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Lai ETC, Chau AKC, Ho IYY, Hashimoto H, Kim CY, Chiang TL, Chen YM, Marmot M, Woo J. The impact of social isolation on functional disability in older people: A multi-cohort study. Arch Gerontol Geriatr 2024; 125:105502. [PMID: 38876082 DOI: 10.1016/j.archger.2024.105502] [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: 04/25/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES We assessed the relationship between social isolation and functional disability in older people. DESIGN Comparison of longitudinal cohort studies. SETTING AND PARTICIPANTS Harmonised longitudinal datasets from the United States, England, European countries, Japan, Korea, China and Hong Kong. METHODS Social isolation was operationalised as a composite score with five domains, such as marital status, living alone, and social contact with others. Functional disability was defined as whether the cohort participant had any difficulty in activities of daily living (ADL). In each dataset, we used robust Poisson regression models to obtain the relative risks (RRs) and the corresponding 95 % confidence intervals (CI). We combined the RRs to synthesize a pooled estimate using meta-analysis with random-effects models. RESULTS Overall, the social isolation composite score was not associated with ADL disability (pooled RR = 1.05, 95 % CI [0.97-1.14], n = 40,119). Subgroup analysis suggested social isolation composite score was associated with ADL disability in Asian regions (pooled RR = 1.09, 95 % CI [1.02, 1.16], but not in Western regions (pooled RR = 1.01, 95 % CI [0.96, 1.07]). The relationships between different domains of social isolation and ADL disability were heterogeneous, except that no participation in any social clubs or religious groups was consistently associated with ADL disability (pooled RR = 1.12, 95 % CI [1.04, 1.21]). CONCLUSION Targeting social isolation may prevent decline in functional abilities in older adults, providing an avenue to active and healthy ageing. Nonetheless, interventions tackling social isolation should tailor to the unique cultural and social underpinnings. A limitation of the study is that reverse causality could not be ruled out definitively.
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Affiliation(s)
- Eric Tsz-Chun Lai
- Institute of Health Equity, Chinese University of Hong Kong, Shatin, Hong Kong; Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Anson Kai Chun Chau
- Institute of Health Equity, Chinese University of Hong Kong, Shatin, Hong Kong; School of Psychology, University of New South Wales, Sydney, Australia
| | - Irene Yuk-Ying Ho
- Institute of Health Equity, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hideki Hashimoto
- Department of Health and Social Behavior, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Chang-Yup Kim
- School of Public Health, Department of Health Policy and Management, Seoul National University, Seoul, South Korea
| | - Tung-Liang Chiang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ya-Mei Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Michael Marmot
- Department of Epidemiology and Public Health, Institute of Health Equity, University College London, London, UK
| | - Jean Woo
- Institute of Health Equity, Chinese University of Hong Kong, Shatin, Hong Kong; Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
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Chen TF, Pien LC, Fan CS, Liang KL, Chiu YW. Financial strain and social support as moderators of the relationship between living alone and depressive symptoms in older people. BMC Geriatr 2024; 24:646. [PMID: 39090539 PMCID: PMC11293015 DOI: 10.1186/s12877-024-05237-1] [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: 11/28/2023] [Accepted: 07/22/2024] [Indexed: 08/04/2024] Open
Abstract
This study investigated the moderating effect of financial strain or social support on depressive symptoms among older people living alone in Taiwan. Data were collected from the "Taiwan Longitudinal Study on Aging (TLSA)," which included 1513 participants aged 65 and over, among them, 153 (10.1%) were living alone, while 1360 (89.9%) were living with others. Measurement tools included the Depression scale (CES-D), financial stress scale, social support scale, ADL scale, IADL scale, and stress scale, with Cronbach's α coefficients were 0.85, 0.78, 0.67, 0.91, 0.90, and 0.70 respectively. Hierarchical multiple regression was used to examine the moderator effect. The findings revealed that (1) Financial strain was found to moderate the relationship between living alone and depressive symptoms, acting as a promotive moderator among older men living alone. For older women, financial stress does not moderate the relationship between living alone and depressive symptoms. However, financial strain was also identified as a significant factor associated with depressive symptoms among older women living alone. (2) Social support does not moderate effect on the relationship between living alone and depressive symptoms in older men or older women. These results underscore the importance of considering financial stress in mental health policy development by government agencies. It is imperative to address the unique challenges faced by older individuals living alone, particularly in relation to financial strain, in order to promote their mental well-being.
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Affiliation(s)
- Tsui-Fang Chen
- Department of Geriatric Health Promotion, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County, Houlong, 356006, Taiwan
| | - Li-Chung Pien
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei City, 110301, Taiwan
| | - Chun-Sung Fan
- Department of Geriatric Health Promotion, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County, Houlong, 356006, Taiwan
| | - Kai-Lin Liang
- Department of Aging Health and Long-Term Care Management Program for Undergraduate Indigenous Students, National Chi-Nan University, Nantou County, 545301, Taiwan
| | - Yi-Wen Chiu
- Department of Nursing, Chung Shan Medical University & Chung Shan Medical University Hospital, No. 110, Sec 1, Jianguo N. Rd, Taichung, 402306, Taiwan, R.O.C..
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Kikuchi K, Ikeuchi T, Awata S. A study on the incidence rate of missing persons with dementia living alone in Chiba prefecture, Japan. Geriatr Gerontol Int 2023; 23:890-891. [PMID: 37823231 DOI: 10.1111/ggi.14695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Kazunori Kikuchi
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Tomoko Ikeuchi
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shuichi Awata
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
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Shaw BA, Yang TC, Kim S. Living Alone During Old Age and the Risk of Dementia: Assessing the Cumulative Risk of Living Alone. J Gerontol B Psychol Sci Soc Sci 2023; 78:293-301. [PMID: 36179214 PMCID: PMC9938918 DOI: 10.1093/geronb/gbac156] [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: 04/17/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study examines the association between living alone during old age and dementia. Whereas most previous studies on this topic utilize measures of living alone status that were obtained at a single point in time, we compare this typical approach to one that measures long-term exposure to living alone among older adults and assesses whether dementia is more likely to occur within individuals with more accumulated time living alone. METHODS Data come from the Health and Retirement Study, with a follow-up period of 2000-2018. A total of 18,171 older adults were followed during this period, resulting in 78,490 person-waves analyzed in a series of multi-level logistic models. Contemporaneous living alone was recorded when a respondent's household size was equal to 1 in a given wave. Cumulative living alone was calculated by adding the number of living alone statuses up to a given wave. RESULTS Contemporaneous living alone was either not associated (male-only subsample), or inversely associated (female-only subsample) with dementia. By contrast, a one-unit (i.e., one wave) increase in cumulative living alone was associated with about a 10% increase in the odds of dementia for both men (odds ratio [OR] = 1.111) and women (OR = 1.088), net of several covariates, including marital status, age, social activities, and social support. DISCUSSION Living alone during late life is an important risk factor for dementia, but the cognitive effects of solitary living probably do not take hold immediately for most older adults and potentially demonstrate a dose-response relationship.
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Affiliation(s)
- Benjamin A Shaw
- Division of Community Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Tse-Chuan Yang
- Department of Sociology, University at Albany SUNY, Albany, New York, USA
| | - Seulki Kim
- Department of Sociology, University Nebraska, Lincoln, Nebraska, USA
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What is the relationship between falls, functional limitations, and depressive symptoms among Chinese older adults? The role of living alone. Maturitas 2023; 168:78-83. [PMID: 36521395 DOI: 10.1016/j.maturitas.2022.10.007] [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: 10/19/2021] [Revised: 08/26/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Although the association between falls and depressive symptoms is well documented, the mechanisms underlying this association remain largely unexplored. We investigated the mediation role of functional limitations in the association between falls and depressive symptoms among Chinese older adults and determined whether the living arrangement (living alone or not) is a significant moderator of the above-mentioned mediation pathway. STUDY DESIGN Cross-sectional study. MAIN OUTCOME MEASURES Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale short form (CESD-10), on which higher scores indicate higher levels of depressive symptoms. RESULTS We used the harmonized China Health and Retirement Longitudinal Study national baseline data (2011-2012 year) involving 7410 participants aged 60 years and over. After adjusting for covariates (e.g., age and sex), the effects of falls on depressive symptoms were seen to be mediated by functional limitations among Chinese older adults (β = 0.82, p < .001). The moderated mediation analysis, which assesses whether an indirect effect is conditional on values of a moderating variable, found that the mediation effect was contingent upon the living arrangement (β = -0.60, p = .029). Specifically, the levels of functional limitations and depressive symptoms were higher for people with falls who were living with others relative to those living alone. CONCLUSIONS These results suggest that functional limitations are an important intervening variable that links falls to depressive symptoms among Chinese older adults. Interventions to promote older adults' physical function and prevent falls are recommended to decrease the risk of depressive symptoms. These interventions can particularly benefit those who live with others.
