Trajectories of social engagement and mortality in late life

"I Love You to Death": Social Networks and the Widowhood Effect on Mortality

Research on "the widowhood effect" shows that mortality rates are greater among people who have recently lost a spouse. There are several medical and psychological explanations for this (e.g., "broken heart syndrome") and sociological explanations that focus on spouses' shared social-environmental exposures. We expand on sociological perspectives by arguing that couples' social connections to others play a role in this phenomenon. Using panel data on 1,169 older adults from the National Social Life, Health, and Aging Project, we find that mortality is associated with how well embedded one's spouse is in one's own social network. The widowhood effect is greater among those whose spouses were not well connected to one's other network members. We speculate that the loss of a less highly embedded spouse signals the loss of unique, valuable, nonredundant social resources from one's network. We discuss theoretical interpretations, alternative explanations, limitations, and directions for future research.

Functional teeth and cognitive function among the Chinese elderly: The chain mediating effect of depressive symptoms and social participation

The objective of this study was to investigate the chain mediating effects of depressive symptoms and social participation between functional teeth and cognitive function based on the biopsychosocial model. Data from the 2018 China Health and Retirement Longitudinal Study were analyzed. The findings revealed a favorable connection between the lack of edentulism and cognitive function, persisting even when accounting for the mediating factors of denture usage, depressive symptoms, and social participation. Furthermore, the study identified six indirect pathways in this relationship. The present study has substantiated the correlation between edentulism and cognitive function, thereby proposing that interventions aimed at denture usage, depressive symptoms, and social participation could potentially serve as preventive measures against cognitive decline in elderly individuals afflicted with edentulism. This underscores the significance of addressing these factors to alleviate cognitive decline.

Developing and validating machine learning-based prediction models for frailty occurrence in those with chronic obstructive pulmonary disease

Background

Frailty is a medical syndrome caused by multiple factors, characterized by decreased strength, endurance, and diminished physiological function, resulting in increased susceptibility to dependence and/or death. Patients with chronic obstructive pulmonary disease (COPD) tend to be more vulnerable to frailty due to their physical and psychological burdens. Therefore, the aim of this study was to develop a reliable and accurate vulnerability risk prediction model for frailty in patients with COPD in order to improve the identification and prediction of patient frailty. The specific objectives of this study were to determine the prevalence of frailty in patients with COPD and develop a prediction model and evaluate its predictive power.

Methods

Clinical information was analyzed using data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database, and 34 indicators, including behavioral factors, health status, mental health parameters, and various sociodemographic variables, were examined in the study. The adaptive synthetic sampling technique was used for unbalanced data. Three methods, ridge regressor, extreme gradient boosting (XGBoost) classifier, and random forest (RF) regressor, were used to filter predictors. Seven machine learning (ML) techniques including logistic regression (LR), support vector machines (SVM), multilayer perceptron, light gradient-boosting machine, XGBoost, RF, and K-nearest neighbors were used to analyze and determine the optimal model. For customized risk assessment, an online predictive risk modeling website was created, along with Shapley additive explanation (SHAP) interpretations.

Results

Depression, smoking, gender, social activities, dyslipidemia, asthma, and residence type (urban vs. rural) were predictors for the development of frailty in patients with COPD. In the test set, the XGBoost model had an area under the curve of 0.942 (95% confidence interval: 0.925-0.959), an accuracy of 0.915, a sensitivity of 0.873, and a specificity of 0.911, indicating that it was the best model.

Conclusions

The ML predictive model developed in this study is a useful and easy-to-use instrument for assessing the vulnerability risk of patients with COPD and may aid clinical physicians in screening high-risk patients.

Perceived social position, active engagement with life, and depressive symptoms among older adults

RATIONALE

Despite the existing literature on the relationship between perceived social position (PSP) and depressive symptoms, there remain gaps in our understanding, particularly regarding the potential for asymmetric effects of increases and decreases in PSP and the underlying mechanisms involved.

OBJECTIVE

This study aims to examine whether increases and decreases in PSP are differentially associated with depressive symptoms and to explore the potential mediating role of active engagement with life in these associations.

METHODS

This study utilized data from the Korean Longitudinal Study of Aging (KLoSA), collected between 2008 and 2018, involving a sample of 3506 individuals aged 65 or older. Asymmetric fixed effects (FE) models were employed, which enable the estimation of differential effects for increases and decreases in PSP, while accounting for unobserved individual-level heterogeneity. To assess the mediating role of active engagement in life, Sobel mediation tests were conducted.

RESULTS

The asymmetric FE estimates revealed a stronger association between decreases in PSP and increases in depressive symptoms compared to the association between increases in PSP and decreases in depressive symptoms. The Sobel mediation tests indicated that formal social activities had the most substantial mediating effect, explaining 14% and 9% of the total effect mediated for increased and decreased PSP and depressive symptoms, respectively. Leisure/hobby activities explained 10% and 4% of the total effect mediated for increased and decreased PSP and depressive symptoms, respectively.

CONCLUSION

This study provides evidence that increases and decreases in PSP have differential effects on depressive symptoms among older adults in Korea. Policy interventions aimed at improving the psychological well-being of older adults should prioritize efforts to both enhance PSP and minimize declines, as the latter can have a stronger negative impact on depressive symptoms. Active engagement in life may serve as a potential pathway for achieving the desired effects.

Association between participation in social network service groups and offline social networks

AIM

Although some previous studies have suggested using a social networking service (SNS) to create and maintain offline social networks among younger generations, whether similar outcomes would apply to middle-aged and older individuals is uncertain. This study aimed to examine the association between participation in groups via SNS and greater offline social networks among middle-aged and older individuals.

METHODS

We conducted a web-based questionnaire survey on 3106 respondents from September to October 2021 among members of "the Shumi-to Club," an SNS in Japan. They indicated the number of SNS groups they belonged to and were classified into two categories, namely, those with and without participation in SNS groups. The current study assessed offline social networks using the total frequency of face-to-face interactions with distant family members and friends. Ordinal logistic regression analyses were performed, and the frequency of offline interactions was set as the outcome with adjustment for sociodemographic variables and self-rated health.

RESULTS

Approximately 70.8% (n = 2200) of the participants belonged to SNS groups. Participation in SNS groups was associated with higher frequencies of face-to-face interaction with friends (odds ratio [95% confidential intervals]: 1.78 [1.53-2.07]). However, the current study found no association between belonging to a group and face-to-face interaction with distant family members (1.09 [0.93-1.26]).

CONCLUSIONS

The participation in SNS groups potentially promotes offline social networks, particularly with friends. Geriatr Gerontol Int 2024; 24: 279-284.

Dual trajectories of depression and social participation among Chinese older adults

OBJECTIVES

This study aimed to investigate the dual trajectories of social participation (SP) and depression among older adults, and explore common factors that may influence both trajectories.

METHODS

The study utilized data from four waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011 to 2018). The dual-trajectory model was employed to estimate the dual trajectories of SP and depression.

RESULTS

This study identified two SP and three depression trajectories. The results revealed that the reciprocal relationship between SP and depression trajectories is confirmed in all sub-groups of the dual trajectories. Our study identified six distinct sub-groups of individuals based on their SP and depression trajectories and some commen risk factors of SP and depression trajectories.

