Social Network Types in Old Age and Incident Dementia

Exploring the associations between structural and functional aspects of social relationships and cognition in very old age

OBJECTIVES

Few studies have examined the associations between social relationships and cognition in very old adults (80+ years). Moreover, limited research has considered structural and functional aspects of social relationships together when exploring their associations with cognition. Therefore, the present study aimed to investigate the associations between structural and functional social aspects and cognition in very old age.

METHOD

The sample comprised 518 two-wave participants of the NRW80+ Study, who showed no indication of dementia and an average age of 85 years at baseline (range: 80-97 years). They were assessed twice over an approximate 2-year interval. Multilevel linear growth curve analysis was employed to model cognitive development over very old age and to examine the associations between structural and functional aspects of social relationships and cognitive development. It was controlled for demographic and health characteristics.

RESULTS

A larger social network size (ß = 0.05, 95% CI [0.02, 0.08], p = 0.002) and frequent compared with occasional, seldom, and no contact with others (ß = 0.16, 95% CI [0.03, 0.28], p = 0.013) were associated with higher global cognition in the fully-controlled model. Model comparisons further revealed that structural aspects better predicted global cognition in very old age compared to functional aspects (χ2(2) = 16.17, p < 0.001).

CONCLUSION

The findings underline the positive association between structural aspects of social relationships and global cognition in very old age. They also highlight the need for interventions promoting a socially active lifestyle to prevent cognitive decline in this vulnerable age group.

The impact of loneliness and social isolation on the development of cognitive decline and Alzheimer's Disease

Alzheimer's Disease (AD) is the leading cause of dementia, observed at a higher incidence in women compared with men. Treatments aimed at improving pathology in AD remain ineffective to stop disease progression. This makes the detection of the early intervention strategies to reduce future disease risk extremely important. Isolation and loneliness have been identified among the major risk factors for AD. The increasing prevalence of both loneliness and AD emphasizes the urgent need to understand this association to inform treatment. Here we present a comprehensive review of both clinical and preclinical studies that investigated loneliness and social isolation as risk factors for AD. We discuss that understanding the mechanisms of how loneliness exacerbates cognitive impairment and AD with a focus on sex differences will shed the light for the underlying mechanisms regarding loneliness as a risk factor for AD and to develop effective prevention or treatment strategies.

Association between social integration and risk of dementia: A systematic review and meta-analysis of longitudinal studies

BACKGROUND

Dementia is an emerging public health issue. Growing evidence emerged on the association between social integration and the risk of dementia. However, the magnitude of the association between different aspects of social integration and the risk of dementia is unclear.

METHODS

Five databases were systematically searched. Newcastle-Ottawa scale for assessing the quality of the reporting was used for quality appraisal. Longitudinal cohort studies examining the association between social integration and the risk of dementia were analyzed using random effects model. A series of sensitivity analyses was conducted to enhance the robustness of the findings.

RESULTS

Forty publications generated from 32 studies/databases were included. The meta-analysis showed that strong social engagement (overall RR = 0.81, 95% CI = 0.74-0.89, p < 0.001) and frequent social contact (overall RR = 0.86, 95% CI = 0.76-0.97, p = 0.018) were positively associated with decreased risk of dementia. The influence of social support (overall RR = 0.92, 95% CI = 0.80-1.06, p = 0.238) and close social contact (overall RR = 0.74, 95% CI = 0.48-1.13, p = 0.167) was not significant. Loneliness was significantly associated with an increased risk of dementia (overall RR = 1.42, 95% CI = 1.26-1.60, p < 0.001), whereas the influence of social isolation (overall RR = 1.58, 95% CI = 0.80-3.12, p = 0.192) was not significant. A larger social network size (RR = 0.75, 95% CI = 0.59-0.97, p = 0.028) was a promising influencing factor even though the number of studies was insufficient for a meta-analysis. However, the heterogeneity among studies was generally high even though sensitivity analysis was conducted.

CONCLUSIONS

Our findings reveal that high social engagement and frequent social contact are significantly associated with a lower risk of dementia, whereas loneliness is associated with a higher risk. The promising impact of large social network size is also identified. Substantial heterogeneity appeared in most of the analysis, making the inference tentative. Nevertheless, the sensitivity analysis provided valuable implications that enhancing social engagement and reducing loneliness may prevent or delay the onset of dementia among middle-aged and older adults.