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Liu K, Peng W, Ge S, Li C, Zheng Y, Huang X, Liu M. Longitudinal associations of concurrent falls and fear of falling with functional limitations differ by living alone or not. Front Public Health 2023; 11:1007563. [PMID: 37124793 PMCID: PMC10131081 DOI: 10.3389/fpubh.2023.1007563] [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: 07/30/2022] [Accepted: 02/22/2023] [Indexed: 05/02/2023] Open
Abstract
Background Falls and fear of falling (FOF) are independent risk factors for functional limitations in older adults. However, the combined effect of falls and FOF on functional limitations and the moderating role of living alone or not is unclear. We aimed to examine (1) the independent and combined effect of falls and FOF on functional limitations in older adults and (2) whether living alone moderates these associations. Methods We used data from the National Health and Aging Trends Study (NHATS) and included 5,950 U.S. community-dwelling older adults aged 65 and older from Round 1 (Year 2011) and Round 2 (Year 2012). Falls and FOF were ascertained by asking participants whether they had any falls in the last year and whether they had worried about falling in the previous month at R1. Assessed functional limitations included any difficulties with mobility, self-care, or household activities at R2. Poisson regression models were used to examine the longitudinal associations of falls and FOF with functional limitations and the moderation effects of baseline living alone. Results Of the 5,950 participants, 16.3% had falls only; 14.3% had FOF only; 14.3% had both, and 55.1% had neither at baseline. In the adjusted model, those who experienced concurrent falls and FOF in R1 had a higher risk of functional limitations at R2 than those with neither (Mobility: Incidence risk ratio [IRR] = 1.34, 95% CI: 1.24-1.45; Self-care: IRR = 1.18, 95% CI: 1.11-1.26; Household: IRR = 1.20, 95% CI: 1.11-1.30). Moreover, living alone significantly moderated the longitudinal associations of concurrent falls and FOF with mobility activity limitations. Conclusion The findings suggest that strategies to improve falls and FOF together could potentially help prevent functional limitations. Older adults who live with others and have falls or FOF should receive interventions to promote their mobility activities.
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Affiliation(s)
- Kehan Liu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Wenting Peng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Song Ge
- Department of Natural Sciences, University of Houston-Downtown, Houston, TX, United States
| | - Chunxiao Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yu Zheng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiaoting Huang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Minhui Liu
- Xiangya School of Nursing, Central South University, Changsha, China
- *Correspondence: Minhui Liu ; @MinhuiLiu2
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Hayashi C, Tanaka H, Ogata S. Assessing timewise changes over 15 months in life-space mobility among community-dwelling elderly persons. BMC Geriatr 2020; 20:502. [PMID: 33238895 PMCID: PMC7687835 DOI: 10.1186/s12877-020-01882-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine the differences of timewise changes in life-space mobility between elderly people living alone and those living with others among community-dwelling elderly people from a day care facility with a rehabilitation service for seniors. METHODS The present study used a longitudinal design with repeated measures every 3 months. In conformity with our inclusion criteria, this study included 233 community-dwelling elderly users of a day care facility with rehabilitation services for seniors in Japan. We analyzed the life-space assessment (LSA) scores collected at five time points (baseline, 3 months, 6 months, 9 months, and 12 months) using mixed-effects models with random intercepts and slopes over time. In the present study, the explanatory variables of interest were time, and living situation (living alone or with others). As possible confounders, we considered the following: (a) age, (b) sex, (c) social frailty, (d) physical frailty, (e) mild cognitive impairment (MCI), (f) depression, and (g) economic satisfaction. RESULTS The mean age of participants was 78.9 years (SD = 7.7), their mean LSA score was 60.1 points (SD = 25.7), and 42.9% of the participants were men. After adjusting for age, gender, frailty, depression, MCI, and economic satisfaction, the mean LSA score of older adults who lived with others was significantly lower (7.42 points, 95%CI = - 18.30 to - 0.15, p = 0.048) than that older adults who lived alone. DISCUSSION Community-dwelling older adults who used a day care center with rehabilitation services and lived with others had a smaller life-space at baseline than those who lived alone. This suggests that there is a need to pay more attention to social frailty among both older adults who live alone and those who live with others. CONCLUSIONS According to a multilevel analysis growth model, elderly persons who lived with others had significantly lower life-space mobility than those who lived alone.
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Affiliation(s)
- Chisato Hayashi
- University of Hyogo, 13-71 Kitaoji-cho, Akashi, Hyogo 673-8588 Japan
| | - Haruka Tanaka
- Nagoya University, Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nahgoya City, Aichi Prefecture 461-8673 Japan
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe - Shimmachi, Suita, Osaka, 564-8565 Japan
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Lu LT, Huang CM, Huang SF, Wu SI, Guo JL. Perspectives of the Elderly with Mild Cognitive Impairment Living Alone on Participating in a Dementia Prevention Program: A Q Methodology Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217712. [PMID: 33105662 PMCID: PMC7659959 DOI: 10.3390/ijerph17217712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022]
Abstract
This study aimed to identify and describe the various patterns of perspectives among older adults with mild cognitive impairment (MCI) living alone on participating in a dementia prevention program. Q methodology was applied to investigate the perspectives of 30 community-dwelling elderly people with MCI living alone from March to August 2018. As Q methodology applies a forced distribution through the Q-sorting technique, it could capture participants’ perspective patterns. Thirty-two Q-statements were constructed to explore the participants’ attitudes regarding their participation in a dementia prevention program. The participants performed Q-sorting to rank the 32 statements into a Q-sort grid. Principal component analysis was conducted using the PQ Method 2.35 software to identify patterns in participants’ perspectives. Four patterns of shared perspectives, accounting for 54.65% of the total variance, were identified: (a) awareness of health benefits and readiness to take preventive actions; (b) emphasis on cost consideration, and not ready to participate; (c) concern about family’s attitude and needing family support; (d) emphasis on medical care and needing providers’ recommendation. The exploration of clusters of the elderly with MCI could assist health professionals in acknowledging elderly people’s attitudes and responses towards participating in a dementia prevention program.
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Affiliation(s)
- Li-Ting Lu
- Department of Nursing, University of Kang Ning, Taipei 114, Taiwan;
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei 106, Taiwan
| | - Chiu-Mieh Huang
- Institute of Clinical Nursing, School of Nursing, National Yang-Ming University, Taipei 112, Taiwan;
| | - Su-Fei Huang
- Department of Senior Citizen Service, Mackay Junior College of Medicine, Nursing, and Management, Taipei 112, Taiwan;
| | - Shu-I Wu
- Xinyi District Health Center, Taipei City 110, Taiwan;
| | - Jong-Long Guo
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei 106, Taiwan
- Correspondence: ; Tel.: +886-2-7749-3705
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Chan E, Procter-Gray E, Churchill L, Cheng J, Siden R, Aguirre A, Li W. Associations among living alone, social support and social activity in older adults. AIMS Public Health 2020; 7:521-534. [PMID: 32968675 PMCID: PMC7505797 DOI: 10.3934/publichealth.2020042] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/08/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives We examined cross-sectional associations of living alone with social isolation among community-dwelling older adults in Worcester County, Massachusetts, USA. Methods Four hundred participants 65 years old and older were recruited in community group settings or by direct mail. Participants were queried for living status, social support, frequency of social activity, sociodemographic and lifestyle factors, and health conditions. Social isolation was assessed by lack of social support and decreased frequency of social activity. Physical activity (PA) was measured via an accelerometer and global positioning system (GPS), which was worn by the participant, for at least 7 consecutive days. Results Participants living alone (N = 110) had less social support than those living with others (N = 290) (p < 0.001) but did not differ significantly in the frequency of their social activities. Group-setting recruitment was strongly associated with greater social activity (p < 0.001). Less social support was independently associated with a less-than-high-school education (p = 0.001), higher CES-D depression score (p < 0.001) and lower PA (p = 0.003). Less social activity was independently associated with a less-than-high-school education (p = 0.007) and annual income less than $50,000 (p = 0.01). Discussion Older adults who are socioeconomically disadvantaged, have less social support, and who live alone are more likely to be socially isolated and may benefit from continuation of low-cost social activities and increased social support inside the home. Identifying correlates of social isolation may inform future interventions.
