Types of social participation and psychological distress in Japanese older adults: A five-year cohort study

The impact of intergenerational support on social participation patterns of older adults in rural China

Objectives

This study aimed to examine the association between different dimensions of bi-directional intergenerational support and the social participation patterns of rural older adults, while also exploring the heterogeneity of these older adults by gender and age.

Methods

Based on longitudinal survey data from the 'Well-Being of Older People in Anhui Province (WESAP)' in 2018 and 2021, this study used latent class analysis to identify social participation patterns and used multinomial logistic regressions to explore the relationship between intergenerational support and social participation patterns among rural older adults.

Results

First, the social participation patterns of rural older persons can be divided into four categories: leisure type (9%), work type (11%), housekeeping type (57.9%) and family labor type (22.1%). Second, there is heterogeneity in the relationship between intergenerational support and social participation patterns in older people, among them, receiving financial support decreased the likelihood of older adults being categorized as work type and family labor type by 14 and 7.7%, respectively, while providing financial support increased the likelihood of older adults belonging to the family labor type by 7.5%; receiving caring support increased the likelihood of older parents being categorized as leisure type by 6%, while providing caring support decreased the likelihood of older parents being categorized as leisure type by 10%; emotional support is related to all patterns of social participation among older adults. Third, the effects of intergenerational support vary across subgroups based on gender and age.

Conclusion

Two-way intergenerational support was significantly associated with social participation among rural older adults, and there was significant heterogeneity in this association. Children and older persons should be encouraged to strengthen two-way intergenerational mobility to give full play to the positive impact of different dimensions of intergenerational support on the social participation of older persons in rural areas, ultimately enhancing the quality of life for rural older adults.

Sex and gender differences in social participation among community-dwelling older adults: a systematic review

Background

Frequent social participation among older adults is associated with greater health. Although understanding how sex and gender influence social participation is important, particularly in developing sex-inclusive health promotion and preventive interventions, little is known about factors influencing engagement of older women and men in social activities.

Aim

This study thus aimed to examine factors influencing social activities of older women and men.

Methods

A mixed-method systematic review was conducted in nine electronic databases from inception to March 2023. The studies had to define social participation as activities with others and examine its influencing factors among community-dwelling older women and men. Data were analyzed using convergent synthesis design from a socio-ecological perspective.

Results

Forty-nine studies, comprising 42 quantitative, five qualitative and two mixed method design were included. Themes identified concerned: (a) sociodemographic factors, (b) personal assets, (c) interpersonal relationships and commitments, (d) physical environment, and (e) societal norms and gender expectations. The findings identified the heterogeneous needs, preferences and inequalities faced by older women and men, considerations on sociocultural expectations and norms of each gender when engaging in social activities, and the importance of having adequate and accessible social spaces. Overall, this review identified more evidence on factors influencing social participation among women than in men.

Conclusion

Special attention is needed among community care providers and healthcare professionals to co-design, implement or prescribe a combination of sex and gender-specific and neutral activities that interest both older women and men. Intersectoral collaborative actions, including public health advocates, gerontologists, policymakers, and land use planners, are needed to unify efforts to foster social inclusion by creating an age-friendly and sustainable healthy environment. More longitudinal studies are required to better understand social participation trajectories from a sex and gender perspective and identify factors influencing it.

Systematic reviews registration

http://www.crd.york.ac.uk/PROSPERO, identifier [CRD42023392764].

Impact of Residential Area Characteristics and Political Group Participation on Depression Among Middle-Aged and Older Adults: Results of an 11-Year Longitudinal Study

Background and Objectives

The claim that political group attendance is associated with poor mental health among older adults may be conditioned on geographic conditions. This study examined the geographical context in which political group participation may be associated with depression.

Research Design and Methods

The 11-year follow-up data from the Taiwan Longitudinal Study on Aging, covering 5,334 persons aged ≥50 years, were analyzed using random-effects panel logit models. Depression was assessed using 10 items on the Centre for Epidemiologic Studies Depression scale. Participants were asked to indicate whether they belonged to different social groups. We modeled depression as a function of political group participation (the independent variable) and geographical region (moderators), adjusting for individual-level characteristics.

Results

Respondents in political groups were more likely to report depression than those in nonpolitical groups (adjusted odds ratio [AOR] = 1.90, 95% confidence interval [CI] = 1.34-2.68). Between urban and rural settlements, there were no statistically significant differences in mental health outcomes among older adults engaged in political groups (AOR = 1.72, 95% CI = 0.81-3.67). For those who remained politically engaged, living in areas with lower levels of electoral competition was associated with a lower likelihood of depression (AOR = 0.92, 95% CI = 0.86-0.98); this conditional effect was not prevalent among those who were solely engaged in nonpolitical groups (AOR = 1.02, 95% CI = 0.99-1.03).

Discussion and Implications

Political group participation is associated with poor mental health among older adults living in politically competitive regions.

Social Participation of Older Adults in Rural and Urban Areas: A Cross-Sectional Survey in Turkey

Social participation is important in terms of active aging and quality of life during old age. This cross-sectional study aimed to determine the social participation of older adults in rural and urban areas in Turkey. Related factors were similarly identified. The sample comprised 1,224 people over the age of 60, with a mean of 69.78 ± 7.48 years. Among the participants, 61.4% live in urban areas. The data were collected in family health centers through face-to-face interview and the Interview Form, Social Participation Assessment Form, and Social Participation Dimension of the Turkish Version of the Aging Module of the World Health Organization Quality of Life (WHOQOL) Scale. The scores obtained from the social participation dimension of the scale among the elderly in urban areas were higher than those obtained among the elderly in rural areas (p = .002). In addition, older adults in the urban areas who talked on the phone several times a month (p = .025), went to concerts, theater/cinema, museum/exhibition, various visual/musical shows (p = .046), and engaged in gardening (p = .032) obtained higher scores in the social participation dimension than the other participants. Health care professionals should take an advocacy role in building relationships with policy makers and create suitable socialization opportunities for older adults in urban and rural areas.

Older Adults' Experiences Living With and Having Spine Surgery for Degenerative Spine Disease

BACKGROUND AND OBJECTIVES

Globally, older adults are undergoing spine surgery for degenerative spine disease at exponential rates. However, little is known about their experiences of living with and having surgery for this debilitating condition. This study investigated older adults' understanding and experiences of living with and having surgery for degenerative spine disease.

RESEARCH DESIGN AND METHODS

Qualitative methods, grounded theory, guided the study. Fourteen older adults (≥65 years) were recruited for in-depth interviews at 2 time-points: T1 during hospitalization and T2, 1-3-months postdischarge. A total of 28 interviews were conducted. Consistent with grounded theory, purposive, and theoretical sampling were used. Data analysis included open, axial, and selective coding.

RESULTS

A conceptual model was developed illustrating the process older adults with degenerative spine disease experience, trying to get their life back. Three key categories were identified (1) Losing Me, (2) Fixing Me, and (3) Recovering Me. Losing Me was described as a prolonged process of losing functional independence and the ability to socialize. Fixing Me consisted of preparing for surgery and recovery. Recovering Me involved monitoring progression and reclaiming their personhood. Conditions, including setbacks and delays, slowed their trajectory. Throughout, participants continually adjusted expectations.