CONCLUSIONS

Related intervention policies should consider the dual trajectories of SP and depression and focus on subgroups with high vulnerability, such as high depression but low SP. Additionally, attention should be given to addressing the common risk factors that underlie these trajectories.

Social engagement and subjective health among older adults in South Korea: Evidence from the Korean Longitudinal Study of Aging (2006-2018)

Background

Social engagement serves as the foundation for social connections by providing a sense of belonging, social identity, and fulfillment. Previous studies have mainly focused on the one-way relationship between social engagement and subjective health among older individuals, and little attention has been paid to their mutual relationship. Therefore, this study aimed to examine the mutual association relationship between social engagement and their subjective health in older Koreans.

Methods

Seven waves of data samples (aged ≥60 years) from 2006 to 2018 from the Korean Longitudinal Study of Aging (KLoSA) was used in this study. Descriptive analysis, chi-squared tests, 2-year lagged Generalized estimating equation (GEE) model, and cross-lagged panel model were performed to investigate the mutual association between social engagement and subjective health among six survey periods.

Results

Results of the GEE model revealed when controlling for other variables, older Koreans who reported good subjective health only had a higher OR (1.678 vs. 1.650, p < 0.001) of participating in social engagement than those who had bad subjective health in 2006-2008 period; the occurrence rate of more social engagement was significantly higher among older adults with good subjective health than among those with bad subjective health (five out six survey periods). Cross-lagged analysis showed similar results that coefficients of social engagement on subjective were relatively larger in three survey periods; coefficients of subjective health on social engagement were relatively larger in the other three survey periods. The impact of social engagement on subjective health might be greater than that of subjective health on social engagement.

Conclusion

All-around participation and engagement of older people in society have become a consensus among the international community. In view of the single social engagement activities and less relevant participation channels in Korea, government departments should consider not only regional but also local characteristics to create more social participation opportunities for older individuals.

Psychosocial implications of early COVID-19 restrictions on older adults in a small-town region in Southwestern, Pennsylvania (USA)

OBJECTIVES

The restrictions put in place in 2020 to mitigate the spread of the coronavirus disease 2019 limited or eliminated social connections that are vital for psychosocial well-being. The objectives of this research were to examine the impact of early pandemic-related restrictions on feelings of loneliness, depression, and anxiety as well as social activity disruption and their concomitant associations in a sample of community-dwelling older adults residing in a small-town region in the USA.

DESIGN AND SETTING

Cross-sectional data collected from an ongoing population-based cohort study in Southwestern, Pennsylvania.

PARTICIPANTS

Analyses included 360 adults aged 65 years and older whose annual study assessment occurred during the first 120 days of pandemic-related restrictions.

MEASUREMENTS

Self-reported feelings of loneliness, depression, and anxiety due to the pandemic-related restrictions were each measured using a single question. Depressive symptoms and anxiety were also assessed with the modified Center for Epidemiologic Studies-Depression and Generalized Anxiety Disorder-7 item tools. Disruption in a variety of common social activities was also assessed.

RESULTS

Feeling lonely affected 36% of participants who were more likely to be female, not currently married, and living alone. Giving up in-person visits with family was associated with significantly higher odds of feeling lonely, and feeling lonely was associated with significantly higher odds of feelings of anxiety and depression.

CONCLUSIONS

Loneliness is a serious outcome of pandemic-related restrictions among older adults, potentially linked to loss of connection with family, and may be associated with increased feelings of depression and anxiety.

Social Engagement and All-Cause Mortality: A Focus on Participants of the Minority Aging Research Study

INTRODUCTION

Social engagement is known to improve health; less is known about whether social activities at the core of African American life decrease mortality risk in this minoritized population. This study investigated whether and which aspects of social engagement predict mortality risk in older African Americans.

METHODS

Data from 768 African Americans (aged ∼73 years; nondemented at baseline) participating in the Minority Aging Research Study, a longitudinal community-based, cohort study of aging, was collected between 2004 and 2020 and analyzed in 2020. Participants self-reported late-life social activity, social network size, life space, and purpose in life at baseline and completed approximately 6.5 years of annual follow-up (range=15.70). Cox models included time from baseline to death or censoring and an indicator for death versus censored with age, sex, education, cardiovascular disease risk factor burden, depressive symptomatology, and motor gait performance as covariates.

RESULTS

As of March 2020, 25% of participants died (n=192; age at death ∼83 years). In fully adjusted Cox models, mortality risk decreased by 34% (hazard ratio=0.66; 95% CI=0.48, 0.91; p=0.012) for those with higher compared with that for those with lower social activity generally, with community/volunteer-, group-, and socially-related activities specifically driving these results.

CONCLUSIONS

Engaging in late-life social activity, especially group- and socially-based activities, was most consistently and robustly associated with reduced mortality risk in African Americans regardless of health. These results lay the foundation for considering community-based approaches to increase and/or maintain social participation in older African Americans as a potential means by which to increase longevity in this population.

Removable partial dentures and mortality among partially edentulous adults

OBJECTIVES

The aim of this study was to evaluate whether the use of removable partial dentures (RPDs) has an effect on long-term survival outcomes amongst partially edentulous adults.

METHODS

Data were extracted from the Third National Health and Nutrition Examination Survey and linked to public-use mortality files for the period up to 2019. Partially edentulous adults with fewer than 20 teeth were included. RPD use and dentition status were determined by clinical examination. The cohort was propensity score weighted to create a sample which was balanced across 27 covariates (sociodemographics, health behaviors and insurance, laboratory markers, and general health status). Survival analysis was undertaken to compute absolute (mortality rate and median survival time) and relative (event time ratio [ETR]) measures of exposure effect.

RESULTS

The analyzed cohort included 1246 participants, which equated to 22,557 person-years of follow-up. The difference in all-cause mortality rate between RPD wearers and non-wearers was found to be -6.5 (95% CI: -11.6 to -1.4), with the median survival time in RPD wearers being 3.1 years longer (20.3 years versus 17.2 years). A 26% increase in survival time was observed in RPD wearers (ETR: 1.26, 95% CI: 1.17 to 1.37) and it was found that, for every 7.5 individuals treated with RPDs, one death would be prevented after 10 years of treatment.

CONCLUSIONS

The use of RPDs may have long-term benefits in reducing mortality amongst adults with a non-functional dentition, but further research is needed to validate these findings and assess the factors mediating the relationship.

CLINICAL SIGNIFICANCE

The use of RPDs may have long-term benefits in reducing mortality amongst adults with a non-functional dentition.

Scoping study of definitions of social participation: update and co-construction of an interdisciplinary consensual definition

Background

considering the importance of social participation for quality of life and active ageing in older adults, it is an important target of social and health professionals’ interventions. A previous review of definitions of social participation in older adults included articles up to 2009; new publications and changes in the social context (e.g. social media and the COVID-19 pandemic) justify continuing this work.

Objective

this paper provides an updated inventory and synthesis of definitions of social participation in older adults. Based on a critical review by content experts and knowledge users, a consensual definition is proposed.

Methods

using a scoping study framework, four databases (MEDLINE, CINAHL, AgeLine, PsycInfo) were searched with relevant keywords. Fifty-four new definitions were identified. Using content analysis, definitions were deconstructed as a function of who, how, what, where, with whom, when, and why dimensions.