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Affiliation(s)
- Elizabeth Chan
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Linda Churchill
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jie Cheng
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rachel Siden
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Annabella Aguirre
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Wenjun Li
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Zrour C, Haddad R, Zoghbi M, Kharsa Z, Hijazi M, Naja W. Prospective, multi-centric benchmark study assessing delirium: prevalence, incidence and its correlates in hospitalized elderly Lebanese patients. Aging Clin Exp Res 2020; 32:689-697. [PMID: 31203529 DOI: 10.1007/s40520-019-01242-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/05/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND With the increase in the proportion of elderly Lebanese patients, little is known about delirium's prevalence, incidence and correlated factors. AIMS To identify the prevalence, incidence and factors associated with overall and incident delirium in hospitalized elderly Lebanese patients. METHODS A convenient sample was recruited from three university hospitals affiliated to the Lebanese university faculty of medical sciences. We included patients aged more than 65 years. Baseline factors were examined upon presentation and the confusion assessment method (CAM) was used to detect prevalent delirium upon admission or within the first 48 h. Enrolled patients were then assessed every other day to detect incident delirium cases. RESULTS Among the 230 patients included, delirium prevalence was 17% and incidence 8.7%. We found that a history of falls (odds ratio (OR) = 5.12; p = 0.001), immobilization (OR = 7.33; p = 0.035), polypharmacy (OR = 5.07; p = 0.026) along with tachycardia (OR = 6.94; p = 0.03) and severe anemia (OR = 12.5; p = 0.005) upon admission were significant factors associated with overall delirium (incident and prevalent delirium cases). Whereas, living alone was significantly associated with lower odds for overall delirium (OR = 0.03; p = 0.02). Moreover, current smoking (OR = 14; p = 0.02), low oxygen saturation (OR = 9.6; p = 0.008) and severe anemia (OR = 8.4; p = 0.013) upon admission remained significantly associated with higher odds for incident delirium along with urine catheter placement (OR = 7.8; p = 0.015). CONCLUSION Secondary to the burden of delirium and its impact on mortality among elderly population, trying to understand and adjust modifiable factors would promote more appropriate prevention strategies.
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Affiliation(s)
- Carmen Zrour
- Psychiatry Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon. .,, Boulevard de Smet de Naeyer 414, Jette 1090, Brussels, Belgium.
| | - Ramzi Haddad
- Psychiatry Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Marouan Zoghbi
- Family Medicine Department, Faculty of Medical Sciences, Saint Joseph University, Beirut, Lebanon
| | - Zahraa Kharsa
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Mariam Hijazi
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Wadih Naja
- Psychiatry Department, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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Does Living Alone Mean Spending Time Differently? Time Use and Living Arrangements Among Older Canadians. CANADIAN STUDIES IN POPULATION 2020. [DOI: 10.1007/s42650-020-00017-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
OBJECTIVES To address how different residential situations impact the likelihood of death among mature adults and elderly persons. DESIGN Population-based study with administrative data linked to census data. SETTING Spain. PARTICIPANTS Spanish population alive on 1 January 2012, observed between 1 January 2012 and 31 December 2012. A 10% random sample of the Spanish population, including 2 054 427 person years and 28 736 deaths, is used. MAIN OUTCOME MEASURE Registered deaths in the 2012 Spanish vital statistics. METHODS Using a new data set based on linked administrative registers, we estimate unadjusted and adjusted mortality rates by coresidential situation. Differential mortality is measured by rate ratios (RR) estimated with Poisson regression. Cause of death data are used to explore the mechanisms involved in excess mortality by residential status. RESULTS Compared with men 45-54 living with partners, the risk of death is much higher for those without partners living with others (RR 2.0, 95% CI 1.7 to 2.4) or for those living alone (RR 1.9, 95% CI 1.5 to 2.4). After 84, excess mortality among men living with others persists (RR 1.4, 95% CI 1.3 to 1.5), but disappears for those living alone (RR 1.0, 95% CI 0.9 to 1.1). Both among women 45-64 living with others but without partner (RR 1.8, 95% CI 1.5 to 2.3) and among those living alone (RR 2.2, 95% CI 1.5 to 3.1) the pattern is similar to men. At higher ages, however, excess mortality for women living alone decreases (RR 1.2, 95% CI 1.1 to 1.2), though it persists for women living with others (RR 1.9, 95% CI 1.7 to 2.0). CONCLUSIONS These findings indicate direct effects of living arrangements on mortality and health-related selection effects influencing residential choices. These effects may be partially affected by age and prevailing societal and cultural contexts.
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Affiliation(s)
- Miguel Requena
- Sociologia II, Universidad Nacional de Educacion a Distancia, Madrid, Spain
| | - David Reher
- Sociologia Aplicada, Universidad Complutense de Madrid, Madrid, Spain
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Interventions to improve the health and wellbeing of older people living alone: a mixed-methods systematic review of effectiveness and accessibility. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x19001818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe global population is ageing and the likelihood of living alone increases with age. Services are necessary to help older people living alone to optimise health and wellbeing. This systematic review aimed to summarise the effectiveness and accessibility of interventions to improve the health and wellbeing of older people living alone. Relevant electronic databases (CINAHL, MEDLINE, PsycINFO and Scopus) were searched for all years up to August 2018. Studies were included if they involved older people (aged ⩾55 years) living alone, and an intervention with measured health and wellbeing outcomes. All study types were included. The Theory of Access was used to assess interventions across dimensions of accessibility, availability, acceptability, affordability, adequacy and awareness. Twenty-eight studies met the eligibility criteria; 17 studies focused on ageing safely in place and 11 on psychological and social wellbeing. Studies comprised quantitative (N = 19), qualitative (N = 4) and mixed-methods (N = 5) approaches. Dimensions from the Theory of Access were poorly addressed in the studies, particularly those of higher-quality methodology. Studies were heterogeneous, preliminary in scope and lacked consistent study design, methodology or measurement. Services that do not address user accessibility in design or evaluation may be limited in their uptake and impact. It is recommended that dimensions of access and co-creation principles be integrated into service design processes and be evaluated alongside clinical effectiveness.
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Sugisawa H, Sugihara Y. Mediators and Moderators of the Influences of Living Alone on Psychological Distress Among Japanese Older Adults. FAMILY & COMMUNITY HEALTH 2020; 43:313-322. [PMID: 32384289 DOI: 10.1097/fch.0000000000000256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study explored gender differences in mediators and moderators of the association between living alone and psychological distress among 2556 Japanese older adults aged 65 years and older. Putative mediators and moderators were physical health, income, informal networks, and social support. Living alone was significantly related to psychological distress only in men. Significant mediators were income in both genders and social support only in men. Living alone in women was related to having more informal networks, which reduced psychological distress. This contributed to mitigating the effect of living alone on psychological distress among women. Effective moderators were not discovered.
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Affiliation(s)
- Hidehiro Sugisawa
- Graduate School of Gerontology, J. F. Oberlin University, Machida-shi, Tokyo, Japan (Dr Sugisawa); and Graduate School of Urban Environment Sciences, Tokyo Metropolitan University, Hachioji-shi, Tokyo, Japan (Dr Sugihara)
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NanZhu Y, Xin L, Xianghua Y, Jun C, Min L. Risk factors analysis of nosocomial pneumonia in elderly patients with acute cerebral infraction. Medicine (Baltimore) 2019; 98:e15045. [PMID: 30921230 PMCID: PMC6456111 DOI: 10.1097/md.0000000000015045] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/17/2019] [Accepted: 03/05/2019] [Indexed: 12/22/2022] Open
Abstract
To investigate the risk factors of nosocomial pneumonia (NP) in elderly patients with acute cerebral infarction (ACI).In this study, 324 aged 70 years and over patients with ACI who were admitted to the inpatient department of TianJin First Hospital (China) from January 2012 to February 2018 were retrospectively analyzed. The patients were divided into NP group (80 patients) and non-NP group (244 patients) according to whether NP was occurred 48 hours after hospitalization. Baseline profiles and biochemical analyses were compared between 2 groups. Information regarding risk factors for NP in elderly patients with ACI was collected from all patients. Associations with NP and outcome were evaluated.Among the total patients, NP occurred in 80 (24.69%) patients. There were no statistically significant differences between risk of NP and sex, current drinking, diabetes mellitus, stroke history, and levels of serum UA, TG, HDL-C, LDL-C, Glucose, chloride, potassium. Multivariate logistic regression analysis showed that the independent risk factors for NP were living alone (OR 4.723; CI 1.743∼12.802; P = .002), initial NIHSS score (OR 1.441; CI 1.191∼1.743; P = .000), NRS2002 score (OR 0.139; CI 0.087∼0.223; P = .000), BMI (OR 1.586; CI 1.353∼1.858; P = .000), a past pneumonia history (OR 0.073; CI 0.017∼0.321; P = .001), atrial fibrillation (AF) (OR 0.129; CI 0.033∼0.499; P = .003), CRP (OR 1.050; CI 1.017∼1.085; P = .003), BUN (OR 0.603; CI 0.448∼0.812; P = .001) and Cr (OR 1.036; CI 1.015∼1.057; P = .001). Level of albumin was an independent protective factor of NP in elderly patients with ACI (OR 0.865; CI 0.750∼0.999; P = .048). Furthermore, elderly patients with ACI who had NP had worse clinical outcomes both during hospitalization and after discharge (P < .05).We identified significant risk factors for NP in elderly patients with ACI, including living alone, initial NIHSS score, malnutrition, a past pneumonia history, AF, CRP, and Renal function were associated with NP in elderly patients with ACI. The clinical course was worse and the duration of hospital stay was longer in NP patients than in non-NP patients.