DISCUSSION AND IMPLICATIONS

The conceptual model, based on real patient experiences, details how older adults living with and having surgery for degenerative spine disease engage in recovering who they were prior to the onset of symptoms. Our findings provide a framework for understanding a complex, protracted trajectory that involves transitions from health to illness working toward health again.

Interpersonal relationships, subjective health, psychological well-being, and quality of life among older adults in South India: Evidence from a population-based study

BACKGROUND

Subjective health and well-being are closely linked with quality of life (QoL) in older adults. Self-reported health, happiness, satisfaction with life and interpersonal relationships, social support, loneliness, and social isolation make robust indicators for the psychological well-being of older adults. This study aimed to explore subjective health, psychological well-being and associated factors, and their relationship with QoL in older adults.

MATERIALS AND METHODS

This was a cross-sectional, community-based survey that included adults aged 60 years and above (n = 260) who were living in selected communities. A semi-structured questionnaire was used to collect data on self-reported health, happiness, satisfaction with family and marital relationships, and felt loneliness and isolation. The relationship between psychological well-being and QoL was identified. Data analysis was carried out by descriptive and analytical statistical applications using Statistical Package for the Social Sciences (SPSS) version 20 at P ≤ 0.05.

RESULTS

Study findings showed that a significant number of older adults (56%) reported poor general health; 56.4% of men and 59.2% of women were "not at all happy" with their family and interpersonal relationships, and 13.5% of respondents were not at all happy in general. Self-reported health (0.277**) and happiness (0.506**) were positively correlated with the psychological domain of QoL (P ≤ 0.01).

CONCLUSIONS

The study findings identified the interrelationship between changing family and social relationships and psychological well-being of older adults, which is an immediate public health concern. Inadequate social support and deficient quality of interpersonal relationships predispose loneliness and isolation in later life. Strategies to promote social support and age-friendly social and healthcare resources are urgent needs for healthy aging.

Effects of types and levels of social capital on emotional well-being for older people in Indonesia: A longitudinal study

OBJECTIVES

The purpose of this study was to examine the effects of different types and levels of social capital and emotional well-being in older adults in Indonesia by a longitudinal data.

METHODS

The fourth and the fifth waves of Indonesian Family Life Survey data were used for this study. The participants aged 60 years or older who participated in both waves were included for analysis (n = 1374). Depressive symptoms and happiness were used to assess emotional well-being. Cognitive social capital (neighborhood trust) and structural social capital (participating in arisan, community meetings, volunteers, village improvement programs, and religious activities) were the main independent variables. The generalized estimating equations model was used for analysis.

RESULTS

Participation in arisan (B = -0.534) and attending religious activities (B = -0.591) were related to lower depressive symptoms, but the effect of religious activities would offset over time. Both a low or high social participation showed protective effects on depressive symptoms at the intercept and the time slope. Having higher neighborhood trust was related to more chance of feeling very happy (OR = 1.518).

CONCLUSION

Structural social capital is protective from depressive symptoms, while cognitive social capital contributes to happiness. Facilitating social participation and improving neighborhood trust through policies and programs is suggested to promote emotional well-being for older people.

Social Participation Considered as Meaningful in old age - the Perceptions of Senior Housing Residents in Finland

As populations across the world age, there is a recognised need for promoting social participation in older adults. Previous studies related to social participation have addressed that interactions perceived as meaningful may improve quality of life in old age. However, what is less clear is the nature of such participation from the perspective of older adults, as the vast majority of studies have been quantitative. The present study aimed to explore what characterises social participation that contributes to a meaningful everyday life, from the viewpoint of independently living Finnish older adults. Thematic analysis was used as an interpretative method drawing on semi-structured in-depth interviews with six residents aged 82 to 97 years from one senior housing facility. The analysis showed that social participation perceived as meaningful involved caring reciprocal interactions with people they connected with; having the freedom to make autonomous decisions and influence matters that affected their own or others' everyday life; and, on a more abstract level, feeling significant as a person. It furthermore fostered independence and companionship as well as reduced loneliness. To describe social participation that is perceived as meaningful from a theoretical perspective, we used Levasseur and colleagues' (2010) taxonomy and found that such involvement creates a sense of connectedness, a sense of belonging and relates to the concepts of social integration, social networking and social engagement. This type of involvement is associated with enhanced quality of life and a more meaningful life, highlighting the importance of creating environments where older adults can socially connect.

Perceptions on Their Own Social Participation: A Qualitative Exploration of Ethiopian Secondary Students with Visual Impairments

Social participation is a vital part of life and has multifaceted positive outcomes on personal health and wellbeing. Social participation or the lack thereof might have more profound psychological impacts on individuals in a collectivist culture than its counterpart. The current study explored personal and environmental barriers that have hindered the effective social participation of secondary students with visual impairments. Exploration addressed various activities in and outside school settings in Ethiopia and discussed findings in relation to the prevailing cultural orientation. In-depth semi-structured interviews were conducted to gather qualitative data on barriers to social participation of 17 secondary students with visual impairments in Addis Ababa, Ethiopia. The qualitative data were analysed thematically, yielding four major themes and identifying twenty sub-themes that limited the social participation of students with visual impairments, such as personal, attitudinal, sociocultural, and practical barriers. The study showed a range of barriers that participants experienced related to social participation, the criticality of cultural orientation in providing context to understand the impacts of social participation, and the need for future research in the area.

Effect of multidisciplinary collaborative empowerment education on psychological distress and quality of life in patients with colorectal cancer undergoing chemotherapy

PURPOSE

To evaluate the effects of multidisciplinary collaborative empowerment education on psychological distress and quality of life (QoL) in patients with colorectal cancer undergoing chemotherapy.

METHODS

A quasi-experimental study was conducted using repeated measures at pre- and post-intervention in the fourth chemotherapy cycle. Sixty patients with colorectal cancer aged 36-84 years were allocated to the intervention and control groups. The intervention group received multidisciplinary empowerment education, while the control group received routine health education. Psychological distress involving depression and anxiety symptoms was assessed using The Kessler Psychological Distress Scale (K10) and QoL was measured using The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTCQLQ-C30). Repeated-measures analysis of variance was used to examine intervention effects. Statistical analyses were performed using the SPSS software (version 26.0).

RESULTS

Psychological distress was considerably lower and QoL was considerably better in patients following multidisciplinary empowerment education in the intervention group than those in the control group. In addition, psychological distress significantly decreased and QoL improved in the intervention group compared to baseline.

CONCLUSION

Multidisciplinary collaborative empowerment education was effective in improving the psychological distress and QoL among patients with colorectal cancer undergoing chemotherapy. These findings suggest that the establishment of multidisciplinary collaborative empowerment education might be considered as an innovative means of clinical patient education during combination chemotherapy to improve health outcomes in patients with colorectal cancer. However, our results should be interpreted with caution because of the small sample size. Further validation in a larger sample or randomized controlled design is necessary in the future.

