Living arrangements and participation in leisure-time physical activities in an older population

The impact of physical activity on household out-of-pocket medical expenditure among adults aged 45 and over in urban China: The mediating role of spousal health behaviour

Background

Increasing medical expenditure is viewed as one of the critical challenges in the context of population ageing. Physical activity (PA), as a primary prevention strategy for promoting health, is considered as an effective way to curb the excessive growth in medical expenditure. This study aimed to analyze the association between PA and the household out-of-pocket medical expenditure (HOPME) among Chinese urban adults aged 45 and over, and to explore the mediating role of spousal health behaviour.

Methods

This study analyzed a nationally longitudinal survey: 2014-2018 China Family Panel Studies (CFPS). Fixed effects regression model was applied to estimate the association between PA and annual HOPME. Sobel model was utilized to test the mediating effect.

Results

(1) PA was negatively associated with the annual HOPME among urban resident aged 45 and over in China. Exercising 1-5 times per week and maintaining the duration of each exercise session at 31-60 min were effective in reducing annual HOPME. (2) Spousal PA played a significant mediating role in the relationship between respondent's PA and annual HOPME. (3) The negative association between the respondent's PA and HOPME were found among women and those aged between 45 and 65, so was the mediating effect of spouse's PA.

Conclusion

Individual PA not only directly reduces HOPME but also indirectly contributes to this reduction by enhancing the PA levels of their spouses. To capitalize on these benefits, more actions should be taken to increase the availability of PA facilities, enhance the public awareness of PA's benefits, and encourage residents to consistently engage in regular PA.

Objective assessment of the association between frailty and sedentary behavior in older adults: a cross-sectional study

BACKGROUND

Given the inconsistent findings of the association between frailty and sedentary behavior in older adults, this cross-sectional study investigated the aforementioned association using four different frailty criteria and two sedentary behavior indices in older adults.

METHODS

Data from older adults (age ≥ 65 y) who participated in health examinations or attended outpatient integrated clinics at a medical center in Taipei, Taiwan, were collected. Frailty was measured using the modified Fried Frailty Phenotype (mFFP), Clinical Frailty Scale in Chinese Translation (CFS-C), Study of Osteoporotic Fractures (SOF) index, and Clinical Frailty-Deficit Count (CF-DC) index; sedentary behavior was assessed with a waist-worn accelerometer. Adjusted linear regression ascertained the association between frailty and both sedentary behavior outcomes.

RESULTS

Among the 214 participants (mean age 80.82 ± 7.14 y), 116 were women. The average total sedentary time and number of sedentary bouts were 609.74 ± 79.29 min and 5.51 ± 2.09 times per day, respectively. Frail participants had a longer total sedentary time (odds ratio [OR]: 30.13, P = .01 and 39.43, P < .001) and more sedentary bouts (OR: 3.50 and 5.86, both P < .001) on mFFP and CFS-C assessments, respectively. The SOF index revealed more sedentary bouts among frail than in robust participants (OR: 2.06, P = .009), without a significant difference in the total sedentary time. Frail participants defined by the CF-DC index were more likely to have frequent sedentary bouts (OR: 2.03, P = .016), but did not have a longer total sedentary time.

CONCLUSIONS

Regardless of the frailty criteria adopted, frailty was positively associated with the number of sedentary bouts per day in older adults. A significant correlation between frailty and total sedentary time was detected only with mFFP and CFS-C indices. Further research may target decreasing the sedentary bouts in older adults as a strategy to improve frailty.

Ageing, Leisure Time Physical Activity and Health in Europe

The goal of this article is to analyse leisure time physical activity (LTPA) and health-driven motivations to engage in such activity among elderly people in the European Union. We use as a base the recommendations of the World Health Organisation (WHO) and the theory of the correlation between physical activity according to individual factors (age, gender, socio-economic status) and contextual factors (habitat, community infrastructures, the model of the welfare state of the country of residence). Data are taken from Eurobarometer 88.4. The Generalized Structural Equation Model (GSEM) methodology was used, with the STATA program. The results show that 65.3% of EU citizens over the age of 60 engage in some form of LTPA, that 40.4% do so for health reasons, and that only 32.3% engage in LTPA that meets the minimum guidelines set by the WHO. In addition, there are large differences based on individual and contextual characteristics. The following group was found to be those who practice the most: men, with high socio-economic status, belonging to the middle and upper social classes, living in rural areas where there is infrastructure for physical activity, and above all, in the countries of the Nordic model of social welfare.

The Relationship between Living Arrangements and Sleep Quality in Older Adults: Gender Differences

(1) Background: This study examined the effects of living arrangements on the quality of sleep among older adults and analyzed related gender differences; (2) Methods: A total of 4756 older adults in Seoul were included. After adjusting for socio-demographic factors, older adults living alone showed a poorer sleep quality compared with those living with others; (3) Results: When we analyzed the effects of living arrangements on sleep quality by gender, there was no difference in the risk of poor sleep quality between male older adults living alone and those living with others (OR = 1.089, 95% CI = 0.729–1.628), whereas the risk of poor sleep quality was higher for female older adults living alone than those living with others (OR = 1.359, 95% CI = 1.088–1.696); (4) Conclusions: In this study, we have confirmed that older women living alone had poor sleep quality compared to older men. Hence, gender-based approaches will be helpful when providing social support resources to older adults living alone.

Physical inactivity in nine European and Central Asian countries: an analysis of national population-based survey results

Background

Physical inactivity is a major risk factor for non-communicable diseases. However, recent and systematically obtained national-level data to guide policy responses are often lacking, especially in countries in Eastern Europe and Central Asia. This article describes physical inactivity patterns among adults in Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan.

Methods

Data were collected using the Global Physical Activity Questionnaire drawing nationally representative samples of adults in each country. The national prevalence of physical inactivity was calculated as well as the proportional contribution to total physical activity (PA) during work, transport and leisure-time. An adjusted logistic regression model was applied to analyze the association of age, gender, education, household status and income with physical inactivity.

Results

National prevalence of physical inactivity ranged from 10.1% to 43.6%. The highest proportion of PA was registered during work or in the household in most countries, whereas the lowest was during leisure-time in all countries. Physical inactivity was more likely with older age in eight countries, with female gender in three countries, and with living alone in three countries. There was no clear pattern of association with education and income.