Rethinking Spaces of Leisure: How People Living with Dementia Use the Opportunities Leisure Centres Provide to Promote their Identity and Place in the World

We report on research that found joining activities within community leisure and fitness centres (Centres) enabled people living with dementia to create meaning about everyday life and foster identity. Focusing on three Centres in England, the study was informed by the experiences and accounts of four people living with dementia, their life-partner (if applicable) and the sports professional most closely associated with the person as each participated within a range of leisure opportunities. The methodology was underpinned by phenomenological philosophy and utilised participative methods. Theoretically, the paper draws upon considerations of serious leisure that provide ways in which the participants’ experiences could be understood and wider implications considered. Conceptual themes we derived from the data analysis were place, citizenship, and belonging (where the Centre acting as a physical space was important); identity and interaction (where the focus was upon space making and embodiment); safe spaces and care (i.e., how wellbeing was sustained and how participation and meaningful engagement occurred within the space); and, the value of Centres as opportunity structures (where all of these themes coalesced). Amid current public health debates over resourcing and care, this research provides timely insights and continued needed debates on the relationship between adequate social, economic and political support/resourcing, and the ability of Centres to facilitate and sustain meaningful and safe spaces. Beyond, we suggest our findings offer learning that might extend to wider contexts; for example, through including Centres within social care and health initiatives, where emphasis will be upon participation as a citizen rather than as a patient.

Social Isolation and Incident Dementia in the Oldest-Old-A Competing Risk Analysis

Purpose

Social isolation is considered a risk factor for dementia. However, less is known about social isolation and dementia with respect to competing risk of death, particularly in the oldest-old, who are at highest risk for social isolation, dementia and mortality. Therefore, we aimed to examine these associations in a sample of oldest-old individuals.

Methods

Analyses were based on follow-up (FU) 5-9 of the longitudinal German study AgeCoDe/AgeQualiDe. Social isolation was assessed using the short form of the Lubben Social Network Scale (LSNS-6), with a score ≤ 12 indicating social isolation. Structured interviews were used to identify dementia cases. Competing risk analysis based on the Fine-Gray model was conducted to test the association between social isolation and incident dementia.

Results

Excluding participants with prevalent dementia, n = 1,161 individuals were included. Their mean age was 86.6 (SD = 3.1) years and 67.0% were female. The prevalence of social isolation was 34.7% at FU 5, 9.7% developed dementia and 36.0% died during a mean FU time of 4.3 (SD = 0.4) years. Adjusting for covariates and cumulative mortality risk, social isolation was not significantly associated with incident dementia; neither in the total sample (sHR: 1.07, 95%CI 0.65-1.76, p = 0.80), nor if stratified by sex (men: sHR: 0.71, 95%CI 0.28-1.83, p = 0.48; women: sHR: 1.39, 95%CI 0.77-2.51, p = 0.27).

Conclusion

In contrast to the findings of previous studies, we did not find an association between social isolation and incident dementia in the oldest-old. However, our analysis took into account the competing risk of death and the FU period was rather short. Future studies, especially with longer FU periods and more comprehensive assessment of qualitative social network characteristics (e.g., loneliness and satisfaction with social relationships) may be useful for clarification.

Evaluation of a multidisciplinary concept of mental demands at work on cognitive functioning in old age

OBJECTIVES

Previous work has shown that high mental demands are associated with better cognitive functioning in old age. As there is a lack of a general conceptual framework for this association, the aim of the study was to investigate how mental demands and other work-related factors relate to cognitive functioning as a foundation for developing such a framework.

METHODS

An expert panel discussion was conducted with the aim of determining relevant work-related factors, which were then tested in a survey with 346 employees aged 50+ years, who were actively working. Assessment of cognitive functioning comprised complex attention, executive function, learning/memory, language, perceptual-motor, and social cognition. Confirmatory factor analysis was conducted to confirm factor belonging. Associations with cognitive functioning were analyzed using structure equation modelling to confirm associations and to identify additional direct and indirect paths.