Results

social participation definitions mostly focused on people’s involvement in activities providing interactions with others in society or the community. According to this new synthesis and input from content experts and knowledge users, social participation can be defined as a person’s involvement in activities providing interactions with others in community life and in important shared spaces, evolving according to available time and resources, and based on the societal context and what individuals want and is meaningful to them.

Conclusion

a single definition may facilitate the study of active ageing and the contribution of older adults to society, socioeconomic and personal development, benefits for older adults and society, self-actualisation and goal attainment.

Social network ties before and after retirement: a cohort study

Social networks are associated with individual's health and well-being. Working life offers opportunities to create and maintain social networks, while retirement may change these networks. This study examined how the number of ties in social network changes across the retirement transition. The study population consisted of 2319 participants (84% women, mean age 63.2 years) from the Finnish Retirement and Aging study. Information about social network ties, including the number of ties in the inner, middle and outer circles of the social convoy model, was gathered using annual postal surveys before and after retirement. Three repeat surveys per participant covered the retirement transition and the post-retirement periods. Mean number of network ties was 21.6 before retirement, of which 5.6 were situated in the inner, 6.9 in the middle and 9.1 in the outer circle. The number of ties in the outer circle decreased by 0.67 (95% CI - 0.92, - 0.42) during the retirement transition period, but not during the post-retirement period (0.11, 95% CI - 0.33, 0.12) (interaction period * time, p = 0.006). The pattern of change in these ties did not differ by gender, occupational status, marital status, number of chronic diseases and mental health during the retirement transition period. The number of ties in the inner and middle circles overall did not decrease during these periods. The number of peripheral relationships decreased during the retirement transition but not after that, suggesting that the observed reduction is more likely to be associated with retirement rather than aging.

Transitions between social network profiles and their relation with all-cause mortality among older adults

BACKGROUND

The importance of social network in mortality among older adults has been acknowledged. However, existing studies typically overlook the interplay among social network indicators, and seldom consider the change in social network over time. We take a person-centered approach to identify transitions between social network profiles, and examine the linkage of such transitions with subsequent mortality risk.

METHODS

Data came from 2738 older Singaporeans enrolled in a longitudinal study. Latent transition analysis examined nine social network indicators assessed at two time points, two years apart to reveal the corresponding transitions between social network profiles. Adjusted Cox regression then associated the identified transitions with all-cause mortality risk in the subsequent four years.

RESULTS

We observed three diverse social network profiles (that featured diversified social interaction and involved both household and non-household members) and three relatively restricted social network profiles (that focused on household or non-household members). Compared to sustained diverse profiles over time, sustained restricted profiles or a transition from diverse to restricted profiles entailed increased mortality risk. The mortality risk following a restricted-to-diverse profile transition could be as low as that associated with sustained diverse profiles.

CONCLUSIONS

Dynamics of social network profiles have implications for mortality risk in later life. To promote longevity, initiatives are needed to help older people to maintain or shift to diverse social network profiles.

Creation and validation of a polysocial score for mortality among community-dwelling older adults in the USA: the health and retirement study

BACKGROUND

the interrelatedness between social determinants of health impedes researchers to identify important social factors for health investment. A new approach is needed to quantify the aggregate effect of social factors and develop person- centred social interventions.

METHODS

participants ([n = 7,383], 54.5% female) were aged 65 years or above who complete an additional psychosocial questionnaire in the health and retirement study in 2006 or 2008. Social determinants of health encompassed five social domains: economic stability, neighbourhood and physical environment, education, community and social context, and healthcare system. We used the forward stepwise logistic regression to derive a polysocial score model for 5-year mortality. Indices of goodness-of-fit, discrimination and reclassification were used to assess model performance. We used logistic regression to identify the association between polysocial score and mortality. Subgroup analyses were conducted to examine sex- and race-specific association.

RESULTS

polysocial score was created using 14 social determinants of health. In the training cohort, the C-statistic was 0.71 for the reference model (only age, sex and race/ethnicity) and increased to 0.75 for the continuous and categorical polysocial score. Compared with the reference model, the integrated discrimination index for adding the continuous or categorical polysocial score was both 0.03 (P values < 0.001). Participants with an intermediate (odds ratio [OR] = 0.69; 95% confidence interval [CI], 0.51-0.82) or high (OR = 0.48; 95% CI, 0.38-0.60) polysocial score had lower odds of death than those in the low category in the fully adjusted model, respectively.

CONCLUSIONS

the polysocial approach may offer possible solutions to monitor social environments and suggestions for older people to improve their social status for specific health outcomes.

Homeostasis Revisited: Patterns of Stability and Rebalancing in Older Adults' Social Lives

OBJECTIVES

To examine patterns of change in later-life social connectedness: (a) the extent and direction of changes in different aspects of social connectedness, including size, density, and composition of social networks, network turnover, and three types of community involvement and (b) the sequential nature of these changes over time.

METHOD

We use three waves of nationally representative data from the National Social Life, Health, and Aging Project, collected from 2005/2006 to 2015/2016. Respondents were between the ages of 67 and 95 at follow-up. Types of changes in their social connectedness between the two successive 5-year periods are compared to discern over-time change patterns.

RESULTS

Analyses reveal stability or growth in the sizes of most older adults' social networks, their access to non-kin ties, network expansiveness, as well as several forms of community involvement. Most older adults experienced turnover within their networks, but losses and additions usually offset each other, resulting in generally stable network size and structural features. Moreover, when older adults reported decreases (increases) in a given form of social connectedness during the first half of the study period, these changes were typically followed by countervailing increases (decreases) over the subsequent 5-year period. This general pattern holds for both network and community connectedness.

DISCUSSION

There is an overwhelming tendency toward either maintaining or rebalancing previous structures and levels of both personal network connectedness and community involvement. This results in overall homeostasis. We close by discussing the need for a unifying theoretical framework that can explain these patterns.

The effect of roles prescribed by active ageing on quality of life across European regions

The active ageing approach supports a set of roles or activities that are supposed to be beneficial for older adults. This paper reassesses the benefits of activities for the quality of life by (a) analysing many activities at the same time to control each other, (b) using panel data to detect the effects of activities over time, and (c) performing separate analyses for four European regions to test the context-specificity of the effects. The effects of roles in later life are tested on panel data from three waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) project. The results of fixed-effects regression show that only some activities – volunteering, participating in a club and physical activity – increase the quality of life, and that care-giving within the household has the opposite effect. Moreover, the beneficial effects are much weaker and less stable than the other types of regression suggest; they are beneficial only in some regions, and their effect is much weaker than the effects of age, health and economic situation. Therefore, the active ageing approach and activity theory should reflect the diverse conditions and needs of older adults to formulate more-context-sensitive and less-normative policy recommendations.

Staying Connected: Alternative Transportation Use, Neighborhoods, and Social Participation among Older Americans

BACKGROUND AND OBJECTIVES

A wealth of empirical evidence documents improved health among older adults who participate in social activities. Alternative transportation can serve as a bridge linking older adults to social activities and improving person-environment fit.