Conclusion

Prevalence of physical inactivity is heterogeneous across the region. PA during leisure-time contributes minimally to total PA in all countries. Policies and programs that increase opportunities for active travel and leisure-time PA, especially for older adults, women and people living alone will be an essential part of strategies to increase overall population PA.

Patterns of Sedentary Behavior among Older Adults in Care Facilities: A Scoping Review

Understanding the sedentary patterns can guide the design of strategies to engage older adults in physical activity. This scoping review aimed to synthesize available evidence on sedentary behaviors in care facilities. We searched PubMed/MEDLINE and Web of Science for studies published from inception through October 2020. Eighteen studies were included and reviewed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Data obtained were analyzed based on levels of care provided. Overall, daily sedentary time was higher among residents in high level care facilities (e.g., nursing homes) (11.6 h/day) than intermediate/mixed level care facilities (e.g., assisted living) (9.5 h/day). In intermediate/mixed level care facilities, television (TV) viewing was the most common sedentary activity (2.5-2.9 h/day; 26% of daily sedentary time), while napping was the most favorite sedentary activity (4.7 h/day; 36% of waking hours) in high level care facilities. Sex differences in daily patterns of sedentary behavior (sedentary time, uninterrupted bouts, and bout durations) were commonly observed in intermediate/mixed level care facilities, as exemplified by men being more sedentary by 0.7-1.1 h/day. In summary, this study highlights distinctive sedentary patterns among older adults residing in different levels of care facilities, addressing a pressing need for customized interventions to engage care facility residents in physical activity.

Older adults' social network and support and its association with physical activity

The purpose of this study was to describe older adults' social network and support during a physical activity intervention and its association with physical activity. Mixed methods were used for this secondary analysis of existing data from a physical activity intervention. Seventy-three participants who completed a session by telephone on using support comprised the sample. Participants reported on average approximately eight individuals in their social network. Half reported support for physical activity from a spouse/partner, adult child, or friend. Those who perceived support for self-reported physical activity tended to have greater improvements on average from baseline for mean daily minutes of physical activity than those with no perceived support. Four-fifths developed a plan for a spouse/partner, friend, adult child, or sibling to provide physical activity support. Participants reported that the session was helpful and increased their confidence in using support; over one-quarter intended to use support after the intervention ended.

Socioeconomic disparities in leisure activities over the life course of the oldest-old in China

OBJECTIVE

To identify the socioeconomic factors leading to disparities in participation in leisure activities over the life course among Chinese oldest-old people.

METHODS

Data are from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a sample of adults aged 80 years or older in the period 1998-2012, featuring 38 312 individuals (58 945 observations).

RESULTS

The younger birth cohorts were found to have significantly higher levels of participation in leisure activities, with a non-linear decrease in age observed for oldest-old men and women. Higher participation levels were significantly related to higher education levels, economic independence and non-manual occupations before retirement among the Chinese oldest-old.

CONCLUSIONS

Leisure activity participation has increased substantially in recent cohorts of Chinese oldest-olds. Those with lower socioeconomic status may represent a disadvantaged population in terms of participation in leisure activities over their life course.

Correlating the Physical Activity Patterns of People with Moderate to Severe Multiple Sclerosis Disability and Their Family Caregivers

Purpose: People with multiple sclerosis (PwMS) and their family caregivers often react to the impact of the disease as an interdependent dyad. The aim of this exploratory study was to examine interdependence in the physical activity (PA) patterns of dyads affected by moderate to severe MS disability. Method: A total of 15 pairs of PwMS and their family caregivers wore accelerometers for 7 days. By collecting data simultaneously from both partners, we tested interdependence using the dyad as the unit of analysis. Results: PwMS and caregivers averaged 4,091.3 (SD 2,726.3) and 6,160.2 (SD 1,653.0) steps per day, respectively. The mean number of minutes per day of sedentary, light, and moderate to vigorous activity for PwMS was 566.3 (SD 97.7), 167.4 (SD 94.0), and 7.6 (SD 12.4), respectively, and 551.9 (SD 92.4), 199.6 (SD 63.4), and 21.4 (SD 18.2), respectively, for caregivers. Interdependence between dyads for sedentary, light, moderate to vigorous activity, and step count was low and non-significant (rs=0.20, 0.26, 0.13, and -0.27, respectively; p>0.05). Conclusions: Although our findings do not support the interdependence of PA between caregivers and care recipients with MS, they do show that both partners are not engaging in sufficient PA to achieve important health benefits. These findings are important because they indicate that the dyads are likely to benefit from interventions for changing PA behavior.

Are Differences in Physical Activity across Socioeconomic Groups Associated with Choice of Physical Activity Variables to Report?

Despite being challenged in recent years, the hypothesis that individuals of higher socioeconomic status (SES) are more physically active than their lower SES counterparts is generally considered a fact. Recent reviews, however, have suggested that differences across groups might be related to which physical activity (PA) domains have been investigated. In the present review, searches for relevant studies were performed in the MEDLINE, ISI Web of Knowledge and SPORTDiscus databases. Search terms included “socioeconomic”, “socio-economic”, “socio economic” and “social class” to meet all variations of the variable “socioeconomic status” in combination with the term “physical activity”. Studies were included when applying the dimensions of intensity, frequency, type/mode, and duration in measuring PA. Fifty-six studies were included and were subsequently split into four PA domains: transport PA (TPA), occupational PA (OPA), housing PA (HPA) and leisure time PA (LTPA). It turned out that the positive relationship held only for LTPA, whereas the relationship was non-existent or even opposite for all other domains. It is concluded that the assumed positive relationship between SES and PA is mainly a relationship between LTPA and SES. It is further suggested that the PA domain should always be considered when studying said relationships.

Spousal influence on physical activity in physically inactive pregnant women: A cross-sectional study

Regular physical activity (PA) is recommended during pregnancy, but the prevalence of pregnant women who met the recommended level for PA is very low. In this descriptive study, we examined the association between spousal characteristics (belief, knowledge, social support, and PA level) and pregnant women's PA level in 18 couples living in the San Francisco Bay Area. Among other spousal characteristics, only spousal PA level was a significant predictor of pregnant women's PA level regardless of whether it was unadjusted or adjusted by spouses' age and body index mass (p = .01). Our finding shows a need to develop strategies to incorporate spousal support for PA.