Associations between patterns of participation in community activities and social support, self-efficacy, self-rated health among community-dwelling older adults

Certain types of community-based social activities improve the health issues of older adults; however, the present patterns of participation in community activities remain unknown. This study aims 1) to identify community-dwelling older adults' patterns of participation in community-based activities and 2) to evaluate the relationships between social support, self-efficacy, self-rated health, and the patterns of participation in community activities. This cross-sectional study used data collected from 146 older adults aged ≥65 years who participated in community events in Japan in 2018. Cluster analysis was used to identify subjects' patterns of participation in community activities. In the multinomial logistic regression model, the participation pattern (dependent variable), and social support and self-efficacy (independent variables), were included, adjusting for age, sex, and years of residency. Three participation pattern clusters were identified: diverse activities (58%), municipal events (30%), and senior citizen club (12%). The proportion of participants reported themselves healthy were 93%, 88%, and 78% for diverse activities, municipal events, and senior citizen club clusters, respectively. Compared to those in the senior citizen club cluster, older adults in the diverse activities cluster were more likely to have self-efficacy (adjusted odds ratio (aOR): 1.19, p = .041) and social support (aOR: 2.35, p = .018), while participants in the municipal events cluster were associated with only social support (aOR: 3.29, p = .022). Increasing social support and self-efficacy may promote seniors' participation in diverse community activities, which would be beneficial for their healthy aging. Further studies are needed to evaluate the causal relationships.

Value of social activities and prerequisites for continued participation of rural older adults: A qualitative study

AIMS

To explore the value of social activities and the prerequisites for continuous participation among rural older adults based on their experiences.

DESIGN

Qualitative, descriptive design.

METHODS

Individual semi-structured interviews were conducted with 14 older adults from voluntary community salons in a rural area in Japan. Participants were selected through purposeful sampling. Data were analyzed using qualitative content analysis. The consolidated criteria for reporting qualitative research (COREQ) checklist were used.

RESULTS

Four values of social activities were identified: "Mutual benefit connectedness," "Preventing and coping with aging," "Making life brilliant 'now'," and "Building a safety net." Three prerequisites for activities were identified: "Do not overreach," "Do not infringe on personal territory," and "Do not go against community norms." Social activities provide rural older adults with reciprocity ties, coping with aging, enhanced daily lives, and a social safety net. Continued participation in rural social activities requires adherence to cultural norms and moderation of relationship distances. Community and public health nurses are expected to promote social activities that incorporate these values and adhere to these prerequisites.

Participation in community seniors' organizations and mental health among retired adults in urban China: The mediating role of interpersonal needs

Purpose

This study aimed to investigate the association between participation in community seniors' organizations (CSOs) and mental health among retired adults in urban China, and illustrate the causal mechanism.

Methods

We collected data on participation from a community seniors' organization and mental health survey in Shenzhen City, China, in July 2022. The survey used a two-stage cluster sample design, based on administrative divisions as the primary sampling unit and communities as the second sampling unit, where retired adults were randomly sampled. The inclusion criteria were individuals >60 years old (the mandatory age for retirement in China) or women who retired early at the age of 45 years. We used three multivariable regression models to estimate the effects of participation in CSOs on mental health. Furthermore, we used structural equation models to examine the mediator of acquired interpersonal needs in the association between CSOs participation and mental health.

Results

The study examined the values of CSOs, generated explicitly for older adults and explained how participation in such organizations benefits retired adults' mental health. Mental health is defined in three dimensions: aggregate mental health, positive emotions, and negative emotions. The results show that constituting social networks with like-minded individuals and perceiving interpersonal needs are the two main benefits of CSOs on mental health. The retired individual who participated in CSOs with a higher level of diversity and frequency, joined specific types such as health- and study-related CSOs, could receive more interpersonal needs and were probably mentally healthier. The mediating mechanism of interpersonal needs associated with participation in mental health was significant. Besides, mental health is generally affected by physical health, sleep quality, and socioeconomic status.

Conclusion

This study suggested that CSOs have expanded the social interaction channels of retired adults and affected their mental health by providing basic interpersonal needs such as inclusion, dominance, and affection. Among the types of CSOs, health and study organizations might enhance mental health most effectively, while semi-official organizations have no effect.

Impact of residing in neighborhoods of high social participation on health of retired workers: A multilevel analysis using nationwide longitudinal data in Japan

Retirement is a key determinant of health among middle-aged and older adults. Social participation (SP) has a favorable impact on health outcomes. Combining these two issues, we examined how neighborhood-level SP may affect the health outcomes of retired workers. We used 94,661 longitudinal observations of 13,185 full-time workers aged 50–59 years in 2005 from a nationwide 14-wave survey conducted in Japan from 2005 to 2018. First, we computed neighborhood SP using an econometric method. We then conducted multilevel analysis to examine how neighborhood SP, retirement, and their interaction affected the probabilities of SP, poor self-rated health (SRH), problems in activities of daily living (ADL), and psychological distress (SD). The estimation results showed that retirement in a high-SP neighborhood reduced the probabilities of poor SRH, ADL problems, and SD by 1.1 (95% confidence interval [CI]:0.5–1.7), 0.9 (95% CI:0.0–1.8), and 2.1 (95% CI:0.6–3.7) percentage points, respectively. These effects were substantial in magnitude, considering that the prevalence of poor SRH, ADL problems, and SD were 3.7%, 7.4%, and 18.5%, respectively, among retired men. In contrast, such interaction effects between retirement and neighborhood SP were not observed among the women. The results suggest that policy measures to encourage SP at the neighborhood level should be developed to help individuals enjoy a healthier life in retirement.

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Interaction between neighborhood social participation and retirement was examined.

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High neighborhood social participation enhanced health of retired workers.

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Impact of neighborhood social participation was observed mainly among men.

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Policy measures to encourage neighborhood social participation should be developed.

Patterns of social participation and impacts on memory among the older people

This study employs latent class analysis to analyze the social participation patterns of elderly Chinese, as well as the impact of different social participation patterns on memory. According to the results, older persons exhibit four distinct social participation patterns. and senior citizens with a strong emphasis on entertainment had a better memory than those with a low participation level. Although there was no difference in urban elders' memory across the four social engagement patterns, the connection varied significantly between urban and rural seniors. As a result, it is suggested that the elderly's memory be improved by protecting their right to social involvement, enriching the style and content of social participation, and assuring the continuity of their social obligations.

Factors Associated with Passive Sedentary Behavior among Community-Dwelling Older Women with and without Knee Osteoarthritis: The Otassha Study

Passive sedentary behavior (SB) may lead to adverse health outcomes; however, it remains unclear whether the factors relevant to passive SB differ between older adults with and without knee osteoarthritis (KOA). This cross-sectional study examined factors associated with passive SB among 688 community-dwelling older women with (n = 128) and without (n = 560) KOA. Passive SB (min/day) was assessed using the Japanese-translated version of the Measure of Older Adults' Sedentary Time questionnaire. Demographic, lifestyle, and psychosocial factors; pain; and physical performance were evaluated in multiple regression models with an interaction term concerning SB between the two groups. The mean (SD) total SB for those without and with KOA was 490.4 (200.9) min/day and 487.4 (185.8) min/day, respectively, and the majority of SB was passive, with no difference between groups. Passive SB was associated with an obese status and less time spent in group activities. However, no KOA-specific SB factors were identified. Therefore, effective interventions to promote social participation and weight loss, especially for individuals with obesity, may reduce passive SB, regardless of KOA. Longitudinal studies are warranted to identify causal relationships.

Social participation and depressive symptoms in older African American cancer survivors: a comparison with non-cancer subjects

OBJECTIVES

African Americans are differentially affected by most cancers compared to other racial groups. Social participation has demonstrated beneficial effects on mental health in older adults with a history of cancer. The purpose of the present study is to examine and compare the effects of specific social participation activities on depressive symptoms among older African Americans with and without a history of cancer.