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Affiliation(s)
| | - Li Xin
- Department of Neurology, the Second Hospital of Tianjin Medical University
| | | | - Chen Jun
- Department of Clinical laboratory, TianJin First Hospital, China
| | - Li Min
- Department of Clinical laboratory, TianJin First Hospital, China
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Moncatar TJR, Nakamura K, Rahman M, Seino K. Health Status and Health Facility Utilization of Community-Dwelling Elderly Living Alone in the Philippines: A Nationwide Cross-Sectional Study. Health (London) 2019. [DOI: 10.4236/health.2019.1111117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Natsume M, Watanabe K, Matsumoto S, Naruge D, Hayashi K, Furuse J, Kawamura M, Jinno H, Sano K, Fukushima R, Osawa G, Aruga E, Hashiguchi Y, Tanaka A, Takikawa H, Seki N. Factors Influencing Cancer Patients' Choice of End-of-Life Care Place. J Palliat Med 2018; 21:751-765. [DOI: 10.1089/jpm.2017.0481] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maika Natsume
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Kiyotaka Watanabe
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Satoko Matsumoto
- Department of Quality Improvement, NTT Medical Center Tokyo, Tokyo, Japan
| | - Daisuke Naruge
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kazuhiko Hayashi
- Department of Chemotherapy and Palliative Care, Tokyo Women's Medical University, Tokyo, Japan
| | - Junji Furuse
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Masafumi Kawamura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiromitsu Jinno
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Keiji Sano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Ryoji Fukushima
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Gakuji Osawa
- Department of Palliative Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Etsuko Aruga
- Department of Palliative Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yojiro Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Atsushi Tanaka
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hajime Takikawa
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Nobuhiko Seki
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
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Shaw BA, Fors S, Fritzell J, Lennartsoon C, Agahi N. Who Lives Alone During Old Age? Trends in the Social and Functional Disadvantages of Sweden's Solitary Living Older Adults. Res Aging 2017; 40:815-838. [PMID: 29241401 DOI: 10.1177/0164027517747120] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study identifies specific social and functional disadvantages associated with living alone during old age in Sweden and assesses whether these associations have changed during recent decades. Data came from repeated cross-sectional surveys of Swedish adults aged 77+ during 1992-2014. Findings indicate that several types of disadvantage are consistently associated with the probability of living alone including financial insecurity and having never married for women and having never married and mobility impairment for men. Also for older men, low education has become an increasing strong determinant of living alone. These findings suggest that older adults who live alone are a subgroup that is particularly, and in some cases increasingly, vulnerable with respect to social and functional status. This has important policy implications related to addressing the needs of this growing subgroup as well as methodological implications for studies on the health effects of living alone.
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Affiliation(s)
- Benjamin A Shaw
- 1 Department of Health Policy, Management, and Behavior, Center for Social and Demographic Analysis, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Stefan Fors
- 2 Aging Research Center, Karolinska Institutet, Solna, Sweden
- 3 Aging Research Center, Stockholm University, Stockholm, Sweden
| | - Johan Fritzell
- 2 Aging Research Center, Karolinska Institutet, Solna, Sweden
- 3 Aging Research Center, Stockholm University, Stockholm, Sweden
| | - Carin Lennartsoon
- 2 Aging Research Center, Karolinska Institutet, Solna, Sweden
- 3 Aging Research Center, Stockholm University, Stockholm, Sweden
| | - Neda Agahi
- 2 Aging Research Center, Karolinska Institutet, Solna, Sweden
- 3 Aging Research Center, Stockholm University, Stockholm, Sweden
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Kucukerdonmez O, Navruz Varli S, Koksal E. Comparison of Nutritional Status in the Elderly According to Living Situations. J Nutr Health Aging 2017; 21:25-30. [PMID: 27999846 DOI: 10.1007/s12603-016-0740-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to evaluate the nutritional status of elderly individuals living alone and with their families. PARTICIPANTS AND METHOD The sample of the study included 872 elderly individuals who agreed to participate in the study, were aged 65 or over, and lived in Ankara. The data were gathered from a survey, using face-to-face interviews. The Mini Nutritional Assessment (MNA) was used in evaluating each individual's nutrition. RESULTS The rate of malnutrition in the study population was 5% while the malnutrition risk was 67%. The rate of malnutrition in the individuals living alone was found to be higher than that of those living with their families. The rates of malnutrition in individuals living alone and with their families were, respectively, 7% and 4%, and the rates of malnutrition risk in individuals living alone and with their families were, respectively, 73% and 66% (p<0.05). In both groups, there were significant relationships between individuals' ages, BMI values, mid-upper arm circumference (MUAC), and calf circumference measurements and their MNA scores. While there was a negative and significant relationship between age and MNA scores, the relationships between other parameters and MNA scores were positive and significant (p<0.01). CONCLUSION In this study, it was revealed that the nutrition of elderly individuals living alone differs from the nutrition of elderly individuals living with their families. Malnutrition rates were higher in individuals living alone. Raising the awareness of elderly people and their families regarding the need to improve and maintain nutrition would be beneficial.
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Affiliation(s)
- O Kucukerdonmez
- Eda Koksal, Gazi University Faculty of Health Sciences, Ankara, Turkey, ,
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Abstract
The last 20 years has seen a substantial increase in the number of wheelchair users: in 1973, Fenwick estimated that 137 000 wheelchairs were on loan in England and Wales; in 1990, Kettle and Rowley estimated that 500 000 chairs were on ioan from the Disablement Services Authority. In a survey of requests for new wheelchairs over two separate one-month periods, it was found that 310 requests resulted in the supply of 302 wheelchairs. Females received 66.6% of the chairs. The ages of the recipients ranged from three to 98 years old (average 71). Patients aged 60 and over received 79.8% of all chairs supplied. Attendant-propelled chairs accounted for 75.2% of chairs supplied, and 19.2% were self-propelled. The leading diagnostic groups for provision were: arthritis (21.5%); cerebrovascular disease (19.2%); chronic obstructive airways disease/asthma (16.5%); and ischaemic heart disease/congestive cardiac failure (13.6%) When compared with the earlier two national surveys there have been changes in the age of wheelchair users, the diagnoses necessitating the use of a wheelchair, and the type of wheelchair used. These changes are inter-related and are likely to be driven by an increasingly elderly population.
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Affiliation(s)
- NJ Dudley
- Department of Geriatric Medicine, St Luke's Hospital, Bradford
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Xu Q, Norstrand JA, Du Y. Effects of Living Alone on Social Capital and Health Among Older Adults in China. Int J Aging Hum Dev 2016; 82:30-53. [DOI: 10.1177/0091415015624419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Social capital has been connected with positive health outcomes across countries, including China. Given the rise in the number of seniors living alone, there is a need to examine the health benefits of social capital, accounting for living arrangements. Data from the 2005 Chinese General Social Survey were used to test research hypotheses. Controlling for demographics, elders living alone possessed similar level of social capital compared with elders living with others. While bonding and linking social capital were significant factors in urban areas and linking social capital was a significant factor in rural areas, the relationship between living alone and health did not differ based on the level of social capital possession. When the traditional intergenerational living arrangement has not been a valid option for many older adults in China, seeking new way of family caring, and developing appropriate social and institutional structures to assist elders living alone, becomes critical.
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Affiliation(s)
- Qingwen Xu
- Tulane University School of Social Work, New Orleans, LA, USA
| | | | - Yan Du
- Tulane University Center for Aging, New Orleans, LA, USA
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Turner AJ, Nikolova S, Sutton M. The effect of living alone on the costs and benefits of surgery amongst older people. Soc Sci Med 2015; 150:95-103. [PMID: 26741271 DOI: 10.1016/j.socscimed.2015.11.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 11/26/2015] [Accepted: 11/27/2015] [Indexed: 11/18/2022]
Abstract
Older people who live alone are a growing, high-cost group for health and social services. The literature on how living alone affects health and the costs and benefits of healthcare has focused on crude measures of health and utilisation and gives little consideration to other cost determinants and aspects of patient experience. We study the effect of living alone at each stage along an entire treatment pathway using a large dataset which provides information on pre-treatment experience, treatment benefits and costs of surgery for 105,843 patients receiving elective hip and knee replacements in England in 2009 and 2010. We find that patients who live alone are healthier prior to treatment and experience the same gains from treatment. However, living alone is associated with a 9.2% longer length of in-hospital stay and increased probabilities of readmission and discharge to expensive destinations. These increase the costs per patient by £179.88 (3.12%) and amount to an additional £4.9 million per annum. A lack of post-discharge support for those living alone is likely to be a key driver of these additional costs.