Feasibility and Efficacy of a Shared Yoga Intervention for Sleep Disturbance in Older Adults With Osteoarthritis

The purpose of the current study was to test the feasibility and efficacy of a shared yoga (SY) program for sleep disturbance in older adults with osteoarthritis (OA). Participants (ages 50 to 72) with insomnia related to OA were randomized to 12 weeks of SY (n = 9) or individual yoga (IY; n = 7). The sample was 53% male and 41% self-identified as a race other than White/Caucasian. The groups did not significantly differ in class attendance, home practice, or change scores on efficacy outcomes. Pre-post comparisons in all participants showed statistically significant improvements on the Insomnia Severity Index and Patient-Reported Outcomes Measurement System sleep disturbance scale. Findings support the overall feasibility of the program, both in the shared and individual formats. Efficacy data suggest that this yoga program may improve sleep, but given the study limitations, further research is needed to draw conclusions. [Journal of Gerontological Nursing, xx(x), xx-xx.].

Predictors of social leisure activities in older Europeans with and without multimorbidity

Older people spend much time participating in leisure activities, such as taking part in organized activities and going out, but the extent of participation may differ according to both individual and environmental resources available. Chronic health problems become more prevalent at higher ages and likely necessitate tapping different resources to maintain social participation. This paper compares predictors of participation in social leisure activities between older people with and those without multimorbidity. The European Project on Osteoarthritis (EPOSA) was conducted in Germany, UK, Italy, The Netherlands, Spain and Sweden (N = 2942, mean age 74.2 (5.2)). Multivariate regression was used to predict social leisure participation and degree of participation in people with and without multimorbidity. Fewer older people with multimorbidity participated in social leisure activities (90.6 %), compared to those without multimorbidity (93.9 %). The frequency of participation was also lower compared to people without multimorbidity. Higher socioeconomic status, widowhood, a larger network of friends, volunteering, transportation possibilities and having fewer depressive symptoms were important for (the degree of) social leisure participation. Statistically significant differences between the multimorbidity groups were observed for volunteering and driving a car, which were more important predictors of participation in those with multimorbidity. In contrast, self-reported income appeared more important for those without multimorbidity, compared to those who had multimorbidity. Policies focusing on social (network of friends), physical (physical performance) and psychological factors (depressive symptoms) and on transportation possibilities are recommended to enable all older people to participate in social leisure activities.

Fit for caring: factors associated with informal care provision by older caregivers with and without multimorbidity

Due to an increased prevalence of chronic diseases, older individuals may experience a deterioration of their health condition in older ages, limiting their capacity for social engagement and in turn their well-being in later life. Focusing on care provision to grandchildren and (older) relatives ('informal care') as forms of engagement, this paper aims to identify which individual characteristics may compensate for health deficits and enable individuals with multimorbidity to provide informal care. We use data from the SHARE survey (2004-2012) for individuals aged 60 years and above in 10 European countries. Logistic regression estimates for the impact of different sets of characteristics on the decision to provide care are presented separately for people with and without multimorbidity. Adapting Arber and Ginn's resource theory, we expected that older caregivers' resources (e.g., income or having a spouse) would facilitate informal care provision to a greater extent for people with multimorbidity compared to those without multimorbidity, but this result was not confirmed. While care provision rates are lower among individuals suffering from chronic conditions, the factors associated with caregiving for the most part do not differ significantly between the two groups. Results, however, hint at reciprocal intergenerational support patterns within families, as the very old with multimorbidity are more likely to provide care than those without multimorbidity. Also, traditional gender roles for women are likely to be weakened in the presence of health problems, as highlighted by a lack of gender differences in care provision among people with multimorbidity.

Spousal Influence on Physical Activity in Middle-Aged and Older Adults: The ARIC Study

Low physical activity levels are a public health concern. Few studies have assessed the concordance of physical activity change among spouses. We studied this concordance during a 6-year period (baseline: 1987-1989; follow-up: 1993-1995) in 3,261 spousal pairs from the US-based Atherosclerosis Risk in Communities (ARIC) Study. Linear regression was used to examine the association between change in individuals' sport/exercise and leisure physical activity indices (ranging from 1 (low) to 5 (high)) and change in his or her spouse's indices. The association between individual and spousal changes in meeting physical activity recommendations was assessed with logistic regression. Individual changes in the sport/exercise and leisure indices were positively associated with spousal changes. For every standard deviation increase in their wives' sport/exercise index, men's exercise index increased by 0.09 (95% confidence interval: 0.05, 0.12) standard deviation; for every standard deviation increase in their wives' leisure index, men's leisure index increased by 0.08 standard deviation. Results were similar for women. Individuals had higher odds of meeting physical activity recommendations if their spouse met recommendations at both visits or just follow-up. In conclusion, changes in an individual's physical activity are positively associated with changes in his or her spouse's physical activity. Physical activity promotion efforts should consider targeting couples.

The relationship of social support with treatment adherence and weight loss in Latinos with type 2 diabetes

OBJECTIVE

Little is known about the effects of social support on weight loss in Latinos. This study determined whether sex moderated and treatment adherence mediated the association between social support and weight loss.

METHODS

Data from 278 Latino males and females with type 2 diabetes in the Intensive Lifestyle Intervention of the Look AHEAD trial were analyzed. Multivariable modeling tested for moderation and parallel multiple mediator modeling simultaneously tested the mediating effects of adherence to physical activity, diet, and session attendance on the relationship between baseline social support and percent weight loss at 1 year.

RESULTS

Social support for physical activity (having family and friends join in physical activity) was related to weight loss. Adherence to physical activity was related to both social support for physical activity and weight loss. Sex did not moderate these relationships. Adherence to physical activity completely mediated the relationship between social support for physical activity and weight loss.

CONCLUSIONS

Increasing companionship for physical activity may be an effective intervention strategy to promote behaviors important for weight loss among Latinos.

Older Adults' Opinions on Fall Prevention in Relation to Physical Activity Level

The purpose of this study was to explore and describe older adults' opinions regarding actions to prevent falls and to analyze differences in the opinions of highly versus less physically active older adults. An open-ended question was answered by 262 individuals aged 75 to 98 years living in the community. The answers were analyzed using qualitative content analysis, and differences in the categories were compared between highly and less physically active persons. Physical activity was measured according to a five-level scale. The content analysis resulted in eight categories: assistive devices, avoiding hazards, behavioral adaptive strategies, being physically active, healthy lifestyle, indoor modifications, outdoor modifications, and seeking assistance. Behavioral adaptive strategies were mentioned to a greater extent by highly active people, and indoor modifications were more often mentioned by less active older adults. Support for active self-directed behavioral strategies might be important for fall prevention among less physically active older adults.