RESEARCH DESIGN AND METHODS

Using Waves 1-8 of the National Health and Aging Trends Study (NHATS), this research examines whether alternative transportation use is associated with participation in diverse social activities among a sample of Medicare beneficiaries aged 65 or older. Additionally, this research explores whether the effect of transportation use varies across neighborhood environments. We analyzed individual trajectories of participation in social activities by estimating two-level growth curve models.

RESULTS

The use of public transportation, paratransit, getting a ride, or walking/using wheelchair/scooter to get places was associated with participating in more types of social activities. Respondents who used alternative transportation had less steep declines in participation. The effect of getting rides and using paratransit services was more pronounced among respondents living in disordered neighborhoods.

DISCUSSION AND IMPLICATIONS

This research underscores the importance of alternative transportation use and the neighborhood context for participation among older adults. Age-friendly initiatives aimed at fostering greater community engagement should think broadly about the role of multiple forms of transportation.

Formal and informal social participation and elder mistreatment in a national sample of older adults

BACKGROUND/OBJECTIVES

Older adults' susceptibility to mistreatment may be affected by their participation in social activities, but little is known about relationships between social participation and elder mistreatment.

DESIGN

Cross-sectional analysis.

SETTING/PARTICIPANTS

National probability sample of older community-dwelling U.S. adults interviewed in 2015-2016, including 1268 women and 973 men (mean age 75 years and 76 years, respectively; 82% non-Hispanic white).

MEASUREMENTS

Frequency of participation in formal activities (organized meetings, religious services, and volunteering) and informal social activities (visiting friends and family) was assessed by questionnaire. Elder mistreatment included emotional (four items), physical (two items), and financial mistreatment (two items) since age 60. Multivariable logistic regression examined associations between each type of social participation and elder mistreatment among men and women, adjusting for age, race/ethnicity, education, and comorbidity.

RESULTS

Forty percent of women and 22% of men reported at least one form of mistreatment (emotional, physical, or financial). Women reporting at least monthly engagement in formal social activities were more likely to report emotional mistreatment (adjusted odds ratio (AOR) 1.59, 95% confidence interval (CI) 1.09-2.33). Among men, monthly organized meeting attendance was associated with increased odds of emotional mistreatment (AOR 1.34, 95% CI 1.01-1.93). Weekly informal socializing was inversely associated with emotional mistreatment (AOR 0.59, 95% CI 0.44-0.78) and financial mistreatment (AOR 0.59, 95% CI 0.42-0.85) among women.

CONCLUSION

In this national cohort, older adults who were frequently engaged in formal social activities reported similar or higher levels of mistreatment than those with less frequent organized social participation. Older women with regular informal contact with family or friends were less likely to report some kinds of mistreatment. Strategies for detecting and mitigating elder mistreatment should consider differences in patterns of formal and informal social participation and their potential contribution to mistreatment risk.

Your friends, my friends, and our family: Informal social participation and mental health through the lens of linked lives

RATIONALE

Social participation is an important predictor of individual health outcomes, but few studies have examined it in the context of marriage relationships, even though the social lives of spouses are inextricably linked.

OBJECTIVE

To examine whether individuals' mental health is associated with their spouse's contact with friends and family.

METHODS

Using dyadic data from adults aged 50 and above in the Health and Retirement Study (N = 5030 couples), I examine whether individuals' mental health is associated with their spouse's contact with friends and family (i.e., partner effects) through a longitudinal actor-partner interdependence model. In addition, I test for the presence of gender differences in these effects. Both depressive symptoms and binge drinking are used as measures of mental health to account for the different ways in which men and women may express psychological distress.

RESULTS

Results show partial evidence that spousal contact with friends and family are associated with one's own mental health outcomes, and that within-dyad discrepancies in informal social participation may be detrimental to mental well-being.

CONCLUSIONS

These findings highlight the importance of understanding the dynamics between social participation and health through the lens of "linked lives", especially for married couples.

Diagnosis and Management of Cognitive Concerns in the Oldest-Old

Purpose of review

The fastest-growing group of elderly individuals is the "oldest-old," usually defined as those age 85 years and above. These individuals account for much of the rapid increase in cases of dementing illness throughout the world but remain underrepresented in the body of literature on this topic. The aim of this review is first to outline the unique contributing factors and complications that must be considered by clinicians in evaluating an oldest-old individual with cognitive complaints. Secondly, the evidence for management of these cognitive concerns is reviewed.

Recent findings

In addition to well-established associations between impaired cognition and physical disability, falls, and frailty, there is now evidence that exercise performed decades earlier confers a cognitive benefit in the oldest-old. Moreover, though aggressive blood pressure control is critical earlier in life for prevention of strokes, renal disease, and other comorbidities, hypertension started after age 80 is in fact associated with a decreased risk of clinical dementia, carrying significant implications for the medical management of oldest-old individuals. The oldest-old are more likely to reside in care facilities, where social isolation might be exacerbated by a consistently lower rate of internet-connected device use. The COVID-19 pandemic has not only highlighted the increased mortality rate among the oldest-old but has also brought the increased social isolation in this group to the forte.

Summary

Differing from the "younger-old" in a number of respects, the oldest-old is a unique population not just in their vulnerability to cognitive disorders but also in the diagnostic challenges they can pose. The oldest-old are more likely to be afflicted by sensory deficits, physical disability, poor nutrition, frailty, and depression, which must be accounted for in the assessment of cognitive complaints as they may confound or complicate the presentation. Social isolation and institutionalization are also associated with impaired cognition, perhaps as sequelae, precipitants, or both. Ante-mortem diagnostic tools remain particularly limited among the oldest-old, especially given the likelihood of these individuals to have multiple co-occurring types of neuropathology, and the presence of neuropathology in those who remain cognitively intact. In addition to the symptomatic treatments indicated for patients of all ages with dementia, management of cognitive impairment in the oldest-old may be further optimized by use of assistive devices, augmentation of dietary protein, and liberalization of medication regimens for risk factors such as hypertension.

Engagement in Favorite Activity and Implications for Cognition, Mental Health, and Function in Persons Living With and Without Dementia

Little is known about the impact of engagement in personally meaningful activities for older adults. Thus, this study examines the impact of engagement in one's favorite activity on cognitive, emotional, functional, and health-related outcomes in older adults with and without cognitive impairment. Data were obtained from 1,397 persons living with dementia (PLWD) and 4,719 cognitively healthy persons (CHP) who participated in wave 2 of the National Health and Aging Trends Study (NHATS). Sociodemographic characteristics were examined by cognitive status. A multivariate analysis of variance indicated that, for PLWD, engagement in favorite activity was associated with greater functional independence and decreased depression. For CHP, engagement in favorite activity was associated with greater functional independence, decreased depression and anxiety, and better performance on memory measures. Findings suggest that engagement in valued activities that are considered personally meaningful may have significant and distinct benefits for persons with and without dementia.

Longitudinal Associations Between Short-Term, Repeated, and Sustained Arts Engagement and Well-Being Outcomes in Older Adults

OBJECTIVES

This study investigated whether frequency of receptive arts engagement over 10 years contributes to experienced, evaluative, and eudaimonic well-being in older adults.

METHODS

We used repeated data of 3,188 respondents from Waves 2-7 (2004/2005-2014/2015) of the English Longitudinal Study of Ageing. We examined longitudinal associations between short-term (frequent engagement at one wave), repeated (frequent engagement at 2-3 waves), and sustained (frequent engagement at 4-6 waves) arts engagement and experienced, evaluative and eudaimonic well-being. We fitted linear and logistic regression models adjusted for baseline well-being and a number of sociodemographic, economic, health, and social engagement factors.