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Affiliation(s)
- Alex J Turner
- Manchester Centre for Health Economics, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Silviya Nikolova
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, Charles Thackrah Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK.
| | - Matt Sutton
- Manchester Centre for Health Economics, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
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Park EJ, Sohn HS, Lee EK, Kwon JW. Living arrangements, chronic diseases, and prescription drug expenditures among Korean elderly: vulnerability to potential medication underuse. BMC Public Health 2014; 14:1284. [PMID: 25516064 PMCID: PMC4301451 DOI: 10.1186/1471-2458-14-1284] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 12/12/2014] [Indexed: 11/24/2022] Open
Abstract
Background Insufficient social security combined with family structure changes has resulted in a poverty of the elderly. The objective of this study was to examine an association of living arrangements of the elderly with chronic disease prevalence and prescription drug use. Methods 2008 Korea Health Panel Survey (KHPS) data were used in this study. Information on living arrangements, socio-demographics, health behaviors, chronic disease prevalence and healthcare expenditures including out-of-pocket (OOP) prescription drug expenditures for elderly aged 65 or older were collected from self-reported diaries and receipts. OOP prescription drug expenditure as a total cost that subject paid to a pharmacy for prescription drugs was examined. Logistic regression was used to identify differences in major chronic disease prevalence by living arrangements. The association of living arrangements with prescription drug use was analyzed using generalized linear model with a log link and a gamma variance distribution. Results Proportions of elderly living alone, elderly living with a spouse only, and elderly living with adults aged 20–64 were 14.5%, 48.3%, and 37.2%, respectively. Elderly living alone showed 2.43 odds ratio (OR) (95% confidence interval (CI) = 1.66-3.56) for having major chronic diseases prevalence compared to elderly living with adults. Despite a higher major chronic disease prevalence, elderly living alone showed lower OOP prescription drug expenditures (Cost Ratio = 0.80, 95% CI = 0.67-0.97) after adjusting for the number of major chronic diseases. Total OOP prescription drug expenditures were significantly lower in patients with a low income level versus high income level. Conclusions Even though elderly living alone had a higher risk of chronic disease, they spent less on OOP prescription drug expenditures. Optimal drug use is important for elderly with chronic diseases to achieve good health outcomes and quality of life. Public health policies should be supplemented to optimize medical treatment for vulnerable elderly living alone.
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Affiliation(s)
| | | | | | - Jin-Won Kwon
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu 702-701, South Korea.
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Ismail Z, Mohamad M, Isa MR, Fadzil MA, Yassin SM, Ma KT, Abu Bakar MHB. Factors associated with anxiety among elderly hypertensive in primary care setting. J Ment Health 2014; 24:29-32. [PMID: 25358109 DOI: 10.3109/09638237.2014.971148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is increasing evidence showing that anxiety is associated with morbidity in the older age group. Factors contributing to anxiety may vary among different diseases and settings. AIMS The aim of this study was to determine the factors associated with anxiety symptoms among elderly hypertensive at the primary care level. METHODS A cross-sectional study and face-to-face interviews using Hospital Anxiety and Depression Scale (HADS) were conducted among elderly hypertensive. RESULTS The mean (SD) age of subjects was 68.8 (6.76) years and comprised of 49.5% and 50.5% of males and females, respectively. The majority of respondents were Malays (76.1%), followed by Chinese (14.3%), and Indians (9.5%). The mean (SD) duration of hypertension was 8.44 (7.29) years and the prevalence of anxiety symptoms was 13.3% (95% CI: 9.9, 16.7). Multiple logistic regression analysis showed that elderly hypertensive with a past history of stroke (adjusted OR: 4.472; 95% CI: 1.754, 11.405; p = 0.002) and depression (adjusted OR: 3.715; 95% CI: 2.009, 6.872; p < 0.001) was significantly associated with the factors for anxiety. CONCLUSION Elderly hypertensive with a history of stroke and having depressive symptoms are susceptible to get the anxiety. Therefore, screenings of risk factors and early intervention may improve the quality of life among elderly.
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Affiliation(s)
- Zaliha Ismail
- Department of Population Health and Preventive Medicine, Faculty of Medicine, Universiti Teknologi MARA Sungai Buloh Campus , Jalan Hospital, Sungai Buloh Selangor , Malaysia
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Agrawal S. Effect of Living Arrangement on the Health Status of Elderly in India: Findings from a national cross sectional survey. ASIAN POPULATION STUDIES 2012; 8:87-101. [PMID: 28868080 PMCID: PMC5575814 DOI: 10.1080/17441730.2012.646842] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Epidemiological studies show strong association between lack/inadequate family support with increased mortality and poor health among the elderly. This study examined the effect of living arrangement on elderly health status by analysing the data of 39,694 persons aged 60 and above included in India's second National Family Health Survey conducted in 1998-1999. Results indicate that elderly who are living alone are likely to suffer more from both chronic illnesses, such as asthma and tuberculosis, and acute illnesses, such as malaria and jaundice, than those elderly who are living with their family, even after controlling for the effects of a number of socio-economic, demographic, environmental and behavioural confounders. The findings have important programme and policy implications for countries such as India, which has the second largest elderly population in the world. There is a strong need for the implementation of specific public support systems and health care strategies focused on the elderly population in general and elderly living alone in particular.
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Affiliation(s)
- Sutapa Agrawal
- South Asia Network for Chronic Disease, Public Health Foundation of India, C1/52, First floor, SDA, New Delhi -110016
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Matlabi H, Parker SG, McKee K. The contribution of home-based technology to older people's quality of life in extra care housing. BMC Geriatr 2011; 11:68. [PMID: 22040111 PMCID: PMC3215176 DOI: 10.1186/1471-2318-11-68] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 10/31/2011] [Indexed: 11/10/2022] Open
Abstract
Background British government policy for older people focuses on a vision of active ageing and independent living. In the face of diminishing personal capacities, the use of appropriate home-based technology (HBT) devices could potentially meet a wide range of needs and consequently improve many aspects of older people's quality of life such as physical health, psychosocial well-being, social relationships, and their physical or living environment. This study aimed to examine the use of HBT devices and the correlation between use of such devices and quality of life among older people living in extra-care housing (ECH). Methods A structured questionnaire was administered for this study. Using purposive sampling 160 older people living in extra-care housing schemes were selected from 23 schemes in England. A face-to-face interview was conducted in each participant's living unit. In order to measure quality of life, the SEIQoL-Adapted and CASP-19 were used. Results Although most basic appliances and emergency call systems were used in the living units, communally provided facilities such as personal computers, washing machines, and assisted bathing equipment in the schemes were not well utilised. Multiple regression analysis adjusted for confounders including age, sex, marital status, living arrangement and mobility use indicated a coefficient of 1.17 with 95% CI (0.05, 2.29) and p = 0.04 [SEIQoL-Adapted] and 2.83 with 95% CI (1.17, 4.50) and p = 0.001 [CASP-19]. Conclusions The findings of the present study will be value to those who are developing new form of specialised housing for older people with functional limitations and, in particular, guiding investments in technological aids. The results of the present study also indicate that the home is an essential site for developing residential technologies.
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Affiliation(s)
- Hossein Matlabi
- The Medical Education Research Centre, R & D Campus, Tabriz University of Medical Sciences, Daneshgah Ave., Tabriz, P.C.: 5165665811, Iran.
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Comparison of two frailty screening tools in older women with early breast cancer. Crit Rev Oncol Hematol 2011; 79:51-64. [DOI: 10.1016/j.critrevonc.2010.06.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 05/30/2010] [Accepted: 06/25/2010] [Indexed: 11/23/2022] Open
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Chan A, Malhotra C, Malhotra R, Ostbye T. Living arrangements, social networks and depressive symptoms among older men and women in Singapore. Int J Geriatr Psychiatry 2011; 26:630-9. [PMID: 20677171 DOI: 10.1002/gps.2574] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To examine the association of living arrangements and social networks outside the household with depressive symptoms among older men and women, ascertain if these relationships differ between older men and women, and investigate whether the association of living arrangements with depressive symptoms varies by strength of social networks. METHODS Data for 4489 community-dwelling Singaporeans, aged 60 years and older, from a recent nationally representative survey were analyzed. Depressive symptoms were assessed using the 11-item CES-D (Center for Epidemiologic Studies) scale, social networks through Lubben's revised social network scale, and living arrangements through household composition. Analysis was stratified by gender, and descriptive and multivariate statistics were used to assess the risk of depressive symptoms by living arrangements and social networks, adjusting for age, ethnic group, education, housing type, functional status, number of chronic diseases and involvement in social activities. RESULTS Women had higher depressive symptom scores than men. Living alone and living with at least 1 child (no spouse) (relative to living with spouse and children), and weak social networks outside the household were associated with higher depressive symptom scores among both men and women. Men living alone with weak social networks outside the household had higher depressive symptom scores than those with strong networks. CONCLUSION The findings have implications regarding the importance of strengthening non-familial social networks of older adults, particularly for those living alone.