RESULTS

Only 42.3% (22/52) of the work-related factors and 19.0% (4/21) of the mediating paths suggested by the experts were significant with respect to cognitive functioning. Factor analysis and structural equation modeling indicated that high mental demands are only associated with better cognitive functioning in old age to the extent that they are intellectually stimulating and this effect is embedded in individual capacities and the social context.

CONCLUSION

Based on the panel discussion and the empirical testing, we propose the Conceptual Framework of Social Dependency of Intellectual Stimulation on Cognitive Health. We recommend researchers and workplace health experts to pay attention to the component of this theory when assessing workplace risk.

Operationalizing Social Environments in Cognitive Aging and Dementia Research: A Scoping Review

BACKGROUND

Social environments are a contributing determinant of health and disparities. This scoping review details how social environments have been operationalized in observational studies of cognitive aging and dementia.

METHODS

A systematic search in PubMed and Web of Science identified studies of social environment exposures and late-life cognition/dementia outcomes. Data were extracted on (1) study design; (2) population; (3) social environment(s); (4) cognitive outcome(s); (5) analytic approach; and (6) theorized causal pathways. Studies were organized using a 3-tiered social ecological model at interpersonal, community, or policy levels.

RESULTS

Of 7802 non-duplicated articles, 123 studies met inclusion criteria. Eighty-four studies were longitudinal (range 1-28 years) and 16 examined time-varying social environments. When sorted into social ecological levels, 91 studies examined the interpersonal level; 37 examined the community/neighborhood level; 3 examined policy level social environments; and 7 studies examined more than one level.

CONCLUSIONS

Most studies of social environments and cognitive aging and dementia examined interpersonal factors measured at a single point in time. Few assessed time-varying social environmental factors or considered multiple social ecological levels. Future studies can help clarify opportunities for intervention by delineating if, when, and how social environments shape late-life cognitive aging and dementia outcomes.

Environmental enrichment: A concept analysis

OBJECTIVES

The concept analysis of environmental enrichment aims to clarify the meaning of the term contributing to a shared understanding of its use in healthcare and future research studies. Environmental enrichment has implications in health promotion in children's development and healthy aging in the general population.

METHODS

A literature search using PubMed and CINAHL databases on environmental enrichment was conducted to identify the uses of the term from various disciplines. The keywords are "environmental enrichment", "socialization", "physical activity", "cognitive stimulation", and "experience-dependent". Human studies from 2000 to 2020 were included in the search.

RESULTS

Availability of green spaces, neighborhood safety, walkability to community centers, and accessibility of community resources are antecedents of environmental enrichment. Defining attributes are positive stimulation, interpersonal interaction, and physical engagement. The consequences of environmental enrichment are improved cognitive functioning in children, decline in memory impairment, and reduced risk of developing dementia in the elderly.

CONCLUSION

Engaging and counseling patients, family members, and the community in adverse effects of a deprived environment and the benefits of an enriched environment is a vital tenet of the nursing discipline. Understanding the optimum amount of positive stimulation, interpersonal interaction duration, and frequency are needed in future research.

The situation of elderly with cognitive impairment living at home during lockdown in the Corona-pandemic in Germany

BACKGROUND

The outbreak of the Corona virus is a challenge for health care systems worldwide. The aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of health care provision of people with cognitive impairment during social distancing and lockdown in the primary care system and living at home in Germany.

METHODS

This analysis is based on data of a telephone-based assessment in a convenience sample of n = 141 people with known cognitive impairment in the primary care setting. Data on e.g. cognitive and psychological status prior to the pandemic was available. Attitudes, knowledge about and perceived personal impact of the pandemic, social support, loneliness, anxiety, depression, change in the frequency of social activities due to the pandemic and perceived impact of the pandemic on health care related services were assessed during the time of lockdown.