Toward a neurology of loneliness

Social isolation has been recognized as a major risk factor for morbidity and mortality in humans for more than a quarter century. The brain is the key organ of social connections and processes, however, and the same objective social relationship can be experienced as caring and protective or as exploitive and isolating. We review evidence that the perception of social isolation (i.e., loneliness) impacts brain and behavior and is a risk factor for broad-based morbidity and mortality. However, the causal role of loneliness on neural mechanisms and mortality is difficult to test conclusively in humans. Mechanistic animal studies provide a lens through which to evaluate the neurological effects of a member of a social species living chronically on the social perimeter. Experimental studies show that social isolation produces significant changes in brain structures and processes in adult social animals. These effects are not uniform across the brain or across species but instead are most evident in brain regions that reflect differences in the functional demands of solitary versus social living for a particular species. The human and animal literatures have developed independently, however, and significant gaps also exist. The current review underscores the importance of integrating human and animal research to delineate the mechanisms through which social relationships impact the brain, health, and well-being.

How do couples influence each other's physical activity behaviours in retirement? An exploratory qualitative study

BACKGROUND

Physical activity patterns have been shown to change significantly across the transition to retirement. As most older adults approach retirement as part of a couple, a better understanding of how spousal pairs influence each other's physical activity behaviour in retirement may help inform more effective interventions to promote physical activity in older age. This qualitative study aimed to explore and describe how couples influence each other's physical activity behaviour in retirement.

METHODS

A qualitative descriptive study that used purposive sampling to recruit seven spousal pairs with at least one partner of each pair recruited from the existing EPIC-Norfolk study cohort in the east of England, aged between 63 and 70 years and recently retired (within 2-6 years). Semi-structured interviews with couples were performed, audio-recorded, transcribed verbatim and analysed using data-driven content analysis.

RESULTS

Three themes emerged: spousal attitude towards physical activity, spouses' physical activity behaviour and spousal support. While spouses' attitudes towards an active retirement were concordant, attitudes towards regular exercise diverged, were acquired across the life course and were not altered in the transition to retirement. Shared participation in physical activity was rare and regular exercise was largely an individual and independent habit. Spousal support was perceived as important for initiation and maintenance of regular exercise.

CONCLUSIONS

Interventions should aim to create supportive spousal environments for physical activity in which spouses encourage each other to pursue their preferred forms of physical activity; should address gender-specific needs and preferences, such as chances for socialising and relaxation for women and opportunities for personal challenges for men; and rather than solely focusing on promoting structured exercise, should also encourage everyday physical activity such as walking for transport.

Environmental mobility barriers and walking for errands among older people who live alone vs. with others

Background

Walking is the most popular form of physical activity among older people and for community-dwelling older people walking for errands is especially important. The aim of this study is to examine the association between self-reported environmental mobility barriers and amount of walking for errands among older people who live alone compared to those who live with others.

Methods

This observational study is based on cross-sectional data on 657 people aged 75–81 living in Jyväskylä, Central Finland. Self-reports of environmental mobility barriers were collected under four categories: Traffic, Terrain, Distances and Entrance. Persons who reported walking for errands ≤ 1.5 km/week or at most once a week were categorized as having low amount of walking for errands (LOWER). High walking for errands (HIGWER) was defined as the highest quartile of kilometers walked per week (cut-off 8.5 km, referent). The rest were defined as having moderate amount of walking for errands (MODWER). Multinominal regression analysis was used to compare the odds for LOWER vs. HIGWER and MODWER vs. HIGWER, which were formed for each environmental mobility barrier separately.

Results

Participants walked on average 6.5 km (SD 5.2) and 4.0 times (SD 2.2) per week and 14% reported LOWER. Persons living alone (57% of the participants) reported environmental mobility barriers more often than those living with others. LOWER was more common among those living with others. Among those living with others, all the environmental mobility barriers increased the odds for LOWER. In turn, among those living alone, only Distance- and Entrance- related environmental mobility barriers increased the odds for LOWER. People living alone typically run errands by themselves and become better aware of the barriers to environmental mobility, while those living with others have less exposure to environmental mobility barriers, as their walking for errands is more likely to be low.

Conclusions

These findings emphasize the need to take living arrangements into account when analyzing the association between environmental mobility barriers and walking for errands. Future longitudinal studies are warranted to better understand the temporal order of events and to find ways to enhance walking for errands among older people.

Sociodemographic determinants of leisure participation among elderly in Malaysia

Leisure participation has been proven to be beneficial and has a positive link to successful ageing. This study aims to explore the sociodemographic determinants of leisure participation among the Malaysian elderly. A cross-sectional study was conducted among persons aged 60 years and above, purposively selected from eight health clinics in the state of Selangor. Leisure participation was measured using a validated Leisure Participation Questionnaire specific for Malaysian elderly, consisting of 25 activities, categorized into 4 categories, namely recreational (physical), cognitive, social and productive. Frequency of such participation was measured on a 6-point scale. Its association with sociodemographic variables was examined using inferential and regression analysis. 268 participants were involved in this study (response rate = 100%). The most common daily leisure activities were having conversations while relaxing (78.7%), watching television (74.6%) and reading (63.4%). The least frequently done leisure activities were from the recreational and cognitive categories. The activities were weakly correlated to each other, reflecting the lack of diversity of leisure activities among respondents. Education was the main predictor for leisure participation among elderly, with higher educational level is associated with high RAS (B = 1.020, P < 0.05), CAS (B = 1.580, P < 0.05) and SAS (B = 1.276, P < 0.05). Education level, marital status and locality were important determinants of leisure participation among elderly, with education being the main predictor. Further studies exploring the effective method of educating the ageing society are recommended.

Facilitators of and barriers to physical activity in retirement communities: experiences of older women in urban areas

BACKGROUND

Older people are being encouraged to be physically active for as long as possible as a preventive measure against disease and functional decline. It remains, however, uncertain how living in a retirement community affects physical activity (PA).

OBJECTIVES

This study was conducted to understand the PA experiences of older women living in retirement communities and what they experience as facilitators of and barriers to PA.

DESIGN

The study was qualitative and guided by the Vancouver School of doing phenomenology, a unique blend of phenomenology, hermeneutics, and constructivism.