METHOD

The study sample included 2,000 older African Americans selected from the National Health and Aging Trends Study. Waves from 2011 to 2018 were used. Mixed-effects logistic regressions were applied to examine the effects of four social participation activities on depressive symptoms among older African Americans with or without a history of cancer.

RESULTS

Among older African American who had a history of cancer, visiting family and friends and attending religious services were related to lower odds of depressive symptoms. However, among older African Americans without a history of cancer, joining organized activities and going out for enjoyment predicted lower odds of depressive symptoms.

CONCLUSION

Older African Americans with a history of cancer tend to benefit from visiting family and friends and attending religious services in coping with depressive symptoms. Mental health services for this group could focus interventions on promoting social participation activities with family, friends, and religious congregants.

Impact of COVID-19 on the social relationships and mental health of older adults living alone: A two-year prospective cohort study

Background

Owing to the COVID-19 outbreak, older adults living alone, who can only connect socially outside their homes, are at risk of social isolation and poor mental health. This study aimed to identify the changes, before and after COVID-19, by sex and age, in social relationships (social activity, social network, and social support) and mental health (depression and suicide ideation) among older adults living alone.

Methods

This is a prospective cohort study of community-dwelling older adults who were at least 65 years old and living alone in South Korea. The study was conducted during 2018–2020 with 2,291 participants (795, 771, and 725 for the 1st to 3rd waves, respectively). The data were collected via face-to-face interviews. A generalized linear mixed modeling framework was used to test for changes over three years.

Results

Social activity was reduced after the COVID-19, with an interaction effect of sex: older women (odds ratio [OR], 0.19; 95% confidence interval [CI], 0.15–0.23; p < .001) showed greater reduction than older men (OR, 0.50; 95% CI, 0.34–0.75; p < .001). Interaction with neighbors also reduced after the pandemic, but there was no significant evidence of interaction effects. Interaction with family members increased in both sexes during the pandemic, with the interaction effect of sex: older women (OR, 1.40; 95% CI, 1.11–1.76; p = .004) showed greater increase than men (OR, 1.55; 95% CI, 1.13–2.14; p = .007). Social support increased in both sexes during the pandemic, but there was no significant evidence of interaction effects. Depression and suicide ideation showed no significant differences before and after the pandemic.

Conclusions

The findings provide health administrators and health providers with explorative insights into the impact of the COVID-19 on social relationships and mental health among older adults living alone and can guide further studies of interventions considering specific properties of social relationships.

Comparative Study on Volunteering among Older Korean Immigrants in the United States and Older Koreans in South Korea

This study aimed to determine the most important factors that influence the prevalence of volunteering among older Koreans in the United States and in Korea and to identify sociodemographic resources, cultural resources, and social resources that are correlated with volunteering. The data were gathered from older Koreans aged 60 or over from the two countries (n = 480). The prevalence of volunteering was 23.3% for older Korean immigrants in the United States versus 14.7% for the older Koreans in Korea. This study found that there was a significant relationship between human capital (individual resources) and volunteering in both countries. Education and financial status had a positive relationship with volunteering among older Koreans in both countries. Cultural resources and social resources were the only important predictors of volunteering among older Korean immigrants in the United States. Regarding types of volunteering, older Koreans in both countries were more likely to participate in informal volunteering than formal volunteering. These findings differ somewhat from those reported by previous studies. This study was the first attempt to examine older adults from these two countries with a focus on the correlation between cultural factors, social resources, and volunteering.

Many Paths to Recovery: Comparing Basic Function and Participation in High-Functioning Older Adults After Acute Hospitalization

Function after acute hospitalization is mostly operationalized by Basic Activities of Daily Living (BADL), a limited concept that overshadows a wide range of instrumental, social, and recreational activities, otherwise referred to as participation. Participation is important for patients' health and quality of life after hospitalization. This study focuses on high-functioning older adults, examining functional recovery after hospitalization by comparing BADL assessment with assessment of participation at one and three months following discharge relative to pre-hospitalization. Quantitative data were collected from 72 participants divided into two age groups of hospitalized older adults (age 65-74, n = 38; age ≥75, n = 34), followed by home visits after 1 month and telephone interviews 3 months after discharge. Both groups experienced a significantly greater decline in participation, compared with BADL, which were mostly preserved. A comprehensive assessment of participation better captures functional changes in high-functioning older adults. Early identification of participation withdrawal is crucial for preventing disability.

Does Residing in a Neighborhood of High Social Participation Postpone Deterioration in Health among Middle-Aged Adults? A Multilevel Survival Analysis in Japan

Social participation (SP) is known to have a favorable impact on an individual's health. This study examined whether residing in a neighborhood with a high SP level would be predictive of delayed deterioration in health outcomes, even after controlling for individual SP. With the 14-wave longitudinal data of 32,388 individuals (15,749 men and 16,639 women) aged 50-59 years residing in 2,477 neighborhoods in 2005, we used multilevel Cox proportional hazards models to examine the impact of neighborhood SP on the onset of problems in activities of daily living (ADL), poor self-rated health, and psychological distress. Residing in a neighborhood with high SP levels modestly postponed the onset of health problems in individuals. The hazard ratio (HR) of ADL problems in response to residing in a neighborhood with above-average SP levels was 0.92 (95% confidence interval [CI]: 0.85-0.99) and 0.93 (95% CI: 0.87-1.00) for men and women, respectively, even after controlling for an individual's SP and other attributes. The results for other health outcomes showed a similar pattern. These findings suggest that high neighborhood SP has a favorable impact on health among middle-aged adults, independent of individual SP. Policy measures to enhance and promote neighborhood SP are thus needed in terms of public health.

Association of Instrumental Activities of Daily Living, Physical Function, and Mental Health among Older Returnees after the Fukushima Daiichi Nuclear Power Station Accident

The 2011 Great East Japan Earthquake and consequent Fukushima Daiichi Nuclear Power Station accident caused a large-scale evacuation, generating various health issues. Although residents gradually returned, their independence of daily living and associated factors remain unknown. This study examines the hypothesis that physical and mental status are associated with the instrumental activities of daily living (IADL) of older returnees (65 years and above) after the disaster. Older returnees to Kawauchi Village, Fukushima Prefecture, located 20–30 km southwest of the power plants, were recruited. IADL was assessed using the Japan Science and Technology Agency Index of Competence, physical function via the 30-s chair stand test, and mental health via the Japanese version of the World Health Organization Five Well-Being Index. To examine the association of IADL and possible factors, a t-test or Pearson’s product-moment correlation coefficient was used, stratified by sex. The data of 29 participants (75.5 ± 7.4 years, 19 female) were analyzed. Physical function was associated with IADL in females. Mental health was associated with IADL in males and females. Taking measures to strengthen physical function in females, as well as to improve mental health in both sexes, for enhancing IADL ability could be beneficial.

An Overview of Social Participation in Older Adults: Concepts and Assessments

In older adults, social participation is an important component of rehabilitation and health promotion. Several studies have attempted to describe the definition and concepts of social participation, and there were many outcomes to measure social participation. This overview provides information about representative social participation and related concepts that have been defined in the literature. A standardized definition of social participation has not been developed; commonly, recognition for social participation was proposed as focused on involvement in social activities that provide interaction with others in a society or community. Many instruments assess the various aspects of social participation. Because of operational definition and diversity in social participation, performance in social participation was adopted as an aspect of assessment. Further discussions are needed to clarify the definition of social participation and evaluate the instruments used to assess social participation for it to be useful for rehabilitation and health promotion. In doing so, determining and developing assessment and intervention based on the purpose or perspective of social participation in older adults with and without disabilities is important.