RESULTS

The vast majority of participants are sufficiently informed about Corona (85%) and most think that the measures taken are appropriate (64%). A total of 11% shows one main symptom of a depression according to DSM-5. The frequency of depressive symptoms has not increased between the time before pandemic and lockdown in almost all participants. The sample shows minimal (65.0%) or low symptoms of anxiety (25%). The prevalence of loneliness is 10%. On average seven activities have decreased in frequency due to the pandemic. Social activities related to meeting people, dancing or visiting birthdays have decreased significantly. Talking with friends by phone and activities like gardening have increased. Utilization of health care services like day clinics, relief services and prescribed therapies have been reported to have worsened due to the pandemic. Visits to general practitioners decreased.

CONCLUSIONS

The study shows a small impact of the pandemic on psychological variables like depression, anxiety and loneliness in the short-term in Germany. There is a decrease in social activities as expected. The impact on health care provision is prominent. There is a need for qualitative, in-depth studies to further interpret the results.

Model of User Data Analysis Complex for the Management of Diverse Web Projects during Crises

This article discusses the relevant task of analyzing user data in the process of managing various web projects. The results of this analysis will help to improve the management of diverse web projects during crises. The authors explore the concept of data heterogeneity in web projects, classify web projects by function and purpose, and analyze the search models and data display in web projects. The proposed algorithms for analyzing user data in the process of managing diverse web projects will improve the structuring and presentation of data on the web project platform. The model user data analysis complex developed by the authors will simplify the process of managing various web projects during crises.

Living alone and risk of dementia: A systematic review and meta-analysis

AIMS

To systematically review longitudinal studies on living alone and incident dementia, to pool the results in a meta-analysis and calculate the population risk.

METHODS

Embase, Medline and PsycInfo were searched from inception to August 2019 for longitudinal cohort studies of people living alone and risk of dementia. Relative risks (RR) were extracted and effect sizes pooled, with a sensitivity analysis for risk of bias (QUIPS quality rating tool). Population Attributable Fraction (PAF) was calculated, with prevalence of living alone calculated from UK Census data.

RESULTS

Twelve studies were identified for inclusion, nine of which had low risk of bias. The pooled effect size indicated an elevated risk of incident dementia when living alone (all studies RR = 1.30; 95 % CI: 1.15-1.46; low risk of bias studies (RR = 1.31; 95 % CI: 1.13-1.51). The PAF for living alone was 8.9 %.

CONCLUSIONS

Social isolation is a more important risk factor for dementia than previously identified, with living alone associated with greater population risk than physical inactivity, hypertension, diabetes and obesity.

Neighborhood, social isolation and mental health outcome among older people in Ghana

OBJECTIVE

Loneliness and living alone have been strongly related to mental health but limited empirical evidence of these relationships exists among older people in Ghana. We examine the pathways of independent and interactive impacts of loneliness and living alone on psychological distress (PD) risk among older people in Ghana and to investigate whether the associations are moderated by neighborhood characteristics.

METHODS

Data were analyzed for 1200 community-dwelling adults aged ≥50 years from a 2016/2017 Aging, Health, Psychological Wellbeing and Health-seeking Behavior Study. Mental health and loneliness were respectively assessed using the Kessler Psychological Distress Scale (KPDS-10) and the Three-Item Loneliness Scale of the University of California, Los Angeles. OLS models estimated the associations and interactions.

RESULTS

Participants were mostly women (63.3% [95%CI: 60.5-66.0%]) with a mean age of 66.2 ± 11.9. Mean scores for PD and loneliness were 15.9 ± 4.7 and 5.3 ± 3.9 respectively whilst the prevalence of living alone was 38.2% (95%CI: 35.4-41.0%). After full adjustment, the OLS regressions showed that loneliness (β = 1.474, SE = 0.151, p < 0.001), living alone (β = 0.381, SE = 0.162, p < 0.05) and the interaction between them (β = 0.917, SE = 0.308, p < 0.05) significantly increased the PD risk. However, engagement in regular physical activity, family contacts and social participation decreased PD outcomes among the socially isolated.

LIMITATION

The cross-sectional nature of the data may prohibit any causal and directional inferences.

CONCLUSIONS

Social connectedness and neighborhood engagements strongly buffer against the risk of later life mental disorders in the context of loneliness, and living alone. Moderate-to-rigorous physical activity and social cohesion should be effectively and strategically included in interventions targeted to improve older age mental health.