METHOD

Participants were 10 women, aged from 72 to 97 years (mean=84 years). In-depth interviews were conducted, recorded, transcribed, and thematically analyzed.

RESULTS

A model was constructed with 3 main themes: (1) the women themselves, including their experienced health condition, individual aspects of functioning, and various personal factors; (2) the physical environment; and (3) the social environment. These main themes all include subthemes of experienced influences on PA, such as health, design of housing and environment, and local culture. These influences could both facilitate and hinder PA, depending on the context. The facilitating effects of good outdoor areas, accessible physical training facilities, a familiar neighborhood, and finding joy in PA were clear in the study. The barriers included worsening health, a colder climate with ice and wind, and lack of a PA culture within the retirement community.

CONCLUSIONS

An older woman's residence may strongly influence her ability and motivation to be physically active. Physical therapists should acquaint themselves with the facilitators of and barriers to PA of women within retirement communities and use that knowledge to influence the physical and social environment and to target PA interventions to the women themselves.

Social isolation

Social species, by definition, form organizations that extend beyond the individual. These structures evolved hand in hand with behavioral, neural, hormonal, cellular, and genetic mechanisms to support them because the consequent social behaviors helped these organisms survive, reproduce, and care for offspring sufficiently long that they too reproduced. Social isolation represents a lens through which to investigate these behavioral, neural, hormonal, cellular, and genetic mechanisms. Evidence from human and nonhuman animal studies indicates that isolation heightens sensitivity to social threats (predator evasion) and motivates the renewal of social connections. The effects of perceived isolation in humans share much in common with the effects of experimental manipulations of isolation in nonhuman social species: increased tonic sympathetic tonus and HPA activation; and decreased inflammatory control, immunity, sleep salubrity, and expression of genes regulating glucocorticoid responses. Together, these effects contribute to higher rates of morbidity and mortality in older adults.

Physical activity during pregnancy in a prospective cohort of British women: results from the Avon longitudinal study of parents and children

We sought to examine the levels, types, and changes of physical activity and their correlates among pregnant women. Data came from 9,889 pregnant women with due dates between April 1, 1991 and December 31, 1992 who were participants of the Avon Longitudinal Study of Parents and Children (ALSPAC) in Bristol, Avon, Southwest England. Self-reported physical activity during pregnancy was collected via questionnaires administered at 18 and 32 weeks of gestation. We found, at 18 weeks of gestation, the prevalence of engaging in physical activity that was sufficient to cause sweating for ≥ 3 h/week (referred to as strenuous physical activity) was 48.8%. This percentage was similar at 32 weeks of gestation. The most common physical activity during pregnancy reported by these women was brisk walking, followed by swimming and ante-natal exercise. In models that mutually adjusted for all characteristics examined, younger women, women in lower social classes, those not employed during pregnancy, married and parous women (compared to those not in each of these groups) were more likely to report engaging in strenuous physical activity. After becoming pregnant, about two out of three of these women reported reducing physical activity levels at 18 weeks of gestation. In mutually adjusted models, women who were younger, fit and well, parous, and women from lower social classes (compared to those not in each of these groups) were less likely to report reducing their physical activity. Our findings provide insights that are relevant to the design of future observational and intervention studies concerned with the effects of physical activity during pregnancy on health outcomes for mothers and offspring.

Changes in activities of wives caring for their husbands following stroke

PURPOSE

The purpose of this study was to explore the perspectives of caregivers of persons with stroke with respect to their own physical activity.

METHODS

A qualitative, descriptive approach was used to study 10 caregivers of persons with stroke, recruited from a stroke exercise class in a large urban rehabilitation facility. Caregivers participated in individual, semi-structured interviews that were audiotaped, transcribed verbatim, and analysed using a constant comparative method. An inductive, iterative approach was applied to determine the codes and themes.

RESULTS

Four main themes were identified: change in role, change in activity, barriers to activity and health, and change in meaning of activity. Barriers to activity included guilt, time, and energy. Participants revealed that activity became more therapeutic after stroke and that participants preferred purposeful, functional, and partnered activities.

CONCLUSIONS

These findings emphasize the importance of the husband-wife dyad and of movement toward a family-centred care approach. Education should be provided to caregivers regarding their role, barriers, and health-promoting activities. Future research should focus on determining appropriate physical-activity programmes for caregivers as well as on evaluating implementation of partnered exercise programmes for caregivers and persons with stroke.

Living arrangements, social integration, and loneliness in later life: the case of physical disability

Despite the theoretical linkages between household composition and social integration, relatively limited research has considered how living arrangements affect risk for loneliness in later life. Prior work has also failed to consider whether physical disability moderates this potentially important relationship. Using data from a sample of older adults with and without a physical disability (N = 868), this study aims to (1) document variations in loneliness across living arrangements, (2) assess whether any observed association varies by physical disability status, and (3) evaluate the mediating role of social integration and social support. Results reveal that those living alone or with people other than a spouse (children, extended family members) report greater loneliness than those living with a spouse. However the magnitude of these differences is greater for older adults with a physical disability. Measures of social integration and social support attenuated, but did not fully explain, inter-household variations in loneliness. These findings point to the independent significance of living arrangements for experiences of loneliness in later life among both disabled and nondisabled adults.

Walking and the preservation of cognitive function in older populations

PURPOSE

This cross-sectional study takes a unique look at the association between patterns of walking and cognitive functioning by examining whether older adults with mild cognitive impairment differ in terms of the community settings where they walk and the frequency, intensity, or duration of walking.

DESIGN AND METHODS

The sample was based on interviews with 884 adults aged 65 years and older, residing in 4 locations across the United States: Alameda County, California; Cook County, Illinois; Allegheny County, Pennsylvania; and Durham/Wake Counties, North Carolina. Cognitive function was assessed using a modified Mini-Mental State Examination (MMSE) and the Mental Alternation Test (MAT). Multiple linear regressions were conducted between self-reported walking activities and cognitive measures, controlling for psychosocial, demographic, health status, functional performance, and neighborhood characteristics.

RESULTS

The community setting where people walk and the intensity of walking in their neighborhood were significantly associated with cognitive status. After controlling for individual and neighborhood characteristics, better MAT scores were significantly associated with brisk walking and walking fewer times per week. Compared with the MMSE, the MAT was more likely to be associated with patterns of walking among older adults. Older adults with lower MAT scores were more likely to walk in indoor shopping malls and less in parks, whereas those with higher cognitive function scores on the MMSE were less likely to walk in indoor gyms.