Association between political group participation and depressive symptoms among older adults: an 11-year longitudinal study in Taiwan

BACKGROUND

Given the speculation that political participation is causing an epidemic of depression, this study examined how participation in political and non-political groups influenced depressive symptoms among older adults in Taiwan.

METHODS

The 11-year follow-up data from the Taiwan Longitudinal Study on Ageing, covering 5334 persons aged 50 years and older, were analysed using random-effects panel logit models.

RESULTS

Engagement in social groups reduced the likelihood of depression (adjusted odds ratio [AOR]: 0.71, 95% confidence interval [CI]: 0.64-0.80). However, there was a greater likelihood of depressive symptoms among older adults who were engaged in political groups when compared with those who were engaged in non-political groups (AOR: 1.87, 95% CI: 1.31-2.65). For older adults who remained politically engaged, participation in a greater number of non-political group types was associated with a lower likelihood of depression (e.g. at 1: AOR: 0.53, 95% CI: 0.30-0.91; at 2+: AOR: 0.35, 95% CI: 0.18-0.67); this numbers-based effect was not prevalent among those who were solely engaged in non-political groups.

CONCLUSIONS

Political group attendance can result in negative mental health outcomes among older adults. Our findings suggest that reducing the prevalence of depression through social participation is conditional to the engagement type.

Predictors and Importance of Social Aspects in Ikigai among Older Women

Ikigai is a unique Japanese concept that encompasses not only joy and happiness, but also the purpose and meaning of life. The purpose of this study was to explore the factors that contribute to Ikigai, an important concept in the health of older women, and to clarify the relationship between Ikigai and the enhancement of the social aspects of their health. The participants in this longitudinal study, conducted between October 2017 and February 2020, were physically healthy older women aged 65 years and above (N = 132). Physical function and social activity were used as predictors of Ikigai. In addition, willingness for new interactions was used to examine the social aspects of health. A causal model was created from these factors, and path analysis was performed. The results demonstrated that participating in numerous interpersonal activities was predictive of increased Ikigai, but physical function was not. In addition, Ikigai was found to affect the willingness for new interactions. Further, Ikigai could be related to the willingness for new interactions. To enhance the social aspects of older women’s health, it is necessary to focus on Ikigai.

Social participation and life satisfaction among older adults: diversity of practices and social inequality in Switzerland

This paper examines the associations between social participation and individual life satisfaction among older adults. It specifically considers the diversity of the practices and social inequalities among this population. For analyses, we used a large survey of individuals of 65 years and older conducted in 2011 in Switzerland (N = 2,727). The first set of linear regression analyses examines Diener's Satisfaction with Life Scale and its association with various indicators of social participation. While the second set of logistic regression addresses the issue of social inequalities by evaluating the impacts of gender, age group, region and education on social participation indicators that are significantly associated with the satisfaction with life score. Our results stressed the importance of combining multiple forms of participation for life satisfaction and shows that some forms are particularly meaningful: in particular, the involvement in associations, visitation of family or visitation of friends/acquaintances and church attendance. When inequalities among older adults are considered, having rich and varied social participation, being involved in associations and maintaining private sociability with non-kin appear more elitist. While institutionalised and/or private sociability types of participation appear particularly significant for older adults’ life satisfaction, the most traditional integration forms – i.e. family and religions – are crucial for the more vulnerable. Implications for active ageing was equally discussed as well.

Discharge transition experienced by older Korean women after hip fracture surgery: a qualitative study

BACKGROUND

This study aimed to explore older Korean women's discharge transition experiences after hip fracture surgery.

METHODS

This was a descriptive qualitative study. Face-to-face interviews following hip fracture surgery were conducted on 12 women aged 65-87 years. Data were collected 1 to 2 days before discharge and again 4 weeks after discharge following hip fracture surgery, and were analyzed using qualitative content analysis.

RESULTS

Four main themes were identified: (1) challenge of discharge transition: unprepared discharge, transfer into other care settings, and eagerness for recovery; (2) physical and psychological distress against recovery: frail physical state and psychological difficulties; (3) dependent compliance: absolute trust in healthcare providers, indispensable support from the family, and passive participation in care; and (4) walking for things they took for granted: hope of walking and poor walking ability.

CONCLUSIONS

After their hip fracture surgeries, older women hoped to be able to walk and perform simple daily chores they previously took for granted. Considering the physical and psychological frailty of older women undergoing hip surgery, systematic nursing interventions including collaboration and coordination with other healthcare professionals and settings are necessary to ensure the quality of continuous care during their post-surgery discharge transition. Encouraging partial weight bearing and initiating intervention to reduce fear of falling at the earliest possible time are essential to attain a stable discharge transition. Additionally, older women should be invited to participate in their care, and family involvement should be encouraged during the discharge transition period in South Korea.

Prospective pragmatic quasi-experimental study to assess the impact and effectiveness of an innovative large-scale public health intervention to foster healthy ageing in place: the SoBeezy program protocol

INTRODUCTION

With the accelerating pace of ageing, healthy ageing has become a major challenge for all societies worldwide. Based on that Healthy Ageing concept proposed by the WHO, the SoBeezy intervention has been designed through an older person-centred and integrated approach. The programme creates the environments that maximise functional ability to enable people to be and do what they value and to stay at home in best possible conditions.

METHODS AND ANALYSIS

Five levers are targeted: tackling loneliness, restoring feeling of usefulness, finding solutions to face material daily life difficulties, promoting social participation and combating digital divide. Concretely, the SoBeezy programme relies on: (1) a digital intelligent platform available on smartphone, tablet and computer, but also on a voice assistant specifically developed for people with digital divide; (2) a large solidarity network which potentially relies on everyone's engagement through a participatory intergenerational approach, where the older persons themselves are not only service receivers but also potential contributors; (3) an engagement of local partners and stakeholders (citizens, associations, artisans and professionals). Organised as a hub, the system connects all the resources of a territory and provides to the older person the best solution to meet his demand. Through a mixed, qualitative and quantitative (before/after analyses and compared to controls) approach, the research programme will assess the impact and effectiveness on healthy ageing, the technical usage, the mechanisms of the intervention and conditions of transferability and scalability.

ETHICS AND DISSEMINATION

Inserm Ethics Committee and the Comité Éthique et Scientifique pour les Recherches, les Études et les Évaluations dans le domaine de la Santé approved this research and collected data will be deposited with a suitable data archive.

"It's impossible for them to understand me 'cause I haven't said a word": how women baby boomers shape social participation spaces in old age

The baby boom generation's retirement will change the conceptualization of participation in old age due to their particularities from having experienced a specific socio-historical context. Likewise, the feminization of old age underscores the importance of developing research from the perspectives of gender and critical feminist gerontology. The objective of the present study is to identify and analyze women baby-boomers' conceptualizations about social participation regarding the configuration of social participation spaces. Five discussion groups and five individual interviews were conducted with 56 baby boomers residing in Andalusia (Spain). Here we focus on a separate analysis of the 27 women participating in these settings. The results were organized around four factors: desirability of social participation spaces, adaptation of spaces to preferences, facilitators and barriers in the adaptation of spaces, and the importance of agency in the social participation spaces. Through the analyzed discourse it was observed that participants in this study gave special importance to promoting spaces that involve social contribution, self-management, and self-determination of the spaces, adaptation of access, as well as exercising agency.

