS (OR = 0.561, CI 0.390-0.806, p < 0.01) and cMMSE (OR = 0.630, 95% CI 0.413-0.960, p = 0.032). CONCLUSION Almost half of older adults in the community are at risk of social isolation with a very significant association with gait speed, cMMSE and EQ-VAS scores.
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Affiliation(s)
- Reshma A Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Shumei Germaine Liu
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Jia Yi Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xiaoxi Fu
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Nagarajan D, Lee DCA, Robins LM, Haines TP. Risk factors for social isolation in post-hospitalized older adults. Arch Gerontol Geriatr 2020; 88:104036. [PMID: 32113012 DOI: 10.1016/j.archger.2020.104036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Social isolation in older adults is associated with high rates of adverse health outcomes. Older adults who have had a recent significant health event are likely to be at risk of social isolation following hospitalization. This study aims to identify risk factors amongst older adults at hospital discharge that are associated with social isolation at three months post-hospitalization. METHODS Older adults were surveyed at hospital discharge and three months post-hospitalization. Baseline data including demographics, self-reported quality of life, physical activity and capacity levels, lifestyle factors, symptoms of depression and anxiety were collected at discharge. Social isolation was measured using the Friendship Scale at the three-month follow-up. Regression analyses were used to examine the relationship between baseline characteristics and social isolation at three months post-hospitalization. RESULTS Older adults (n = 311) participated in the baseline survey, of whom 241 (78 %) completed the three-month survey. Higher depressive and anxiety symptoms at hospital discharge, comorbidity of cancer, history of cigarette smoking, prior access to community and respite service, and arrangement for shopping assistance post-discharge were factors independently associated with an increased risk of social isolation at three months post-hospitalization. DISCUSSION This study identified risk factors for social isolation that are unique to older post-hospitalized adults. These findings can help clinicians identify individuals at risk of social isolation and to target interventions that address these risk factors for the prevention of social isolation in older adults after hospitalization.
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Affiliation(s)
- Dharani Nagarajan
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia.
| | - Den-Ching A Lee
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia.
| | - Lauren M Robins
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia.
| | - Terry P Haines
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia.
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Echeverria I, Amasene M, Urquiza M, Labayen I, Anaut P, Rodriguez-Larrad A, Irazusta J, Besga A. Multicomponent Physical Exercise in Older Adults after Hospitalization: A Randomized Controlled Trial Comparing Short- vs. Long-Term Group-Based Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020666. [PMID: 31968573 PMCID: PMC7013692 DOI: 10.3390/ijerph17020666] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 01/04/2023]
Abstract
Multicomponent physical exercise is effective in curbing the effect of hospitalization in older adults. However, it is not well established which characteristics of the exercise interventions would optimize intervention sustainability and efficacy. This study compared the effects of two group-based multicomponent exercise interventions of different lengths in older adults after hospitalization. Fifty-five participants were randomly assigned to a short-term group-based branch (SGB, n = 27) or to a long-term group-based branch (LGB, n = 28). The SGB participated in a six-week multicomponent group-based exercise-training program followed by 18 weeks of home-based exercise. The LGB completed 12 weeks of each phase. Physical function, physical activity, quality of life, anthropometrics, and nutritional status were assessed at baseline, after 12 weeks, and after 24 weeks of intervention. Both groups improved physical function and nutritional status and increased physical activity after 12 weeks of intervention (paired student’s t-test, p < 0.01), and maintained the positive effects during the following 12 weeks. No group-by-time interaction was observed in any of the studied variables using mixed-model ANOVA. Based on these findings, we determined that 6 weeks of a group-based exercise intervention caused similar functional and nutritional benefits to a longer group-based intervention of 12 weeks when both are continued at home until 24 weeks.
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Affiliation(s)
- Iñaki Echeverria
- Department of Physiology, University of the Basque Country, UPV/EHU, 48940 Leioa, Spain; (M.U.); (A.R.-L.); (J.I.)
- Department of RMSB, UMR 5536, Université Bordeaux/CNRS, 33000 Bordeaux, France
- Correspondence: ; Tel.: +34-626-504-080
| | - Maria Amasene
- Department of Pharmacy and Food Science, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain;
| | - Miriam Urquiza
- Department of Physiology, University of the Basque Country, UPV/EHU, 48940 Leioa, Spain; (M.U.); (A.R.-L.); (J.I.)
| | - Idoia Labayen
- Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD), Public University of Navarra, 31006 Pamplona, Spain;
| | - Pilar Anaut
- Department of Medicine, Araba University Hospital, Bioaraba Research Institute, OSI Araba, CIBERSAM, University of the Basque Country (UPV/EHU), 01004 Vitoria-Gasteiz, Spain; (P.A.); (A.B.)
| | - Ana Rodriguez-Larrad
- Department of Physiology, University of the Basque Country, UPV/EHU, 48940 Leioa, Spain; (M.U.); (A.R.-L.); (J.I.)
| | - Jon Irazusta
- Department of Physiology, University of the Basque Country, UPV/EHU, 48940 Leioa, Spain; (M.U.); (A.R.-L.); (J.I.)
| | - Ariadna Besga
- Department of Medicine, Araba University Hospital, Bioaraba Research Institute, OSI Araba, CIBERSAM, University of the Basque Country (UPV/EHU), 01004 Vitoria-Gasteiz, Spain; (P.A.); (A.B.)