IMPLICATIONS

This investigation provides insight into the extent to which walking is associated with preservation of cognitive health, setting the stage for future longitudinal studies and community-based interventions.

Invited commentary: toward a more comprehensive social epidemiology of marital trajectories and mortality

In this issue of the Journal, Dupre et al. (Am J Epidemiol. 2009;170(5):546-555) use data from a nationally representative cohort of older US adults to examine the association of current marital status, timing of first marriage, number and kind of transitions out of marriage, and durations spent in various marital statuses with the risk of all-cause mortality. Their study offers a wealth of empirical findings that make important contributions to research on the relation between marital status and mortality. The richness of their findings suggests the need for future research to provide a more complete account of the mechanisms that lead from specific dimensions of marital status (and family structure more broadly) to mortality or other health outcomes over the life course.

Leisure-time physical activity and all-cause mortality in an elderly cohort

BACKGROUND

Physical activity is one of the mainstays of secondary prevention in people with heart disease. It is not well understood, however, how the presence of heart disease or a history of habitual exercise prior to the study modify any mortality-sparing effects of leisure-time physical activity.

METHODS

We analyzed data from a well-described cohort of subjects aged 54 years and older at intake (median age, 70 years) from Sonoma, CA, studied between 1993 and 2001 with mortality follow-up until 2003. A history-adjusted marginal structural model was used to obtain counterfactual excess risk estimates that were pooled across the different time points. Additive interaction was examined by comparing these excess risk estimates across strata of age, heart disease, and precohort physical activity.

RESULTS

Estimates of the excess risk for 2-year all-cause mortality comparing Centers for Disease Control and Prevention-recommended levels of current physical activity to lower levels of activity ranged from -0.7% to -4.9% among subjects younger than 75 years of age and from -7.8% to -14.8% among older subjects. Heart disease or precohort physical activity were not found to modify the effect of leisure-time physical activity.

CONCLUSIONS

Our data are consistent with the view that the mortality-sparing effect of recent physical activity is independent of the presence or absence of underlying cardiac disease and the pattern of past physical activity.

Loneliness predicts reduced physical activity: cross-sectional & longitudinal analyses

OBJECTIVE

To determine cross-sectional and prospective associations between loneliness and physical activity, and to evaluate the roles of social control and emotion regulation as mediators of these associations.

DESIGN

A population-based sample of 229 White, Black, and Hispanic men and women, age 50 to 68 years at study onset, were tested annually for each of 3 years.

MAIN OUTCOME MEASURES

Physical activity probability, and changes in physical activity probability over a 3-year period.

RESULTS

Replicating and extending prior cross-sectional research, loneliness was associated with a significantly reduced odds of physical activity (OR = 0.65 per SD of loneliness) net of sociodemographic variables (age, gender, ethnicity, education, income), psychosocial variables (depressive symptoms, perceived stress, hostility, social support), and self-rated health. This association was mediated by hedonic emotion regulation, but not by social control as indexed by measures of social network size, marital status, contact with close ties, group membership, or religious group affiliation. Longitudinal analyses revealed that loneliness predicted diminished odds of physical activity in the next two years (OR = 0.61), and greater likelihood of transitioning from physical activity to inactivity (OR = 1.58).

CONCLUSION

Loneliness among middle and older age adults is an independent risk factor for physical inactivity and increases the likelihood that physical activity will be discontinued over time.

Quality of life in opium-addicted patients with coronary artery disease as measured with WHOQOL-BREF

OBJECTIVE

Several factors can influence the quality of life in patients with coronary artery disease (CAD). The goal of this research was to measure quality of life in opium-addicted patients with CAD in order to assess the effect of CAD risk factors on their quality of life.

METHOD

The WHOQOL-BREF questionnaire was completed through interviews with 275 patients who underwent isolated coronary artery bypass surgery in Tehran Heart Centre between May and September 2006.

RESULTS

No significant differences were found in the mean scores of the four domains of quality of life between the addicted and non-addicted patients. Furthermore, the evaluation of QOL in the groups with CAD risk factors showed that the mean QOL domains were statistically similar between opium addicted and non-opium addicted patients. In the addicted group, men had a higher psychological health score than women. A previous history of myocardial infarction reduced the psychological score in this group. Also, in the addicted patients with a history of diabetes mellitus, social functioning was better than that of the non-diabetics.

CONCLUSIONS

The different domains of quality of life in our opium-addicted and non-addicted patients with CAD were similar; and among all the major risk factors for coronary artery disease, only female gender and a previous history of myocardial infarction could influence quality of life in the opium-addicted patients.

Successful dissemination of a community-based strength training program for older adults by peer and professional leaders: the people exercising program

The objective of this longitudinal study was to determine the feasibility of a model for disseminating community-based strength training programs for older adults through leadership training of laypersons or "peers" and health and fitness professionals. The intervention consisted of a progressive strength training, balance, and flexibility exercise program and a leader training and certification workshop. Feasibility was defined as 75% or more of individuals who completed leader training establishing or teaching at least two 12-week strength training classes within 1 year. Program dissemination was quantified as the number of classes established between January 2005 and December 2006. Demographic characteristics and health status of leaders and program participants were evaluated. Two hundred forty-four leaders (peers, n=149; professionals, n=95) were trained and certified. Seventy-nine percent of all leaders (n=193) met the feasibility criteria of establishing or teaching strength training classes. There was no difference in the percentage of peer leaders (80%, n=119) and professional leaders (78%, n=74) who established or taught classes (P5.71) despite significant differences in their demographic and health profiles. Ninety-seven self-sustaining strength training classes were established in senior and community centers, and 2,217 older adults (women, n=1,942; men, n=275) aged 50 to 97 with multiple chronic medical conditions enrolled. In conclusion, training peer and professional leaders is a feasible and successful model for disseminating a community strength training program for older adults. Widespread dissemination of this program has significant public health implications for increasing physical activity participation by older adults.

Leisure activities and mortality: does gender matter?

OBJECTIVES

This study examines the association between participation in leisure activities and mortality risk among older men and women.

METHODS

A representative sample of 1,246 men and women ages 65 to 95, interviewed in 1991-1992, were followed for 12 years. Cox regressions analyzed mortality risk.