Social Participation in Older Adults after Relocation to Long-Term Care Institutions in China: A Qualitative Study

This study used focus group interviews with older Chinese long-term care residents (N = 40), to explore their perspectives and experiences of social participation in long-term care institutions. Based on previously established taxonomy of different activity levels, we found that their social participation centered on level 3 (involvement with others), level 4 (task-oriented activities), and level 5 activities (helping others). Participants indicated that their social participation had changed after relocation. Thematic analysis revealed three main themes: increased spare time, increased presence of peers, and new participation opportunities with lost old hobbies. Focusing on the positive changes after relocation and promoting meaningful activities of different levels may benefit long-term care residents.

Social Participation in the Daily Lives of Frail Older Adults: Types of Participation and Influencing Factors

OBJECTIVES

The advantages of social participation for older adults are well established and have been adopted in aging policy frameworks. However, little is known about the social participation of frail older adults. This research examined the types of social interaction of very frail older adults and the factors influencing this participation.

METHOD

Interviews with 38 very frail older adults were analyzed using Levasseur and colleagues' (Levasseur, Richard, Gauvin, & Raymond (2010). Inventory and analysis of definitions of social participation found in the aging literature: Proposed taxonomy of social activities. Social Science and Medicine (1982), 71, 2141-2149) taxonomy activity levels of involvement with others. A qualitative hybrid approach with inductive and deductive thematic analyses was used.

RESULTS

Participants often disengaged from activities with high involvement with others, preferring activities with less involvement. Low-key participation emerged as an important type of social participation enabling frail older adults to remain engaged in society. Key factors that influenced social participation were functional decline, and the physical (e.g., traffic, the disappearance of local stores) and social environment (e.g., social networks and the presence of meeting places such as community centers).

DISCUSSION

Findings advance our knowledge and recognition of the different ways frail older adults participate in society. Despite their frailty, older adults wish to stay socially active. Focusing on the social environment in the frameworks and policies of Age-Friendly Cities and Communities will benefit these individuals.

Factors contributing to psychological distress in the working population, with a special reference to gender difference

Background

Psychological distress refers to non-specific symptoms of stress, anxiety and depression, and it is more common in women. Our aim was to investigate factors contributing to psychological distress in the working population, with a special reference to gender differences.

Methods

We used questionnaire data from the nationally representative Finnish Regional Health and Well-being Study (ATH) collected in the years 2012–2016 (target population participants aged 20 +, n = 96,668, response rate 53%), restricting the current analysis to those persons who were working full-time and under 65 of age (n = 34,468). Psychological distress was assessed using the Mental Health Inventory-5 (MHI-5) (cut-off value <=52). We studied the following factors potentially associated with psychological distress: sociodemographic factors, living alone, having children under18 years of age, lifestyle-related factors, social support, helping others outside of the home and work-related factors. We used logistic regression analysis to examine association between having work-family conflict with the likelihood for psychological distress. We first performed the models separately for men and women. Then interaction by gender was tested in the combined data for those independent variables where gender differences appeared probable in the analyses conducted separately for men and women.

Results

Women reported more psychological distress than men (11.0% vs. 8.8%, respectively, p < 0.0001). Loneliness, job dissatisfaction and family-work conflict were associated with the largest risk of psychological distress. Having children, active participation, being able to successfully combine work and family roles, and social support were found to be protective factors. A significant interaction with gender was found in only two variables: ignoring family due to being absorbed in one’s work was associated with distress in women (OR 1.30 (95% CI 1.00–1.70), and mental strain of work in men (OR 2.71 (95% CI 1.66–4.41).

Conclusions

Satisfying work, family life and being able to successfully combine the two are important sources of psychological well-being for both genders in the working population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10560-y.

Membership, Neighborhood Social Identification, Well-Being, and Health for the Elderly in Chile

The world’s elderly population is growing, and in Chile they represent 16.2% of the total population. In Chile, old age is marked by retirement, with a dramatic decrease in income that brings precariousness. Older adults are economically, socially, and psychologically vulnerable populations. This condition increases their likelihood of disengaging from their usual social environment, facilitating their isolation, sadness, and discomfort. From the perspective of social identity, well-being (WB) can be explained by two principles: social groups’ importance for health and people’s psychological identification with those groups. This study analyzes the relationships between belonging to the neighborhood and extra-neighborhood groups and neighborhood social identification with WB. Urban or rural location and gender are measured, and the sample is 1,475 older Chilean adults of both sexes. The results show that the majority are not members of social groups (52%), and the remaining 48% are members of one or two groups or organizations (42.65%). Only 4.47% belong to three groups or organizations. Those who belong to groups obtain higher scores, emotional–mental WB, and positive emotions than older adults who do not belong to any organization. Urban and rural older adults have the same level of WB. Membership in close social organizations (neighborhood councils) or distant ones (clubs for the elderly and religious groups) causes different WB associations. Membership in neighborhood councils reduces gender differences in self-assessment of health. This result supports the idea that participation in heterogeneous groups with a shared sense of belonging to the neighborhood is associated with higher WB and lower perceived loneliness. Social identification with the neighborhood, rather than belonging to the group, had the most widespread impact on WB and health indicators. The variable social identification with the neighborhood was consistently associated with indicators of hedonic WB.

Associations of older adults' physical activity and bout-specific sedentary time with frailty status: Compositional analyses from the NEIGE study

AIM

To examine associations of intensity-specific physical activity and bout-specific sedentary time with frailty status among Japanese community-dwelling older adults, taking into account the interrelationships of these behaviors.

METHODS

Participants were 511 community-dwelling older adults. Physical activity and sedentary time were assessed using a tri-axial accelerometer. Frailty status (frail, pre-frail, or robust) was determined, based on the phenotypic model and used established criteria for Japanese older adults. Associations with frailty status of intensity-specific physical activity and bout-specific sedentary behavior (SB) time were examined using compositional data analysis, adjusted for potential confounders.

RESULTS

Participants included 13 (2.6%) who were frail, 234 (45.8%) pre-frail, and 264 (51.6%) who were robust. For the frail and pre-frail, the proportion of time spent in moderate-to-vigorous physical activity (MVPA) was less than for those who were robust. Frail older adults has larger proportion of time spent in prolonged (≥30 min/bouts) sedentary behavior (SB), and less in short-bout (<30 min/bout) SB, compared to the robust. No statistically-significant differences in the proportion of time spent in light-intensity physical activity was found across frailty levels.

CONCLUSION

Pre-frail and frail older adults spend proportionally less time in MVPA and more time in prolonged SB, compared with those who were robust. These findings need to be confirmed by evidence from larger and more-diverse study samples and by evidence from prospective studies, in order to better understand whether or not avoiding prolonged periods of sitting could be a potential strategy for preventing frailty among community-dwelling older adults.