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Flórez KR, Richardson AS, Ghosh-Dastidar M(B, Troxel W, DeSantis A, Colabianchi N, Dubowitz T. The power of social networks and social support in promotion of physical activity and body mass index among African American adults. SSM Popul Health 2018; 4:327-333. [PMID: 29854917 PMCID: PMC5976839 DOI: 10.1016/j.ssmph.2018.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/26/2017] [Accepted: 03/10/2018] [Indexed: 11/17/2022] Open
Abstract
Social support and social networks can elucidate important structural and functional aspects of social relationships that are associated with health-promoting behaviors, including Physical Activity (PA) and weight. A growing number of studies have investigated the relationship between social support, social networks, PA and obesity specifically among African Americans; however, the evidence is mixed and many studies focus exclusively on African American women. Most studies have also focused on either functional or structural aspects of social relationships (but not both) and few have objectively measured moderate-to-vigorous physical activity (MVPA) and body mass index (BMI). Cross-sectional surveys of adult African American men and women living in two low-income predominantly African American neighborhoods in Pittsburgh, PA (N = 799) measured numerous structural features as well as functional aspects of social relationships. Specifically, structural features included social isolation, and social network size and diversity. Functional aspects included perceptions of social support for physical activity from the social network in general as well as from family and friends specifically. Height, weight, and PA were objectively measured. From these, we derived Body Mass Index (BMI) and moderate-to-vigorous physical activity (MVPA). All regression models were stratified by gender, and included age, income, education, employment, marital status, physical limitations, and a neighborhood indicator. Greater social isolation was a significant predictor of lower BMI among men only. Among women only, social isolation was significantly associated with increased MVPA whereas, network diversity was significantly associated with reduced MVPA. Future research would benefit from in-depth qualitative investigations to understand how social networks may act to influence different types of physical activity among African Americans, as well as understand how they can be possible levers for health promotion and prevention. Contributes to research on the social environment and physical activity among African Americans. Social isolation was associated with lower BMI among men. Social isolation was associated with more physical activity among women. More social network diversity was associated with less physical activity among women.
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Affiliation(s)
- Karen R. Flórez
- CUNY Graduate School of Public Health and Health Policy, 55 West 125th Street, New York, NY 10027, USA
- Corresponding author.
| | | | | | - Wendy Troxel
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Amy DeSantis
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA
| | | | - Tamara Dubowitz
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA 15213, USA
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Lübs L, Peplies J, Drell C, Bammann K. Cross-sectional and longitudinal factors influencing physical activity of 65 to 75-year-olds: a pan European cohort study based on the survey of health, ageing and retirement in Europe (SHARE). BMC Geriatr 2018; 18:94. [PMID: 29661154 PMCID: PMC5902922 DOI: 10.1186/s12877-018-0781-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 04/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background The promotion of physical activity (PA) plays a major role for healthy ageing even in older age. There is a lack of cross-sectional and longitudinal studies explicitly dealing with barriers and drivers to PA in older adults. Therefore the aims of this study are a) to determine the prevalence of insufficient physical activity (IPA) in 65 to 75-year-olds in Europe and to identify factors associated with IPA in cross-section and b) to identify longitudinal risk factors for IPA in prior active persons. Methods This study is using data of the Survey of Health, Ageing and Retirement in Europe (SHARE). SHARE is a cross-national panel database including individual data of the non-institutionalised population aged 50+ from 27 European countries. For the present paper, we included a cohort that participated in all first four waves of SHARE (2004–2011) aged 65-to-75–years at wave four (male n = 1761, female n = 2085) from 10 European countries. To identify cross-sectional and longitudinal associations, we calculated prevalence odds ratios and hazard ratios with 95% confidence intervals. Results The prevalence of IPA in 65–75-year-olds varied widely between countries, ranging from 55.4% to 83.3% in women and from 46.6% to 73.7% in men. IPA was associated with several intrapersonal factors and strength of association was similar for men and women for almost all investigated factors. Statistically significant associated with IPA were socioeconomic factors as low educational level (own and parental) and financial difficulties (male: POR: 1.60: 95%-CI: 1.26–2.03; female: POR: 1.58; 95%-CI: 1.26–1.97) and health-related factors as e.g. number of chronic diseases (male: POR: 1.34: 95%-CI: 1.23–1.45; female: POR: 1.31; 95%-CI: 1.21–1.42). Interpersonal only the size of social network was associated with IPA (male and female: POR: 0.88, 95%-CI: 0.81–0.95). Longitudinally in a fully adjusted model, only grip strength (HR: 0.99; CI-95%: 0.98–0.99) and BMI (HR: 1.02; CI-95%: 1.00–1.04) were statistically significant risk factors for IPA. Conclusions PA promotion programs for older adults should incorporate the heterogeneity of health status and physical condition that can typically occur in this age group. Electronic supplementary material The online version of this article (10.1186/s12877-018-0781-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lena Lübs
- Institute for Public Health and Nursing Sciences (IPP), University of Bremen, Bremen, Germany.
| | - Jenny Peplies
- Institute for Public Health and Nursing Sciences (IPP), University of Bremen, Bremen, Germany
| | - Carina Drell
- Institute for Public Health and Nursing Sciences (IPP), University of Bremen, Bremen, Germany
| | - Karin Bammann
- Institute for Public Health and Nursing Sciences (IPP), University of Bremen, Bremen, Germany
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