RESULTS

Participating in only a few activities doubled mortality risk compared to those with the highest participation levels, even after controlling for age, education, walking ability, and other health indicators. Women had a dose-response relationship between overall participation and survival. Strong associations with survival were found for engagement in organizational activities and study circles among women and hobby activities and gardening among men.

DISCUSSION

Results suggest gender differences in the association between leisure activities and mortality. Women display a decreasing mortality risk for each additional activity. Social activities have the strongest effects on survival among women, whereas men seem to benefit from solitary activities.

Impact of Spouse Vision Impairment on Partner Health and Well-Being: A Longitudinal Analysis of Couples

OBJECTIVES

The purpose of this study was to assess the impact of older spouses' vision impairment on the health and well-being of their partners and to test for gender differences.

METHODS

Participants were 418 older couples from the Alameda County Study. Vision impairment was assessed in 1994 with a 9-point scale assessing difficulty seeing in everyday situations; outcomes were assessed in 1999. Longitudinal analyses included multivariate statistical models adjusting for paired data and partners' own vision impairment, age, gender, chronic conditions, and financial problems. We include results on outcomes for partners' own vision impairment for comparative purposes. We assessed gender differences with interaction tests.

RESULTS

Spouse vision impairment negatively impacted partner depression, physical functioning, well-being, social involvement, and marital quality; these effects were not greatly different in magnitude from those associated with partners' own vision impairment. Three of four outcomes with significant gender differences evidenced stronger impacts of husbands' vision impairment on wives' well-being and marital quality than the reverse.

DISCUSSION

Spouses do not live in isolation; characteristics of one impact the other. Both treatment and rehabilitation programs should include spouses and other family members of visually impaired patients. Why wives appear more sensitive to their husbands' vision impairment is unclear and warrants further study.

The links between health-related behaviors and life satisfaction in elderly individuals who prefer institutional living

Background

Life satisfaction among residents of institutions is becoming an important issue in a rapidly aging population. The aim of this cross-sectional study was to investigate the links between life satisfaction and health-related behaviors amongst functionally independent elderly people who prefer institutional living in İstanbul, Turkey.

Methods

The socio-demographic characteristics, health-related behaviors, leisure-time activities and fall histories of 133 residents of an institution in Istanbul were assessed by a structured questionnaire during face-to-face interviews. A validated life-satisfaction index questionnaire (LSI-A) was completed.

Results

The mean age of the study group was 73.9 ± 8.0 (range 60–90 years). Within the group, 22.6% had never married and 14.3% had university degrees. The majority (71.4%) were in the low income bracket. The overall mean LSI-A score was 20.3 ± 5.9. Participants who declared moderate/high income levels had a significantly higher mean LSI-A score than those in the low-income bracket (p = 0.009). Multivariate analysis of the data suggested that leisure-time activities and participation in regular physical activities are significant predictors of LSI-A scores (R²: 0.112; p = 0.005 and p = 0.02, respectively).

Conclusion

The findings imply that regular physical activity and leisure-time activities are significantly related to life satisfaction among residents in institutions. Participation in physical activity and leisure-time activity programs may help to improve the life satisfaction of elderly people living in institutions.

Does the theory of planned behavior elements mediate the relationship between perceived constraints and intention to participate in physical activities? A study among older individuals

This study aimed to investigate the degree to which the elements of the theory of planned behavior mediate the relationship between constraints and intention to continuing participation in physical activities. The sample of the study consisted of 119 (N = 119) older individuals who participated in organized physical activity programs. The results indicated that attitudes and perceived behavioral control were negatively correlated with constraints, whereas the subjective norm variable had no relationship with them. In terms of the mediation role of the elements of the theory of planned behavior, the results indicated that both attitudes and perceived behavioral control partially mediated the relationship between constraints and intention, with the perceived behavioral control variable being the strongest mediator. These findings suggest that the theory of planned behavior elements mediate the constraints–intention relationship and determine, in a large degree, the older individuals’ intention to continuing taking part in physical activities.

Continuity of leisure participation from middle age to old age

OBJECTIVE

Continuity in habits, activities, and roles is important upon entering old age according to the continuity theory of aging. Few studies have investigated patterns of leisure participation over an extended period of time among older adults. This study examines changes in nine different leisure activities in a nationally representative sample of individuals followed over a 34-year period in Sweden.

METHODS

We used longitudinal data from three waves of an interview survey that followed 495 individuals from 1968 to 2002. Individuals were aged 43-65 in 1968 and 77-99 in 2002. We conducted logistic regression analyses on each of the leisure activities.

RESULT

For the panel followed, a decline in participation rates was the most common pattern over time. Analyses at the individual level showed that late-life participation was generally preceded by participation earlier in life. Previous participation, both 10 and 34 years earlier, predicted late-life participation. The modifying effect of functional status in late life was small.

DISCUSSION

In accordance with the continuity theory of aging, leisure participation in old age is often a continuation of previous participation. However, there is considerable variation among both activities and individuals.

Influence of marital status on physical activity levels among older adults

PURPOSE

The purpose of these analyses was to describe the levels and types of activity in relationship to current marital status among older adults and determine if the physical activity level of the husband was related to the physical activity level of his wife.

METHODS

Participants included 3075 well-functioning white and black men and women aged 70-79 yr with further examination of 345 spousal pairs. Marital status was self-reported and participants were grouped as married versus not married. Based on responses to a leisure-time questionnaire, total physical activity was calculated and participants were classified as low or high active. Descriptive statistics were used to describe level and proportions of type of activity by marital status. Logistic regression was used to determine if marital status was an important determinant of physical activity participation. Regression models were adjusted for demographics, body mass index (BMI), and chronic disease conditions.

RESULTS

When compared with their single counterparts, married men reported higher median levels of exercise participation (P = 0.008) and married women reported higher levels of total (P < 0.0001) and nonexercise activity (P < 0.0001) with a trend toward higher exercise participation (P = 0.05). In spousal pairs, compared with men in the low active group, highly active men were almost three times as likely (OR = 2.97; 95% CI = 1.73, 5.10) to have a similarly active spouse. The model only modestly attenuated when adjusted for age, BMI, and health status of the husband [OR = 2.49 (1.41, 4.42)].

CONCLUSIONS

Marital status and spousal physical activity (PA) levels are important determinants for PA participation among older adults.