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Affiliation(s)
- Angelique Chan
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore.
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Bergland A, Engedal K. Living Arrangements, Social Networks, Health, Mobility, and Balance of Older Women. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2011. [DOI: 10.3109/02703181.2010.541987] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Modernising social care services for older people: scoping the United Kingdom evidence base. AGEING & SOCIETY 2009. [DOI: 10.1017/s0144686x08008301] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTIn common with other developed countries at the end of the 20th century, modernising public services was a priority of the United Kingdom (UK) Labour administration after its election in 1997. The modernisation reforms in health and social care exemplified their approach to public policy. The authors were commissioned to examine the evidence base for the modernisation of social care services for older people, and for this purpose conducted a systematic review of the relevant peer-reviewed UK research literature published from 1990 to 2001. Publications that reported descriptive, analytical, evaluative, quantitative and qualitative studies were identified and critically appraised under six key themes of modernisation: integration, independence, consistency, support for carers, meeting individuals' needs, and the workforce. This paper lists the principal features of each study, provides an overview of the literature, and presents substantive findings relating to three of the modernisation themes (integration, independence and individuals' needs). The account provides a systematic portrayal both of the state of social care for older people prior to the modernisation process and of the relative strengths and weaknesses of the evidence base. It suggests that, for evidence-based practice and policy to become a reality in social care for older people, there is a general need for higher quality studies in this area.
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Fujino Y, Matsuda S. Prospective study of living arrangement by the ability to receive informal care and survival among Japanese elderly. Prev Med 2009; 48:79-85. [PMID: 19010348 DOI: 10.1016/j.ypmed.2008.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 10/15/2008] [Accepted: 10/16/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES In light of recent concerns regarding informal care, we examined the association between living arrangement and survival among elderly Japanese, with living arrangement measured in terms of the ability to receive informal care from the immediate family. METHODS A total of 3000 subjects aged 60 years or older were randomly recruited in Yukuhashi City, Japan, in 2002, of whom 2773 provided complete information for analysis. A trained local welfare commissioner visited the subjects annually from 2002 to 2007 and collected information concerning living arrangements, mobility status, medical status, and use of long-term care insurance service. During the 5 years of follow-up, 381 deaths were recorded. RESULTS Living arrangement was not associated with survival among elderly women. In contrast, compared with men living with others able to provide care throughout the day, mortality was higher for those living with others unable to provide sufficient care due to illness or infirmity; those living with others receiving long-term care insurance service; and those living alone without support from family or friends (multivariable hazard ratio=1.40, 95% Confidence Interval 0.94-2.09; hazard ratio=1.89, 95% Confidence Interval 1.07-3.34; and hazard ratio=5.76, 95% Confidence Interval 2.16-15.36; respectively). CONCLUSION We found that living arrangement as classified by the ability to receive informal care affects survival among elderly men.
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Affiliation(s)
- Yoshihisa Fujino
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Iseigaoka, Yahatanishiku, Kitakyushu, Japan.
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Davin B, Paraponaris A, Verger P. Socioeconomic determinants of the need for personal assistance reported by community-dwelling elderly: Empirical evidence from a French national health survey. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.socec.2008.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Shih SN, Gau ML, Tsai JC, Li IC, Liou YM, Shih FJ. A Health Need Satisfaction Instrument for Taiwan's single-living older people with chronic disease in the community. J Clin Nurs 2008; 17:67-77. [DOI: 10.1111/j.1365-2702.2007.02124.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yoshida Y, Kwon J, Iwasa H, Yoshida H, Kim H, Sugiura M, Furuna T, Suzuki T. [Characteristics of geriatric syndrome-subjects who did not participate in proffered intervention trial]. Nihon Ronen Igakkai Zasshi 2007; 44:231-7. [PMID: 17527026 DOI: 10.3143/geriatrics.44.231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The present study was conducted to identify the characteristics of non-participants in intervention for geriatric syndrome among community-dwelling elderly. METHODS The subjects were 208 men and 399 women aged 70 years and over who were eligible for participation in intervention programs for geriatric syndrome (falls, urinary incontinence, depression, and malnutrition) after recruitment based on a baseline health examination survey in 2002. Multiple logistic regression analysis was performed to assess non-participation in the intervention program as a dependent variable, and the relevant characteristics for participation in the baseline survey as the independent variables. RESULTS The rates of participation in the intervention were 16.8% for men and 32.6% for women. Logistic regression analysis showed that male non-participants had not participated in group social activity (odds ratio (OR)=2.46, 95% confidence interval (CI) 1.08-5.59), and had no medical history of heart disease (OR=0.38, 95%CI 0.17-0.89), whereas female non-participants had not lived alone (OR=0.53, 95%CI 0.34-0.83), and had no medical history of hyperlipemia (OR=0.54, 95% CI 0.34-0.84). CONCLUSION Social activity, living arrangement, and medical history are related to non-participation in intervention for geriatric syndrome. It is necessary to devise various intervention programs and approaches to encourage participation.
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Affiliation(s)
- Yuko Yoshida
- Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology
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Kharicha K, Iliffe S, Harari D, Swift C, Gillmann G, Stuck AE. Health risk appraisal in older people 1: are older people living alone an "at-risk" group? Br J Gen Pract 2007; 57:271-6. [PMID: 17394729 PMCID: PMC2043328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND In the UK, population screening for unmet need has failed to improve the health of older people. Attention is turning to interventions targeted at 'at-risk' groups. Living alone in later life is seen as a potential health risk, and older people living alone are thought to be an at-risk group worthy of further intervention. AIM To explore the clinical significance of living alone and the epidemiology of lone status as an at-risk category, by investigating associations between lone status and health behaviours, health status, and service use, in non-disabled older people. DESIGN OF STUDY Secondary analysis of baseline data from a randomised controlled trial of health risk appraisal in older people. SETTING Four group practices in suburban London. METHOD Sixty per cent of 2641 community-dwelling non-disabled people aged 65 years and over registered at a practice agreed to participate in the study; 84% of these returned completed questionnaires. A third of this group, (n = 860, 33.1%) lived alone and two-thirds (n = 1741, 66.9%) lived with someone else. RESULTS Those living alone were more likely to report fair or poor health, poor vision, difficulties in instrumental and basic activities of daily living, worse memory and mood, lower physical activity, poorer diet, worsening function, risk of social isolation, hazardous alcohol use, having no emergency carer, and multiple falls in the previous 12 months. After adjustment for age, sex, income, and educational attainment, living alone remained associated with multiple falls, functional impairment, poor diet, smoking status, risk of social isolation, and three self-reported chronic conditions: arthritis and/or rheumatism, glaucoma, and cataracts. CONCLUSION Clinicians working with independently-living older people living alone should anticipate higher levels of disease and disability in these patients, and higher health and social risks, much of which will be due to older age, lower educational status, and female sex. Living alone itself appears to be associated with higher risks of falling, and constellations of pathologies, including visual loss and joint disorders. Targeted population screening using lone status may be useful in identifying older individuals at high risk of falling.
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Affiliation(s)
- Kalpa Kharicha
- Department of Primary Care and Population Sciences, University College London, Hampstead Campus, Rowland Hill Street, London, UK.
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Davin B, Paraponaris A, Verger P. [Demographic and socioeconomic factors associated with needs for home assistance among community-dwelling elderly: a study from the French Home Survey Handicaps-Disabilities-Dependence]. Rev Epidemiol Sante Publique 2006; 53:509-24. [PMID: 16434925 DOI: 10.1016/s0398-7620(05)84728-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gains in life expectancy in western countries have mainly come hand in hand with growing chronic diseases and disabilities related to the activities of daily living (ADL) and instrumental activities of daily living (IADL). Although these disabilities have been identified as predictors of institutionalization, the elderly in France continue to live at home, in the community, alone or with others. This work aims at identifying and assessing their needs for assistance and looks especially at the demographic and socioeconomic associated features. METHODS Reported needs for assistance with ADL and IADL are studied through a representative sample of 8,745 people aged 60 years and older and living at home in 1999, taken from the French cross-sectional "Handicaps-Disabilities-Dependence" survey. Statistical associations (non-adjusted and adjusted Odds-Ratio-OR) have been computed in a conceptual framework derived from Andersen and Newman's behavioural model. RESULTS More than 1 million people aged 60 years and older need assistance from another person to perform at least one ADL (bathing, dressing, going to toilet, eating, transferring, getting outside) and about 2.5 millions persons for at least one IADL (shopping, food preparation, housekeeping). Need for assistance for at least one ADL is associated with age (OR=1.4 for 70-79, 3.6 for 80+); male aged 80 and older (OR=0.5); low educational status (OR=1.5); being married (OR=1.7) or living with an other person (OR=2); a disposable income less than 540 euro per capita and per month or between 540 and 1,080 euro (OR=1.3); impairments: motor (OR=3), language (OR=2.1), visual (OR=1.7), mental (OR=1.5) and other (OR=1.2); availability of home equipment devices (OR=3.5), technical devices for moving inside (OR=3) and others (OR=2.1). Need for assistance is especially high among those who required assistance (OR=4) or proxies (OR=5.5) to answer. Declared need for assistance for at least one IADL is roughly associated with the same factors. CONCLUSION These results suggest that the declared needs for human assistance are based not exclusively on functional limitations but are also related to the social and environmental setting.