RESULTS

In the fully adjusted models, short-term engagement was not longitudinally associated with well-being, but repeated engagement with the theater/concerts/opera and museums/galleries/exhibitions was associated with enhanced eudaimonic well-being, and sustained engagement with these activities was associated with greater experienced, evaluative, and eudaimonic well-being.

DISCUSSION

Long-term frequent engagement with certain arts activities is associated with higher levels of happiness, life satisfaction, self-realization, and control/autonomy in older adults. These findings suggest that policies that facilitate older adults' access to arts venues and activities, and support their continued engagement with them, may help to promote happy, fulfilling lives of an increasing segment of the population.

Functional Limitations, Social Integration, and Daily Activities in Late Life

OBJECTIVES

Disability in late life has been associated with increases in receiving care and loss of autonomy. The Disablement Process Model suggests that physical impairments lead to functional limitations that contribute to disabilities in managing household, job or other demands. Yet, we know surprisingly little about how functional limitations are related to activities throughout the day among community-dwelling adults, or the possible moderating role of social integration on these associations.

METHODS

Community-dwelling adults (N = 313) aged 65+ completed a baseline interview assessing their functional limitations, social ties, and background characteristics. Over 5 to 6 days, they answered questions about daily activities and encounters with social partners every 3 hours on handheld Android devices.

RESULTS

Multilevel logistic models revealed that functional limitations are associated with increased likelihood of activities associated with poor health (e.g., TV watching, medical appointments), and reduced likelihood of social activities, or physical activities, chores, or leaving the home. Most moderation analyses were not significant; family and friends did not mitigate associations between functional limitations and daily activities, with the exception of medical appointments. Individuals with functional limitations were more likely to attend medical appointments when with their social partners than when alone.

DISCUSSION

This study provided modest indication that functional limitations in community-dwelling older adults are associated with patterns of activity that may lead to further limitations, disability or loss of autonomy. Findings warrant longitudinal follow-up to establish subsequent patterns of decline or stability.

Social Isolation and Memory Decline in Later-life

OBJECTIVES

To investigate associations between level and changes in social isolation and in memory in older men and women.

METHODS

The sample included 6,123 women and 5,110 men aged 50+ from the English Longitudinal Study of Aging (ELSA). Extended latent change score models from six measurement occasions every 2 years from 2002 were used to investigate associations between social isolation and memory. Models were adjusted for age, socioeconomic position, and health.

RESULTS

Social isolation increased and memory decreased over time. Among men an initially high level of social isolation was associated with a somewhat greater decrease in memory. Among women a greater increase in social isolation predicted a greater decrease in memory and a larger change in social isolation was associated with further larger changes in isolation, although when social isolation reached a higher level it subsequently decreased.

CONCLUSIONS

Results suggest that the association between social isolation and memory decline arises because social isolation is associated with increased memory decline rather than poor memory leading to increases in social isolation. Men with high levels of social isolation and women with accumulated social isolation over time are especially affected as these patterns of isolation were associated with more profound memory decline.

Variety Is the Spice of Late Life: Social Integration and Daily Activity

OBJECTIVES

Social integration (involvement with a diverse array of social ties) has been linked to positive outcomes including better physical health. Research has not investigated whether encounters with diverse social ties enhance individuals' daily behaviors. The objectives of this study were to assess whether social ties connect individuals to more diverse daily behaviors, physical activity, and nonsedentary time as well as more positive mood.

METHOD

Older adults (aged 65+, n = 313) provided information about their 10 closest social ties. Then they completed ecological momentary assessment (EMA) surveys every 3 hr for 5-6 days where they reported on social encounters and behaviors. They also wore Actical accelerometers to objectively measure physical activity.

RESULTS

Multilevel models revealed that encounters with a greater variety of social ties was associated with engaging in a greater variety of behaviors, more objectively measured physical activity, and a smaller proportion of time spent sedentary. Encounters with weak ties/peripheral social ties accounted for this increased activity (compared to being alone or with close friends or family). Moreover, involvement with diverse ties or diverse behaviors was associated with better mood.

DISCUSSION

Findings are discussed in terms of social engagement theory, network diversity, and the benefits of weak ties.

Associations Between Longitudinal Trajectories of Cognitive and Social Activities and Brain Health in Old Age

Importance

Prior neuroimaging studies have found that late-life participation in cognitive (eg, reading) and social (eg, visiting friends and family) leisure activities are associated with magnetic resonance imaging (MRI) markers of the aging brain, but little is known about the neural and cognitive correlates of changes in leisure activities during the life span.

Objectives

To examine trajectories of cognitive and social activities from midlife to late life and evaluate whether these trajectories are associated with brain structure, functional connectivity, and cognition.

Design, Setting, and Participants

This prospective cohort included participants enrolled in the Whitehall II study and its MRI substudy based in the UK. Participants provided information on their leisure activities at 5 times during calendar years 1997 to 1999, 2002 to 2004, 2006, 2007 to 2009, and 2011 to 2013 and underwent MRI and cognitive battery testing from January 1, 2012, to December 31, 2016. Data analysis was performed from October 7, 2017, to July 15, 2019.

Main Outcome and Measures

Growth curve models and latent class growth analysis were used to identify longitudinal trajectories of cognitive and social activities. Multiple linear regression was used to evaluate associations between activity trajectories and gray matter, white matter microstructure, functional connectivity, and cognition.

Results

A total of 574 individuals (468 [81.5%] men; mean [SD] age, 69.9 [4.9] years; median Montreal Cognitive Assessment score, 28 [interquartile range, 26-28]) were included in the present analysis. During a mean (SD) of 15 (4.2) years, cognitive and social activity levels increased during midlife before reaching a plateau in late life. Both baseline (global cognition: unstandardized β [SE], 0.955 [0.285], uncorrected P = .001; executive function: β [SE], 1.831 [0.499], uncorrected P < .001; memory: β [SE], 1.394 [0.550], uncorrected P = .01; processing speed: β [SE], 1.514 [0.528], uncorrected P = .004) and change (global cognition: β [SE], -1.382 [0.492], uncorrected P = .005, executive function: β [SE], -2.219 [0.865], uncorrected P = .01; memory: β [SE], -2.355 [0.948], uncorrected P = .01) in cognitive activities were associated with multiple domains of cognition as well as global gray matter volume (β [SE], -0.910 [0.388], uncorrected P = .02). Baseline (β [SE], 1.695 [0.525], uncorrected P = .001) and change (β [SE], 2.542 [1.026], uncorrected P = .01) in social activities were associated only with executive function, in addition to voxelwise measures of functional connectivity that involved sensorimotor (quadratic change in social activities: number of voxels, 306; P = 0.01) and temporoparietal (linear change in social activities: number of voxels, 16; P = .02) networks. Otherwise, no voxelwise associations were found with gray matter, white matter, or resting-state functional connectivity. False discovery rate corrections for multiple comparisons suggested that the association between cognitive activity levels and executive function was robust (β [SE], 1.831 [0.499], false discovery rate P < .001).