Association of social contact with dementia and cognition: 28-year follow-up of the Whitehall II cohort study

BACKGROUND

There is need to identify targets for preventing or delaying dementia. Social contact is a potential target for clinical and public health studies, but previous observational studies had short follow-up, making findings susceptible to reverse causation bias. We therefore examined the association of social contact with subsequent incident dementia and cognition with 28 years' follow-up.

METHODS AND FINDINGS

We conducted a retrospective analysis of the Whitehall II longitudinal prospective cohort study of employees of London civil service departments, aged 35-55 at baseline assessment in 1985-1988 and followed to 2017. Social contact was measured six times through a self-report questionnaire about frequency of contact with non-cohabiting relatives and friends. Dementia status was ascertained from three linked clinical and mortality databases, and cognition was assessed five times using tests of verbal memory, verbal fluency, and reasoning. Cox regression models with inverse probability weighting to account for attrition and missingness examined the association between social contact at age 50, 60, and 70 years and subsequent incident dementia. Mixed linear models examined the association of midlife social contact between 45 and 55 years and cognitive trajectory during the subsequent 14 years. Analyses were adjusted for age, sex, ethnicity, socioeconomic status, education, health behaviours, employment status, and marital status. Of 10,308 Whitehall II study participants, 10,228 provided social contact data (mean age 44.9 years [standard deviation (SD) 6.1 years] at baseline; 33.1% female; 89.1% white ethnicity). More frequent social contact at age 60 years was associated with lower dementia risk (hazard ratio [HR] for each SD higher social contact frequency = 0.88 [95% CI 0.79, 0.98], p = 0.02); effect size of the association of social contact at 50 or 70 years with dementia was similar (0.92 [95% CI 0.83, 1.02], p = 0.13 and 0.91 [95% CI 0.78, 1.06], p = 0.23, respectively) but not statistically significant. The association between social contact and incident dementia was driven by contact with friends (HR = 0.90 [95% CI 0.81, 1.00], p = 0.05), but no association was found for contact with relatives. More frequent social contact during midlife was associated with better subsequent cognitive trajectory: global cognitive function was 0.07 (95% CI 0.03, 0.11), p = 0.002 SDs higher for those with the highest versus lowest tertile of social contact frequency, and this difference was maintained over 14 years follow-up. Results were consistent in a series of post hoc analyses, designed to assess potential biases. A limitation of our study is ascertainment of dementia status from electronic health records rather than in-person assessment of diagnostic status, with the possibility that milder dementia cases were more likely to be missed.

CONCLUSIONS

Findings from this study suggest a protective effect of social contact against dementia and that more frequent contact confers higher cognitive reserve, although it is possible that the ability to maintain more social contact may be a marker of cognitive reserve. Future intervention studies should seek to examine whether improving social contact frequency is feasible, acceptable, and efficacious in changing cognitive outcomes.

Social support, physical activity and psychological distress among community-dwelling older Ghanaians

OBJECTIVE

Physical activity (PA) has often been linked with improved mental health outcomes among older people but the subject has received limited attention in sub-Saharan African context. This paper examines the moderating effect of social support (SS) on the association between PA and psychological distress (PD) among community-dwelling older persons in Ghana.

METHODS

Individuals 50 years or older (N = 1200) who participated in a 2016/2017 Aging, Health, Psychological Wellbeing and Health-seeking Behavior Study (AHPWHB) were included. PD outcome, measured by the Kessler Psychological Distress Scale (KPDS-K10) was regressed on PA levels, SS and the interaction term.

RESULTS

Findings suggest that regular PA (OR = 0.824; 95%CI: 0.610-0.913) and higher levels of SS (OR = 0.475; 95%CI: 0.360-0.626) were associated with reduced PD outcomes after adjusting for theoretically relevant confounding variables. More importantly, the inclusion of the interaction term (PA × SS) showed a significant negative relationship of regular PA with the PD outcome as SS levels increased (OR = 0.651; 95%CI: 0.376-0.727).

CONCLUSIONS

Although regular PA potentially contributes to reducing PD among older persons, the relationship is even stronger for those embedded in a higher constellation of SS. Policy and practical interventions seeking to improve regular PA engagement such as old-age friendly environment and psychological resources for socially isolated older persons are warranted.