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Affiliation(s)
- B Davin
- INSERM UMR 379, 232, boulevard de Sainte-Marguerite, 13273 Marseille Cedex 9
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Kawamoto R, Yoshida O, Oka Y, Kodama A. Influence of living alone on emotional well-being in community-dwelling elderly persons. Geriatr Gerontol Int 2005. [DOI: 10.1111/j.1447-0594.2005.00285.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lupien SJ, Schwartz G, Ng YK, Fiocco A, Wan N, Pruessner JC, Meaney MJ, Nair NPV. The Douglas Hospital Longitudinal Study of Normal and Pathological Aging: summary of findings. J Psychiatry Neurosci 2005; 30:328-34. [PMID: 16151537 PMCID: PMC1197277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
In 1988, our group initiated the Douglas Hospital Longitudinal Study of Normal and Pathological Aging to assess the association between secretion of the stress hormone cortisol and cognitive performance in a group of 51 older adults. In this paper, we summarize the data obtained in this study to date. We have found that long-term exposure to high endogenous levels of cortisol is associated with both memory impairments and a 14; smaller volume of the hippocampus. We also report on studies showing that in older adults with moderate levels of cortisol over time, memory performance can be acutely modulated by pharmacologic manipulations of cortisol. We describe one participant who was included in the group of older adults presenting with increased cortisol levels over time, memory impairments and reduced hippocampal volume and in whom major depression, followed by Alzheimer's disease, developed during the course of the study. Together, the results of the Douglas Hospital Longitudinal Study of Normal and Pathological Aging show that increased secretion of cortisol in the older human population is significantly associated with impairment of cognitive function during aging.
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Affiliation(s)
- Sonia J Lupien
- Laboratory of Human Stress Research, Douglas Hospital Research Centre, Borough of Verdun, and Department of Psychiatry, McGill University, Montréal, Quebec, Canada.
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Abstract
AIM This paper reports a study comparing the socio-demographic data, quality of life (QoL) and symptoms of older people living at home with and without help. BACKGROUND Despite growing numbers of older people worldwide, little is know about the differences between older people receiving help to live at home and those not receiving this, especially as regards QoL and symptoms. Not only symptoms but also dependency on others per se may reduce older people's QoL. From a nursing perspective, knowledge about such issues is important because the impact of symptoms may be reducible, even when diseases cannot be cured. METHOD A postal questionnaire was sent to an age-stratified random sample of 1866 people aged 75 years or over. Of the respondents (n = 1248) 448 received help and 793 did not. RESULTS The group receiving help had a significantly higher age, more women, more people widowed and living alone, more children, a higher number of self-reported diseases and symptoms, greater inability to remain alone at home and lower QoL. Loneliness, depressed mood and abdominal pain were significantly related to low QoL in both groups. Living alone, not being able to remain alone at home without help, and fatigue were also predictive of low QoL among those receiving help, and number of diseases and sleep problems in those without. CONCLUSION Receiving help with daily living seems to be significantly related to low QoL and goes along with a high number of symptoms that need to be considered in nursing care. Through regular visits, systematic assessment and intervention, especially focusing on older people's symptoms, nurses may contribute to improved QoL for this section of the population.
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Affiliation(s)
- Ylva Hellström
- School of Health Science, Blekinge Institute of Technology, Karlskrona, Sweden.
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Drennan V, Iliffe S, Haworth D, Tai SS, Lenihan P, Deave T. The feasibility and acceptability of a specialist health and social care team for the promotion of health and independence in 'at risk' older adults. HEALTH & SOCIAL CARE IN THE COMMUNITY 2005; 13:136-144. [PMID: 15717915 DOI: 10.1111/j.1365-2524.2005.00541.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Population ageing, escalating costs in pensions, health-care and long-term care have prompted a new policy agenda for active ageing and quality of life in old age across the European Union and other developed countries. In England, the National Service Framework for Older People (NSF OP) explicitly demands for the first time that the NHS and local authorities, in partnership, agree programmes to promote health ageing and to prevent disease in older people. These programmes are expected to improve access for older people to mainstream health promotion services and also to develop multiagency initiatives to promote health, independence and well-being in old age. This paper describes the evaluation of one interagency project team established to test out mechanisms for addressing health promotion for older people through primary care. A mixed methodology was used to understand the processes of service development, the impact of the team's intervention, and the primary and secondary outcomes for older people. The project demonstrated that multi-agency partnerships have the potential to improve the quality of the lives of older people deemed 'at risk' by their general practitioners, particularly through income generation but also in the identification of medical problems such as unrecognised hypertension, hearing loss and visual loss. It also offered some key learning points for other multi-agency groups developing similar services.
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Affiliation(s)
- Vari Drennan
- Primary Care Nursing Research Unit, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London, Archway Campus, Highgate Hill, London, UK.
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Callen BL, Wells TJ. Views of Community‐Dwelling, Old‐Old People on Barriers and Aids to Nutritional Health. J Nurs Scholarsh 2004; 35:257-62. [PMID: 14562494 DOI: 10.1111/j.1547-5069.2003.00257.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To examine barriers and aids to maintaining the nutritional health of community-dwelling old-old residents from their perspectives. DESIGN Cross-sectional exploratory study completed in March 2002 of old-old people living independently in one county in the Midwestern United States (US). METHODS Sixty-eight in-home interviews were conducted with community-dwelling people aged 80 or older. Content analysis was done to examine answers to two open-ended questions about barriers and helps to nutritional health. FINDINGS These old-old people believed they were doing well nutritionally despite reduced independence and physical limitations. They were positive about their lives and creative in problem solving to remain independent. Social connectedness was the major factor for maintaining independence into old age. The leading barrier to maintaining nutritional health was health problems. Those with more barriers were more likely to be depressed. CONCLUSIONS Knowledge of aids and barriers to nutritional health, from a personal perspective, gives an understanding of the issues and concerns of old-old people.
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Affiliation(s)
- Bonnie L Callen
- University of Tennessee, College of Nursing, Knoxville, TN, USA.
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Abstract
BACKGROUND Although a substantial number of studies have identified the prevalence of depression experienced by older adults living in the community and the factors that may precipitate this depression, few have focussed on depression in older people who attend day centres. Consequently, there is no literature suggesting how depression in this population may be psychologically managed. AIMS The aim of this paper is to present the results of a pilot study investigating the incidence of depression in people attending a London Age Concern day centre, and its associations with perceptions of handicap, loneliness, social support networks, satisfaction with social support, and satisfaction with life. METHODS A quasi-experimental, cross-sectional pilot study was conducted with attendees at a London Age Concern day centre between November 1998 and January 1999. The day centre manager selected a convenience sample of 24 of 156 participants. Inclusion criteria were that participants must attend the day centre regularly and be over or equal to 65 years of age. The exclusion criterion was known psychiatric illness. Participants were interviewed using the Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy, which identifies caseness of psychopathology and includes a loneliness subscale, and completed the Satisfaction with Life Scale, Social Support Questionnaire and London Handicap Scale. RESULTS There was a higher level of depression in this day centre setting than that found in other community-based studies. There were the expected significant associations between depression and loneliness, and depression and satisfaction with life. However, unexpectedly, there were no associations between depression and social support, or depression and handicap. CONCLUSIONS The study has several limitations. However, the high level of depression and significant relationships between depression, loneliness and satisfaction with life may indicate that the social function of day centres is not meeting expectations. This suggests that there could be a role for community mental health nurses in offering psychosocial interventions to alleviate some of the distress experienced.
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Affiliation(s)
- Henry A Minardi
- Liaison Psychiatry for Older Adults, Central and North West London Mental Health NHS Trust, St Charles Mental Health Unit, St Charles Hospital, London, UK.