The Effects of Social Participation Restriction on Psychological Distress among Older Adults with Chronic Illness

This study examined how restricted social participation mediates the relationship between chronic illness and psychological distress among community-dwelling older adults. Additionally, the use of the Internet for health care was tested as a moderator to examine whether the relationship between limited social participation and psychological distress differs. Using the multiple-group path analysis approach, 16,032 community-dwelling older adults (65+) from the National Health Interview Survey were analyzed. The findings show that 32.2% suffered from chronic illnesses that limited their daily activities, and 26% reported social participation restrictions to some degree. While having chronic illnesses was associated with greater psychological distress, the association was also through increased social participation restriction (mediation). Furthermore, differences in mediation were found between health information technology users and nonusers (moderated mediation). In contrast to the hypothesis, the adverse relationship between limited social participation and psychological distress was stronger among users, although chronic conditions were associated with greater social participation restrictions among nonusers. The findings suggest that with proper accommodations and interventions that aim to increase the social participation of community-dwelling older adults, the disadvantageous effects of chronic conditions on psychological distress could be ameliorated. Moreover, the importance of such interventions is greater among health information technology users.

Prevalence and factors associated with depression, anxiety, and stress symptoms among older adults: A cross-sectional population-based study

Despite population aging and the increase in mental health problems, studies on the mental health of older people in developing countries are lacking. This population-based cross-sectional study estimated the prevalence and associated factors for depression, anxiety and stress symptoms among older adults in Nepal. Community-dwelling older adults (N = 794) were interviewed using a questionnaire which consisted of the 21-item Depression Anxiety Stress Scales; and a wide range of sociodemographic, health-related, and lifestyle characteristics; functional ability, social support, participation in social activities, and adverse life events. The prevalence of symptoms was 15.4% for depression, 18.1% for anxiety, and 12.1% for stress. Risk factors for symptoms included female gender, working in agriculture, lower household wealth, perceived poor health, smoking, chronic conditions, migration of adult children, and exposure to adverse life events. Receiving an allowance, physical exercise, functional ability, social support, and participation in social activities were found to have protective effects. The findings indicate the need for community-based interventions, including appropriate diagnosis and treatment of mental health conditions, and mental health promotion programs targeting the risk and protective factors.

How Can the Lived Environment Support Healthy Ageing? A Spatial Indicators Framework for the Assessment of Age-Friendly Communities

The Age-Friendly Cities and Communities Guide was released by the World Health Organization over a decade ago with the aim of creating environments that support healthy ageing. The comprehensive framework includes the domains of outdoor spaces and buildings, transportation, housing, social participation, respect and inclusion, civic participation and employment, communication and information, and community and health services. A major critique of the age-friendly community movement has argued for a more clearly defined scope of actions, the need to measure or quantify results and increase the connections to policy and funding levers. This paper provides a quantifiable spatial indicators framework to assess local lived environments according to each Age-Friendly Cities and Communities (AFC) domain. The selection of these AFC spatial indicators can be applied within local neighbourhoods, census tracts, suburbs, municipalities, or cities with minimal resource requirements other than applied spatial analysis, which addresses past critiques of the Age-Friendly Community movement. The framework has great potential for applications within local, national, and international policy and planning contexts in the future.

Development of a Scale for Assessing the Meaning of Participation in Care Prevention Group Activities Provided by Local Governments in Japan

The meaning of participation in care prevention group activities may encourage continuous participation, making older adults active and healthy throughout their lives. This study developed a scale to assess the meaning of participation in care prevention group activities. It involved 427 participants in care prevention group activities (CPGAs) in Japan who filled out a self-administered questionnaire between October 2017 and February 2018. The meaning of participation was assessed using 15 items. In total, there were 379 valid responses. A factor analysis yielded two factors: "promotion of self-growth" and "enrichment of daily life". The goodness of fit index (GFI), comparative fit index (CFI), and root mean square error of approximation (RMSEA) were satisfactory (GFI = 0.923; CFI = 0.960; RMSEA = 0.073). Cronbach's α was 0.939 for the entire scale. The scale scores were significantly correlated with scores of the social activity-related daily life satisfaction scale and Ikigai-9. The scale's reliability and validity were confirmed, indicating its usability for promoting care prevention efforts.

Association between social participation and cognitive function among community-dwelling older adults living alone: Analysis of a nationally representative survey

AIM

Social disengagement and cognitive decline commonly coexist among older adults, and living alone may be a significant risk factor for cognitive decline. This study aimed to identify differences in variables between older adults living alone and living with others; it also evaluated the association between social participation and cognitive function in older adults living alone.

METHODS

A secondary analysis was performed using the data collected between June and August 2017 of 10 299 nationally representative adults aged ≥65 years, obtained from the Korean Institute for Health and Social Affairs and the Ministry of Health and Welfare. Chi-square and t tests were used to compare characteristics between the two groups. Multiple linear regression analyses were utilized to examine the association between social participation and cognition, after adjusting for other variables.

RESULTS

Among 10 055 adults, 24% lived alone. Sociodemographic and health-related variables and social participation differed significantly between the two groups. On multiple linear regression, participation in fraternal group activity, religious activity, and contact with siblings and relatives through phone calls or letters contributed significantly to cognitive function in older adults living alone.

CONCLUSION

Nurses can encourage various intellectually and emotionally stimulating social activities, as they help to maintain and improve the cognitive function of older people living alone.

Impact of social participation on health among middle-aged and elderly adults: evidence from longitudinal survey data in China

BACKGROUND

Social participation (SP) is known to have a favourable impact on health. However, studies on this issue have been conducted mainly in advanced countries, and results in China have been mixed. This study examined the impact of SP on health outcomes of middle-aged and elderly adults in China, adjusted for simultaneity and heterogeneity biases.

METHODS

In total, 57,417 observations of 28,935 individuals obtained from the population-based, three-wave panel survey, Chinese Health and Retirement Longitudinal Study (CHARLS), conducted in 2011, 2013, and 2015 were used. The associations between one- or two-wave-lagged SP and health outcomes (mental health, self-rated health [SRH], activities of daily living [ADL], and diagnosed diseases) were examined by linear regression models. Individual-level heterogeneity was addressed by the random-effects estimation method.

RESULTS

SP was found to have a positive impact on mental health and ADL. Specifically, one-wave-lagged SP improved mental health measure (range: 10-70) by 0.820 (standard error [SE]: 0.199, p <  0.001), the basic ADL measure (range: 6-24) by 0.147 (SE: 0.043, p <  0.001), and the instrumental ADL measure (range: 5-20) by 0.159 (SE: 0.035, p <  0.001). In contrast, SP did not significantly affect SRH or diagnosed diseases. The impact of SP differed by SP type; playing Mah-jong (Chinese traditional game), chess, or cards, or going to the community club had the most favourable effect. The impact of SP on health was also greater for women than men and greater for individuals aged 60-69 years than those aged 45-59 years and aged 70 and older.

CONCLUSIONS

SP had a positive, albeit selective, impact on health outcomes among middle-aged and elderly adults in China. The results suggest that policy measures to encourage these individuals to engage in SP are needed to enhance their health.

Gender Differences in Depressive Symptoms and Work Environment Factors among Dairy Farmers in Japan

Dairy farmers are more likely than nonfarmers to experience high demands and are at risk of mental health problems. However, there is scarce evidence on the current state of psychological health and related factors among dairy farmers, and the knowledge of potential gender differences is limited. This study aimed to examine the prevalence of depressive symptoms assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and its association with work environment characteristics and to identify gender differences. Data were collected from 273 dairy farmer participants (169 males and 104 females) in Japan. Females were more likely to be depressed, and young and middle-aged women appeared to be at risk of depression. For both genders, a demanding work environment was related to depression. There were some gender differences; for example, worries about the harmful effects of pesticides on health and the balancing of family roles and work roles were related to depression in men, while worries about one's financial situation and the health status of livestock were associated with depression in women. Females benefited from support through direct interaction, while males benefited from involvement in social activities. These findings will contribute to the development of a gender-specific approach to promote psychological health in the dairy farming community.