Stability and change in physical activity in old age: the role of changes in disability

The objective was to examine whether stability and change in physical activity in older men and women are influenced by (1) changes in disability and by (2) social relations and psychological well-being. The study is based on baseline, 3 and 4.5 year follow-up data on 917 older men and women. Changes in physical activity were measured through self-reported frequencies of vigorous physical activity at the three measurement points. The analyses were carried out for two outcomes-decline in physical activity versus sustained high level of physical activity (from high to low) and sustained low physical activity versus improvement in physical activity (from low to high). The main results were: older adults with onset of tiredness or continuous tiredness in daily activities during 4.5 years are more likely to have a concurrent decline in their physical activities during the same period. Older adults with onset of need of help and sustained need of help are more likely to have a decline in physical activities or to sustain a low level of physical activities during the same period. The associations between the psychosocial factors and change in physical activity are attenuated by the concurrent changes in disability. The present study supports that health promotion projects should be aware that development of tiredness and continuous tiredness are strongly related to a decline in physical activity and that onset of and sustained need of help are strongly associated with both a decline in and sustained low physical activity.

Older adults' desire for physical competence

PURPOSE

To develop and provide initial psychometric support for a 16-item measure that assesses a new construct termed desire for physical competence (DPC).

METHODS

A total of 157 older adults (aged 60-95) were administered the DPC along with various other questionnaires that assessed demographics, health status, social desirability, desire for control, body satisfaction, and life satisfaction. These data facilitated development and initial psychometric evaluation of the scale. An additional sample of 30 older adults was employed to examine test-retest reliability.

RESULTS

Based on the conceptual foundation of DPC and results from an exploratory factor analysis, a single-dimension Rasch model based on response theory was applied to the data. The proposed model fit the data quite well as indicated by the average mean square of both outfit (1.02) and infit (1.04) statistics. The DPC correlated in expected directions with age, r = -0.33 (P < 0.01), and had r values of 0.23, 0.22, 0.25 (all P values <0.01) with desire for control, body satisfaction, and the SF-36, respectively. Older adults with arthritis had lower DPC scores than those without arthritis. The measure was not confounded by social desirability, and test-retest reliability of the measure (>0.90) was excellent.

CONCLUSIONS

The DPC provides a tool to assess the incentive value of older adults for being physically competent. As such, it provides a more complete social cognitive foundation for studies examining physical activity behavior and the process of physical disablement.

Effects of body composition and leisure-time physical activity on transitions in physical functioning in the elderly

Physical activity and body composition were examined with respect to variation in functional limitation over a 6-year period (four surveys conducted between 1994 and 2000) based on a cohort of 1,655 community-dwelling older women and men living in Sonoma, California. Measures of functional limitation and physical activity were based on standard self-report questions. Measures of body composition (lean mass, fat mass) were estimated from bioelectric impedance by using population-specific prediction equations derived from dual-energy x-ray absorptiometry. For women, a one-unit gain in lean mass:fat mass ratio reduced the report of limitation at all surveys 65.5% (95% confidence interval: 21.8, 87.4). A similar reduction was not observed for men; however, there was a 3% increase in the report of no limitation at any survey. The effect of high levels of physical activity reduced new functional limitation that occurred at the last survey by 36.8% (95% confidence interval: 0.0, 92.2) for men and 52.7% (95% confidence interval: 13.5, 91.9) for women. In summary, higher levels of physical activity appeared to reduce the risk of future functional limitation conditional on the level of functioning established early in the disablement process by lean mass:fat mass ratio.

Health-related social disengagement in elderly diabetic patients: association with subsequent disability and survival

OBJECTIVE

We examined the relationship between health-related social disengagements, as opposed to disengagements related to financial and other non-health-related factors, and subsequent risk of disability and death among initially nondisabled elderly diabetic patients enrolled in Medicare Managed Care plans.

RESEARCH DESIGN AND METHODS

We used data from the Medicare Health Outcomes Survey (HOS) Cohort 1 Baseline (1998) and Cohort 1 Follow-Up (2000). Through mail and telephone surveys, trained interviewers collected information on sociodemographic variables, physical and mental health functioning (using Medical Outcomes Study Short Form-36 [SF-36]), activities of daily living (ADL), and medical conditions. This study reported on diabetic subjects aged >or=65 years with no ADL disability at baseline (n = 8949). Health-related social disengagement (degree to which physical health or emotional problems interfere with social activities) was derived from the social functioning subscale of SF-36 (range 0-100; higher scores depicting better social functioning).

RESULTS

For each 10-point increase in social functioning score at baseline, older diabetic subjects in our study experienced an 18% less chance of any ADL disability (odds ratio [OR] 0.82, 95% CI 0.75-0.89; P < 0.001) and a 12% less chance of death (0.88, 0.78-1.00; P = 0.043) over a 2-year period, adjusting for demographic factors, comorbidities, depression, and general health (assessed by the SF-36).

CONCLUSIONS

Among initially nondisabled older diabetic subjects, health-related interferences with social activities at baseline may be early warning signs of subsequent ADL disability and premature death, independent of other measures of health status.

Social networks and quality of life among female long-term colorectal cancer survivors

BACKGROUND

The population of long-term colorectal cancer survivors in the United States continues to increase, but little is known about how they fare-physically, mentally, or socially-in the years after diagnosis. The current study examines female long-term colorectal cancer survivors' health-related quality of life (HRQoL) in relation to social networks.

METHODS

A population-based sample of female colorectal cancer survivors (n = 726) residing in Wisconsin was recontacted approximately 9 years after the initial diagnosis. Of 443 women who were alive in 1999, 307 women completed a follow-up questionnaire. Analysis was conducted on 259 participants who completed the Medical Outcomes Study Short Form 36 Health Status Survey and a modified version of Berkman and Syme's Social Network Index. Using multivariate analyses, HRQoL summary scores were tested for associations with individual and composite measures of social networks, including marital/partner status; number of children, relatives, and friends; and the frequency of religious and community participation.

RESULTS

After adjusting for age, extent of disease at diagnosis, number of comorbidities, body mass, and education, HRQoL was similar to norms published for the general population. Individual social network measures (including the number of relatives and friends) and composite network measures (including network size, the number of ties seen at least once per month, and overall social connectedness) were associated positively with mental health.

CONCLUSIONS

Social networks may have an important relation with HRQoL-particularly mental health-among female long-term colorectal cancer survivors. The results of this study should be of interest to those seeking to understand or improve HRQoL among this growing population.