Conclusions and Relevance

The findings suggest that a life course approach may delineate the association between leisure activities and cognitive and brain health and that interventions aimed at improving and maintaining cognitive engagement may be valuable for the cognitive health of community-dwelling older adults.

Denture wearing and mortality risk in edentulous American adults: A propensity score analysis

OBJECTIVE

To evaluate the association between complete denture use and subsequent mortality among edentulous adults.

METHODS

Data from 1649 edentulous adults who participated in the Third National Health and Nutritional Examination Survey were linked to public-use mortality files for the period up to December 2015. Denture wearing, defined as use of complete dentures in both arches (clinically inspected) all the time or only when awake, was compared to non-wearing, defined as use of dentures occasionally or not at all. The primary outcome was all-cause mortality. Data on 27 covariates, classified as sociodemographic characteristics, behavioral factors, health insurance, laboratory tests and general health status, were used to create propensity scores for weighted and matched analyses.

RESULTS

In weighted data, the difference in mortality rate between denture and non-denture wearers was 11.1 (95 %CI: 3.6-18.6) deaths per 1000 person-years and the number needed to treat (NNT) at 10 years was 12. Denture wearers had 15 % lower risk of death (HR: 0.85; 95 % CI: 0.73-0.98) than non-denture wearers. In the matched sample, the mortality rate difference between denture and non-denture wearers was 8.8 (95 %CI: 0.2-17.4) deaths per 1000 person-years and the NNT at 10 years was 11. Risk of death was 21 % lower among denture wearers (HR: 0.79; 95 % CI: 0.68, 0.92) than non-denture wearers.

CONCLUSION

This longitudinal analysis showed that the use of complete dentures was associated with longer survival and lower all-cause mortality risk among American edentulous adults. NNT is interpreted as one death prevented after 10 years for every twelve rehabilitated dentitions with removable complete dentures.

CLINICAL SIGNIFICANCE

Edentulous adults wearing complete dentures had longer survival and lower overall mortality risk than non-denture wearers, suggesting that prosthodontic rehabilitation with removable complete dentures might have benefits beyond restoring oral functioning.

Out-of-Home Mobility and Social Participation of Older People: a Photo-Based Ambulatory Assessment Study

Research has shown that social participation contributes to older people’s healthy ageing. Out-of-home mobility may promote higher levels of social participation among older people. However, mobility and social participation are sophisticated constructs. Social participation can be distinguished among different levels, such as being alone, being alone surrounded by others, interacting with others or engaging in activities together. Social participation and time spent in out-of-home-mobility can be difficult to remember and therefore difficult to assess. Picture-based ambulatory assessment provides valid and reliable information about people’s mobility as well as their level of participation with high ecological validity. The aim of the study was to investigate older people’s level of social participation and its association with high or low out-of-home mobility. In sum, 23072 pictures (mean per person = 2307; SD = 686.7) involving ten older people (mean age = 75.4 years; SD = 7.5 years) living in southwestern Germany were analysed. They were asked to wear a wearable camera for two consecutive days. Images were automatically captured every 15 seconds. Image analysis shows that study participants spent most of their time alone (at approximately 35% of analysed time). Out-of-home mobility was associated with higher levels of social participation, such as helping others (chi2 = 200,664, df = 5, p < .001). Picture-based ambulatory assessment can assist in the gathering of necessary sophisticated information that is difficult to assess via questionnaires or other similar methods.

Life satisfaction and participation among community-dwelling older adults: Data from the FIBRA study

This study investigates the association between participation in four domains of physical activity, social activities, and global life satisfaction among 2344 community-dwelling older adults (72.3 ± 5.5 years; 65.6% female) in Brazil. Comparison analyses were performed on the frequencies, and statistical analysis also included univariate and hierarchical logistic regression analysis. Of all the physical activity domains analyzed, only leisure-time physical activity was found to be associated with global life satisfaction. There was also a positive association between global life satisfaction and social activity participation. We conclude that the specific domain in which activity is performed interferes with one’s perception of his or her life.

Religious Attendance and the Social Support Trajectories of Older Mexican Americans

In this paper, we directly assessed the extent to which the association between religious attendance and the social support trajectories of older Mexican Americans is due to selection (spurious) processes related to personality, health status, and health behavior. We employed seven waves of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (1993-2010) to examine the association between religious attendance and perceived social support trajectories (n = 2479). We used growth mixture modeling to estimate latent classes of social support trajectories and multivariate multinomial logistic regression models to predict membership in the social support trajectory classes. Growth mixture estimates revealed three classes of social support trajectories: high, moderate, and low. Multinomial logistic regression estimates showed that the odds of membership in the low support trajectory class (versus the high social support trajectory class) were lower for respondents who attended religious services yearly, monthly, weekly, and more than weekly than for respondents who never attend religious services. Religious attendance could not distinguish between membership in the moderate and high support trajectory classes. These results persisted with adjustments for age, gender, immigrant status, language proficiency, education, income, religious affiliation, marital status, living arrangements, contact with family/friends, secular group memberships, self-esteem, smoking, heavy drinking, depression, cognitive functioning, and physical mobility. We conclude that the association between religious attendance and the social support trajectories of older Mexican Americans is primarily driven by processes related to social integration, not selection.

Social Engagement and Amyloid-β-Related Cognitive Decline in Cognitively Normal Older Adults

OBJECTIVE

Public health recommendations promote social engagement to reduce risk of cognitive decline and dementia. The objective of this study was to evaluate the longitudinal associations of social engagement and cognition in cognitively normal older adults with varying levels of neocortical amyloid-β, the Alzheimer's disease (AD) pathologic marker.

METHODS

Two hundred seventeen men and women, age 63-89 underwent assessments for social engagement and cognitive performance at baseline and 3 years later using the Community Healthy Activities Model Program for Seniors questionnaire and the Preclinical Alzheimer Cognitive Composite (PACC). Amyloid-β was measured using Pittsburgh compound B-PET. Multivariable regression models estimated main and interactive effects of baseline social engagement and amyloid-β on cognitive change. Reciprocal models estimated main and interactive effects of baseline cognitive performance and amyloid-β on change in social engagement.

RESULTS

Baseline social engagement was associated with PACC change as a modifier but not as a main effect. Lower baseline social engagement was associated with greater amyloid-β-related PACC decline, while higher baseline social engagement was associated with relative preservation of PACC scores (β = 0.05, p = 0.03). Reciprocally, lower baseline PACC score was associated with decline in social engagement score (β = 1.1, p = 0.02). This association was not modified by amyloid-β, and there was no direct association of amyloid-β with change in social engagement.

CONCLUSIONS

Low social engagement may be a marker of neurocognitive vulnerability in older adults who are cognitively normal but have evidence of AD pathophysiologic change. Understanding changes in social engagement in older adults may lead to earlier diagnosis of AD and advances in evidence-based prevention and treatment.