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Béland F, Birch S, Stoddart G. Unemployment and health: contextual-level influences on the production of health in populations. Soc Sci Med 2002; 55:2033-52. [PMID: 12406469 DOI: 10.1016/s0277-9536(01)00344-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
While there is a large and growing literature investigating the relationship between an individual's employment status and health, considerably less is known about the effect on this relationship of the context in which unemployment occurs. The aim of this paper is test for the presence and nature of contextual effects in the ways unemployment and health are related, based on a simple underlying model of stress, social support and health using a large population health survey. An individual's health can be influenced directly by own exposure to unemployment and by exposure to unemployment in the individual's context, and indirectly by the effects these exposures have on the relationship between other health determinants and health. Based on this conceptualization an empirical model, using multi-level analysis, is formulated that identifies a five-stage process for exploring these complex pathways through which unemployment affects health. Results showed that the association of individual unemployment with perceived health is statistically significant. Nevertheless, this study did not provide evidence to support the hypothesis that the association of unemployment with health status depends upon whether the experience of unemployment is shared with people living in the same environment. Above all, this study demonstrates both the subtlety and complexity of individual- and contextual-level influences on the health of individuals. Our results caution against simplistic interpretations of the unemployment-health relationship and reinforce the importance of using multi-level statistical methods for investigation of it.
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Affiliation(s)
- François Béland
- Groupe de recherche interdisciplinaire en santé, GRIS, Faculté de Médecine, Université de Montréal, CP 6128, Succursale Centre-Ville, Montréal H3C 3J7, Québec, Canada.
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Koukouli S, Vlachonikolis IG, Philalithis A. Socio-demographic factors and self-reported functional status: the significance of social support. BMC Health Serv Res 2002; 2:20. [PMID: 12361478 PMCID: PMC130039 DOI: 10.1186/1472-6963-2-20] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2002] [Accepted: 10/02/2002] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The aim of the present work was to investigate the relative importance of socio-demographic and physical health status factors for subjective functioning, as well as to examine the role of social support. METHODS A cross-sectional health survey was carried out in a Greek municipality. 1356 adults of the general population were included in the study. Personal interviews were conducted with house-to-house visits. The response rate was 91.2%. Functioning has been measured by five indexes: 'The Social Roles and Mobility' scale (SORM), 'The Self-Care Restrictions' scale (SCR), 'The Serious Limitations' scale (SL), 'The Minor Self-care Limitations' scale (MSCR) and 'The Minor Limitations in Social Roles and Mobility' scale (MSORM). RESULTS Among the two sets of independent variables, the socio-demographic ones had significant influence on the functional status, except for MSORM. Allowing for these variables, the physical health status indicators had also significant effects on all functioning scales. Living arrangements and marital status had significant effects on four out of five indexes, while arthritis, Parkinson's disease, past stroke and kidney stones had significant effects on the SCR and SL scales. CONCLUSIONS These results suggest that socio-demographic factors are as important as physical health variables in affecting a person's ability to function normally in their everyday life. Social support appears to play a significant role in explaining differences in subjective functioning: people living alone or only with the spouse, particularly the elderly, seem to be in greater risk for disability problems and should be targeted by preventive programs in the community.
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Affiliation(s)
- S Koukouli
- Health Planning Division, Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
- School of Social Work, Technological Educational Institute of Crete, Heraklion, Greece
| | - IG Vlachonikolis
- Biostatistics Division, Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - A Philalithis
- Health Planning Division, Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
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Discovery of Decomposed and Mummified Corpses in the Domestic Setting—A marker of Social Isolation? J Forensic Sci 2002. [DOI: 10.1520/jfs15453j] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
The living arrangements of older persons play a key role in their use of formal and informal care, as well as in their health and well-being. Nurses engaged in primary care, discharge planning, and home care are strategically positioned to contribute to an optimal fit between older persons and their home environment. This article describes the demographic significance of late-life living arrangements and proposes a model for organizing the complex web of factors associated with household composition and late-life migration. The article then summarizes qualitative and quantitative evidence in support of the proposed model. Key areas for nursing research and strategies for applying available research are identified.
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Affiliation(s)
- Judith C Hays
- Geriatric Psychiatry and Gerontological Nursing, Duke University Medical Center, Durham, NC 27710, USA.
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Zunzunegui MV, Béland F, Otero A. Support from children, living arrangements, self-rated health and depressive symptoms of older people in Spain. Int J Epidemiol 2001; 30:1090-9. [PMID: 11689528 DOI: 10.1093/ije/30.5.1090] [Citation(s) in RCA: 167] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To assess the association between emotional and instrumental support from children and living arrangements with the physical and mental health of older people in Spain. METHODS A face-to-face home interview was carried out with 1284 community-dwelling people over 65 (response rate = 83%) randomly sampled according to an age- and sex-stratified sampling scheme in 1993 at Leganés (Spain). Close to 93% of the participants had children and 45% of them coresided with them. Depressive symptoms were assessed by the CES-D (Center for Epidemiologic study depression scale) and self-rated health (SRH) by a single-item question. Emotional support was measured with a six-item scale on affection and reciprocity. Instrumental support was assessed by help received from children in 17 activities of daily living. Four living arrangements were considered: Living with spouse only, living with a spouse and children, widower living alone, and widower living with children. RESULTS Multivariate analysis controlling for age, gender, education and functional status showed that low emotional support and reception of instrumental aid were significantly associated with poor SRH. Being a widower and sharing living arrangements with children was associated with good SRH. Living arrangements modify some of the associations of support of children with SRH. Depressive symptoms were associated with low emotional support, reception of instrumental help and being a widower who did not share living arrangements with children. For widowers who do not cohabit with children, reception of instrumental aid is associated with low depressive symptomatology. DISCUSSION Emotional support from children seems to play an important role in maintaining the physical and mental health of elderly people in Spain. Instrumental support is widely available. Coresidence with children is very common and it is associated with good self-perceived health and low prevalence of depressive symptoms in a culture where family interdependence is highly valued. Families should be protected and encouraged to continue care-giving through a variety of community services and respite care, adapted to their needs and preferences. Research should be undertaken to find more efficient ways to help family caregivers in the Mediterranean context.
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Affiliation(s)
- M V Zunzunegui
- Groupe Interdisciplinaire de Recherche en Santé, Faculté de Médecine, Université de Montréal, Québec, Canada.
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Gulliford MC, Mahabir D. Utilisation of private care by public primary care clinic attenders with diabetes: relationship to health status and social factors. Soc Sci Med 2001; 53:1045-56. [PMID: 11556774 DOI: 10.1016/s0277-9536(00)00399-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Private health care provision is important in most middle-income countries but factors influencing the demand for private care have not been well defined. This paper evaluated the relationships of health status and socio-economic variables with utilisation of private care by public primary care clinic attenders. The sample included 2117 randomly selected subjects with clinical diabetes attending 35 government health centres in Trinidad and Tobago. Measures included attendance at a private doctor, the type 2 Diabetes Symptom Checklist, the SF36 questionnaire, and indicators of socio-economic status. Of the sample, 1256 (59%) reported attending a private doctor, 577 (27%) attended a private doctor for diabetes, and 378 (18%) attended a private doctor regularly. Attendance at a private doctor was associated with lower SF36 scores. The odds ratio for a 10 unit increase in SF36 physical component score was 0.81, 95% confidence interval 0.72-0.91. After adjusting for demographic and social factors the relative odds were 0.89, 0.80 to 1.00. After allowing for differences in health status, the relative odds of attending for private care for those without a pipe borne water supply in the home, compared with those with water in the home, were 0.77, 0.63-0.94. Those living alone were less likely to attend a private doctor than those living with their children and partner (odds ratio 0.60, 0.43-0.83). Among people attending public clinics, the decision to utilise private care is sensitive to health status. After adjusting for health status, there was evidence for horizontal inequity in access to private care in relation to household amenities and composition.
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Affiliation(s)
- M C Gulliford
- Department of Public Health Sciences, GKT School of Medicine, Kings College London, UK.
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Regidor E, Calle ME, Domínguez V, Navarro P. [Mortality by social and economic characteristics: The Mortality Study of the Autonomous Community of Madrid]. Med Clin (Barc) 2001; 116:726-31. [PMID: 11412692 DOI: 10.1016/s0025-7753(01)71966-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND To estimate the effect of marital status, household size, employment status, educational level and occupation on mortality. SUBJECTS AND METHOD About 3,100,000 persons 24 years and older resident on first of May, 1996 in Autonomous Community of Madrid. For the next 19 months information on individuals who died were obtained by linking Mortality Register and 1996 Population Census. RESULTS Except for household size, the effect on mortality of characteristics analysed was higher in individuals aged 25 to 44 years than in other group of age. In general, married persons had the lowest mortality, except for men older than 64 years where the lowest mortality was found in the never married category. Men aged 45 to 64 years who lived alone had higher mortality than those who lived with other people, while mortality in people aged older than 64 years increased with household size. Inactive persons had higher mortality than active people. Higher education level and higher skilled occupation were associated with lower mortality, except for women aged 45 to 64 years. CONCLUSIONS This study has identified population groups associated with increased risk of mortality. Monitoring the trend of mortality in those groups will make possible to found the rational basis to implement social and health programmes.
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Affiliation(s)
- E Regidor
- Departamento de Medicina Preventiva, Salud Pública e Historia de la Ciencia. Facultad de Medicina. Universidad Complutense de Madrid
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