Racial/ethnic disparities in depression: Investigating how sources of support and types of integration matter

Although social support and social integration are key predictors of depression and exhibit racial/ethnic patterns in the US, previous research has not examined how they shape racial/ethnic disparities in depression. Applying hybrid models to data from the Americans' Changing Lives study from 1986 to 2002, this study analyzes how sources of social support (spouse and friend/relative) and types of social integration (informal/formal) explain black-white and Hispanic-white disparities in depression. We find that strong social support and high social integration are negatively associated with depression and that the patterns of social support and integration vary by race/ethnicity. The results of hybrid models show that social support from one's spouse and friend/relative account for over 25 percent of the black-white disparity, whereas formal social integration including religious groups widens the black-white differential by roughly 10 percent. However, Hispanic-white disparities in depression are mostly a result of the difference in socioeconomic status. The change in spousal support is the most powerful predictor for the change in depression across race/ethnicity groups. Our findings suggest that the racial/ethnic differences in sources of social support and types of social integration play important roles in shaping racial/ethnic disparities in depression.

Social Integration, Self-Rated Health . . . and Genes?

Objective: This study examined genetic roots of later life social integration, and their confounding of this social factor's health linkages. Method: Data were from the 2010 wave of the Health and Retirement Study. Two dimensions of integration were examined: with one's "stakeholder" network of family and friends and with the community. Genetic measures included polygenic scores for extraversion and educational attainment. Results: Ties to one's stakeholder network had no genetic associations. The extraversion polygenic score was linked to community integration among Blacks as well as Whites. Among the latter, the same was true of one's genetic propensity for educational attainment. Although this score also influenced self-rated health, neither confounded associations of social integration with this indicator. Discussion: Later life social integration seems influenced by genetically rooted propensities for both sociability and human capital accumulation. Health linkages of integration, however, may not reflect mutual dependencies on the same genetic substrates.

Informal Caregiving and Network Turnover Among Older Adults

Objectives

Personal network turnover, a combination of lost and added network contacts, is suggested to affect health as well as moderate access to social support and resources. This article tests whether the caregiving process is associated with network turnover in later life and whether the process is different for men and women.

Methods

Network turnover was assessed using two waves of personal network data from the National Social Life, Health, and Aging Project. Network contacts were uniquely identified in each wave making it possible to document contact loss and addition. Rates of change were modeled using Poisson regression.

Results

Respondents transitioning into caregiving lost and added network contacts at higher rates than non-caregivers. Conversely, respondents providing care during both waves and respondents transitioning out of the role saw no significant levels of network turnover. The analysis provided minimal evidence of gender differences.

Discussion

Findings suggest that the initial shift into the caregiving role is associated with notable personal network change. This is an important consideration given that long-term network instability may lead to poor health and limited access to social resources whereas adaptive network change tends to elicit more positive outcomes.

Social network members who engage in activities with older adults: Do they bring more social benefits than other members?

Active participation in social activities is important for the well-being of older adults. This study explored benefits of active social engagement by evaluating whether relationships that comprise active involvement (e.g., co-engagement in activities) bring more social benefits (i.e., social support, companionship, positive social influence) than other relationships that do not involve co-engagement. A total of 133 adults ages 60 years and older living in a rural Midwestern city in the United States were interviewed once and provided information on 1,740 social network members. Among 1,506 social relationships in which interactions occurred at least once a month, 52% involved engagement in social activities together and 35% involved eating together regularly. Results of the generalized linear mixed model showed that relationships involving co-engagement were significantly more likely to also convey social support (i.e., emotional, instrumental, informational), companionship, and social influence (encouragement for healthy behaviors) than relationships that do not involve co-engagement. Having more network members who provide companionship was associated with higher sense of environmental mastery, positive relations with others, and satisfaction with social network. Interventions may focus on maintaining and developing such social relationships and ensuring the presence of social settings in which co-engagement can occur. Future research may explore whether increasing co-engagement leads to enhanced sense of companionship and psychological well-being.

Spirit or Fleeting Apparition? Why Spirituality's Link with Social Support Might Be Incrementally Invalid

Previously published path models apparently confirm the belief-as-benefit perspective that spirituality boosts well-being via social support. The broad acceptance of such findings has motivated recommendations that clinical psychologists and psychiatrists routinely assess their patients' spiritual status. Skeptics retort that past findings are statistically confounded and that numinous beliefs and well-being are unrelated. A multivariate regression analysis testing whether spirituality explains variance in social support after personality traits are simultaneously included is reported. Although spirituality displays a significant positive correlation and partial correlation (after controlling for socio-demographics) with social support, regression analysis specifying agreeableness and conscientiousness-individual differences related to both spirituality and social support-as predictors renders spirituality nonsignificant. In summary, spirituality's correlation with social support appears spurious; demonstrating the hazards of relying on simple associations and highlighting the urgent need for researchers to utilize statistical methods capable of establishing cause and parsing effects across rival theoretical explanations.

Does economic vulnerability moderate the association between transportation mode and social activity restrictions in later life?

Transportation is critical to older adults’ ability to participate in social activities in their community. We examined the association between modes of transportation and restrictions in social activity (i.e.visiting with others, religious attendance, clubs and organised activities, and going out for enjoyment), with particular attention to the moderating effects of economic vulnerability. We used logistic regression to analyse data from 7,197 community-dwelling older adults from the 2011 wave of the National Health and Aging Trends Study, a representative sample of adults aged 65 and over in the United States of America. Economic vulnerability moderated the association between transportation mode and social activity restrictions. Findings suggest that even when economically vulnerable older adults have access to driving, walking or public transit, they may be at a higher risk for social exclusion than their counterparts with more financial resources.

Racial and Ethnic Variation in the Association of Social Integration with Mortality: Ten-year Prospective Population-based US Study

Substantial data link social relationships with mortality but few studies have examined whether these associations are consistent across racial and ethnic groups. The purpose of the present study was to evaluate the presence and form of the social relationship/mortality association in a representative sample of US Black (n = 4,201), non-Hispanic White (n = 20,217) and Hispanic (n = 5,097) groups. In models adjusted for age, sex, chronic disease, socioeconomic status and smoking social integration was inversely related to ten-year survival in all groups. However, among Whites the association was linear and graded whereas among Blacks the association was linear but was statistically significant only for the highest level of social integration (hazard ratio [HR] = 0.66, 95% confidence interval = 0.47-0.94). A threshold pattern was observed among Hispanics, in that lower mortality risk was found for all social integration categories above the lowest level (HRs from 0.58 to 0.52, P's < 0.01) and each of the higher social integration categories were in turn equivalent. Received social support was unrelated to mortality across all groups. Higher social integration is associated with a survival advantage for Blacks and Whites. For Hispanics, moderate and high levels of social integration were equally protective.

Individual educational attainment, neighborhood-socioeconomic contexts, and self-rated health of middle-aged and elderly Chinese: Exploring the mediating role of social engagement

Analyzing the 2011-2013 China Health and Retirement Longitudinal Study with 14,507 respondents from 393 neighborhoods, and applying generalized linear mixed-effects model, this study examines how individual-level education and neighborhood-socioeconomic contexts affect health through social engagement. Findings reveal that measures of social engagement-social activity and productive activity-are significantly related to self-rated health and partially mediate the effects of individual-level education. Neighborhood-socioeconomic contexts have independent effects on self-rated health beyond individual socio-demographics, and social activity mediates the effects of neighborhood recreational facilities. This study is among the first to simultaneously explore the health effects of individual and neighborhood-level socioeconomic conditions.

Older adult social participation and its relationship with health: Rural-urban differences

In an aging world, there is increased need to identify places and characteristics of places that promote health among older adults. This study examines whether there are rural-urban differences in older adult social participation and its relationship with health. Using the 2003 and 2011 waves of the Wisconsin Longitudinal Study (n=3006), I find that older adults living in rural counties are less socially active than their counterparts in more-urban counties. I also find that relationships between social participation and health vary by the type of activity and rural-urban context.

Association between Cognitive Status and Physical Activity: Study Profile on Baseline Survey of the My Mind Project

Background: The incidence of people with dementia is expected to increase significantly in the coming years, but it seems that there is a relationship between an active lifestyle and cognitive decline. The present study aimed to compare the characteristics and engagement in the physical activity (PA) of three groups of Italian elderly with different cognitive statuses at baseline phase. Methods: Data were examined using the results from the “My Mind Project” on 305 community-dwelling Italians. The sample was comprised of 93 subjects with Alzheimer’s disease (AD), 109 with mild cognitive impairment (MCI) and 103 healthy elderly (HE). Results: Classification of subjects on the basis of Physical Activity Scale for the Elderly (PASE) score showed that 47% of HE performed the highest level of physical activity while 40% of AD performed the lowest level. MCI subjects were distributed quite homogeneously across the levels (p < 0.001). Physical activity such as walking and light sports was carried out mainly and more frequently by HE as compared to the others (p < 0.05). As regards functional status, AD presented worse conditions in basic and instrumental activities of daily living than the other groups (p < 0.001). Conclusions: Our results evidenced that subjects with cognitive decline had the tendency to engage in PA less than HE. In particular, age and education negatively affected engagement in PA.

Patterns of social engagement in the transition to later life

As social roles in later life are shaped by significant life events and changes occurring in the late-life transition, examining social engagement in midlife may provide a context for interpreting the ageing social identity. This is particularly important for women, who are heavily dependent on social relationships and are more influenced by social losses and change.

OBJECTIVE

To examine major social changes occurring in the decade prior to late-life, starting from approximately 45-55 years of age.

STUDY DESIGN

The study accessed data from the longitudinal prospective Women's Healthy Ageing Project (WHAP). Participants were 493 women who had completed at least one assessment in the first 12 years of the study.

RESULTS

Living with a partner was common and stable amongst participants, while the proportion with children still at home decreased markedly (79-44%). Full-time employment also decreased as participants approached the average retirement age (40-13%). Volunteer work was popular throughout the study, increasing slightly with age, and minding grandchildren was common at the end of the study period (80%).

CONCLUSIONS

Taken together, these findings suggest a notable deficit in participants' social lives as they transition into later life, but with some evidence of compensation by increasing other social activities.

Perceived Social Support Trajectories and the All-Cause Mortality Risk of Older Mexican American Women and Men

Although numerous studies of non-Hispanic Whites and Blacks show that social integration and social support tend to favor longevity, it is unclear whether this general pattern extends to the Mexican American population. Building on previous research, we employed seven waves of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to examine the association between perceived social support trajectories and the all-cause mortality risk of older Mexican Americans. Growth mixture estimates revealed three latent classes of support trajectories: high, moderate, and low. Cox regression estimates indicated that older Mexican American men in the low support trajectory tend to exhibit a higher mortality risk than their counterparts in the high support trajectory. Social support trajectories were unrelated to the mortality risk of older Mexican American women. A statistically significant interaction term confirmed that social support was more strongly associated with the mortality risk of men.

Social Engagement and Health

What are the social factors that matter most to the health of elderly Chinese? Are there any gender and age differences? Using a representative sample of elderly Chinese in Shanghai, the most developed city in China with the nation’s largest proportion of elderly residents, this study found that economic conditions, chronic health status, living arrangements, social activity participation, and caring for grandchildren are factors that are most important to the health of elderly Chinese. This is true for both self-rated health and psychological well-being. The beneficial effects of participation in social activities are particularly salient for elderly women and for the old–old, whereas the salutary effects of caring for grandchildren are more substantial for elderly men and for the young–old. Our findings suggest the importance of social engagement in promoting health and successful aging of elderly Chinese and disclose the moderating roles of gender and age in this focal relationship.

Social engagement across the retirement transition among "young-old" adults in the French GAZEL cohort

The objective of this study was to test predictors of change in social engagement across the retirement transition in a cohort of 10,692 French utility workers retiring between 1992 and 2004, aged 51-65 in 2004. Three measures of social engagement (organizational activity participation, number of close family members, and number of close friends) were collected in 1991 and 2004; 1991 scores were subtracted from 2004 scores to determine change. We used ordered logistic regression to model predictors of change. Compared with those retiring just before the follow-up measure, those retiring 2-5 years earlier had greater positive change in organizational activity participation (OR 1.22, 95 % CI 1.07, 1.39) and greater positive change in number of close friends (OR 1.19, 95 % CI 1.04, 1.37) after retirement compared with before, but no difference in family contact, and no clear linear trend by retirement timing relative to the follow-up measure. Women were less likely than men to increase organizational activities and contact with close family ties. Poor self-rated health at follow-up consistently predicted decreased engagement. For specific activities, those retired longest had not only the greatest odds of increased political/religious organizational involvement and sports/hobby/leisure involvement but also the greatest odds of decreased volunteering. Those of low midlife socioeconomic status (SES) were more likely to decrease levels of formal engagement from before retirement to after, compared to those of higher SES. Overall, certain changes in social engagement emerged with increasing time in retirement. However, retirement timing was a weaker predictor of change in engagement than factors such as low midlife SES or poor health. Findings suggest that disparities in social engagement may emerge during retirement.

Volunteering as reciprocity: beneficial and harmful effects of social policies to encourage contribution in older age

Social policy applications of 'active ageing' ideals have recently focussed on volunteering as a beneficial and valuable contribution that older people can make to their communities. In this paper we draw attention to the positive and negative effects of a general imperative to contribute. Understanding the benefits of contribution in terms of the moral force of reciprocity recognises that older people do need and want to contribute to society and these contributions are beneficial for their sense of identity and wellbeing. However, older people vary greatly in their health, financial resources, and social networks and should not be seen as a homogenous group whose members must contribute in the same way. A policy focus on the imperative to contribute as a participating citizen can be oppressive and lead to withdrawal from social engagement by those who are the most in need of support to participate. Priorities for social and organisational policies must include support for the many ways older people are able to be involved in their communities and to provide structures necessary to support their preferences. A focus on individual responsibility for active engagement in society, which does not take account of individual circumstances or past contributions, can be harmful.

Healthy time use in the encore years: do work, resources, relations, and gender matter?

Social engagement is theorized to promote health, with ages 55 to 75-what some call "encore" adulthood-potentially being a time for ongoing engagement or social isolation. We use the American Time Use Survey (N = 11,952) and a life course perspective to examine associations between paid work, resources, relations, and healthy time use for men and women in the first (55-64) and second (65-74) halves of the encore years. Work limits sufficient sleep (full-time working men) and television watching (all workers) but also time spent in physical activity (full-time workers). College-educated and healthy encore adults-across age and gender divides-are more likely to exercise and watch less television. Marriage and caregiving encourage socializing and limit television watching, despite differential effects on physical activity and sleep. These findings fit well with a gendered life course perspective suggesting socially patterned (by work, resources, relationships, gender, age) health behaviors.