Relationship Between Mental Health and the Education Level in Elderly People: Mediation of Leisure Attitude

Purpose

The present study intends to explore the influence of education on the mental health of retired people and the mediating role of a leisure attitude in this relationship.

Design/Methodology

The sample was simple random, and a confidentiality agreement was established. The sample was composed of 403 Portuguese participants (37.2% male; 62.8% female). The participants completed the MHI and the LAS.

Findings

The hypothesized mediation model showed that a leisure attitude mediated the association between education and well-being. In addition, higher levels of distress were found in participants with higher levels of education.

Scientific Contribution

Our results suggest that old-aged people with high education and a more positive leisure attitude have a better psychological adjustment concerning well-being. Also, a higher level of education can lead to a better perception of aging changes (physical, life, profession).

Multi-Level Factors Associated with Social Participation among Stroke Survivors: China's Health and Retirement Longitudinal Study (2011-2015)

Background: This study aims to examine the impact of individual-level and community-based factors on popular social participation activities of Chinese middle-aged and older adults post-stroke. Methods: Sub-samples of survivors of stroke (2011: n = 413, 2013: n = 395, 2015: n = 441) recruited by the China Health and Retirement Longitudinal Study (CHARLS) were included in the analysis. Zero-inflated Poisson and multi-level logistic regression models were used to explore factors associated with social participation. Results: More than half of individuals (55.0%) had no social participation and 23.4% participated in multiple social activities. The most popular social activities that individuals participated in were interacting with friends (32.6%) and going to a community club to play table games (22.7%). Multiple individual-level factors were negatively related to social participation (e.g., depressive symptoms and multiple measures of functional limitations) while the allocation of an outdoor exercise facility in the community/village was positively associated with going to a community club to play table games. Conclusion: Stroke survivors are at high risk of limited social participation. Policymakers and other key stakeholders should consider community design among other potential solutions when identifying ways to link at-risk stroke survivors to both opportunities for rehabilitation (e.g., physical function) and social participation.

Social participation reduces isolation among Japanese older people in urban area: A 3-year longitudinal study

Objectives

Social isolation is a particular problem among older people and social participation may reduce future isolation. However, it is unclear which types of activities and which level of participation are effective. This study examines the relationship between social participation and isolation among Japanese older people by employing a 3-year longitudinal study.

Methods

A mail survey was sent to 3,518 community-dwelling older people in an urban area in 2014 (baseline: BL). We then conducted follow-up mail survey on respondents who were non-isolated at BL in 2017 (follow-up: FL), with isolation being defined as being in contact with others less than once a week. An analysis was carried out on 1,070 subjects (398 men and 672 women). Social participation is defined by participation in group activities (community, senior club, hobbies, sports, volunteering, politics, industry, and religion). A logistic regression analysis was conducted to determine the association between the types of social participation and the number of organization types at BL, and isolation at FL.

Results

At FL, 75 men (18.8%) and 59 women (8.8%) were considered to be isolated. Among the men, participation in a hobby group and sports group both significantly reduced the degree of isolation. Moreover, participation in two organizations and three or more organizations significantly lowered the risk of isolation when compared to non-participants. Among women, there were no significant associations among particular types of social activities and isolation. On the other hand, participation in one organization and three or more organizations significantly reduced their isolation when compared to non-participants. There was a significant linear trend between the number of types of organizations and isolation, regardless of gender.

Conclusions

Participation in social activities reduces future isolation in older people. Encouraging participation in social activities could help reduce negative health outcomes associated with social isolation later in life.

Social participation patterns and their associations with health and well-being for older adults

Older adults are at an elevated risk of adverse health effects associated with social isolation and loneliness. Social participation is considered a modifiable determinant of health and well-being and has been proposed as a means to reduce this risk. However, there is limited knowledge to date about patterns of social activities among older adults. Using two waves of the Swiss Household Panel, a latent class analysis is performed to obtain discrete social participation profiles of adults aged 60 and older. Descriptive statistics and regression methods are used to study group compositions and estimate associations with self-assessed health, negative and positive affect, and life satisfaction. Once individual time-constant characteristics are controlled for, the majority of the positive associations between social participation and health or well-being found in the pooled data becomes small and insignificant, which is indicative of self-selection into different activity profiles. The role of self-selection into social participation implies that the design of interventions targeting social participation in the older adult population should be tailored to their heterogeneous needs and preferences.

Reduced social participation among seniors with self-reported visual impairment and glaucoma

Objective

Social participation benefits health. We assessed the relationship between self-reported visual impairment (VI) and glaucoma versus seniors’ social participation.

Methods

Data from individuals aged ≥65 years responding to the Canadian Community Health Survey Healthy Aging 2008/2009 (n = 16,369) was analyzed. Participation in eight social activities by seniors with and without self-reported VI or glaucoma was compared.

Results

Seniors with VI had significantly reduced participation (p<0.05) in sports/physical activities (18.0% vs. 33.6%), family/friendship activities outside the household (39.7% vs. 53.0%), service club/fraternal organization activities (11.4% vs. 18.4%), volunteer/charity work (13.4% vs. 24.9%), educational/cultural activities (16.2% vs. 24.5%), and other social recreational activities (21.6% vs. 31.0%) compared to those without VI. Differences in participation in church/religious activities (40.6% vs. 44.5%) and community/professional association activities (15.3% vs. 18.0%) were non-significant between seniors with and without VI. Seniors with glaucoma versus those without had significantly reduced participation (p<0.05) in family/friendship activities (46.6% vs. 52.9%), sports/physical activities (26.0% vs. 33.6%) and volunteer/charity work (20.4% vs. 24.9%). No participation in any social activity was significantly higher among seniors with VI versus those without (10.1% vs. 2.9%, p<0.05), but was similar among seniors with and without glaucoma (3.9% vs. 3.1%, p>0.05). After adjusting for the effects of age, sex, education, household income, ethnicity, job status and chronic diseases (adjusted odds ratio, aOR = 3.4 (95% confidence interval (CI) 2.0–5.8), seniors with VI but no glaucoma were more likely not to engage in any social activities compared to seniors without VI and no glaucoma. Seniors with glaucoma but without VI had a similar level of non-participation (aOR = 0.9, 95%% CI 0.5–1.7).

Conclusions

Significantly reduced social participation was found across six community activities among seniors with self-reported VI and in three activities among those with self-reported glaucoma. Policies and programs that help seniors with VI or glaucoma engage in social activities are needed.

Associations between self-reported hearing loss and outdoor activity limitations, psychological distress and self-reported memory loss among older people: Analysis of the 2016 Comprehensive Survey of Living Conditions in Japan

AIM

To investigate the associations between self-reported hearing loss and outdoor activity limitations, psychological distress and self-reported memory loss among older people.

METHODS

We carried out a cross-sectional study using the data from the 2016 Comprehensive Survey of Living Conditions in Japan. The study population included people aged ≥65 years living at home, without a clinical diagnosis of dementia. The exposure of interest was self-reported hearing loss, whereas outcomes included outdoor activity limitations (Yes/No), psychological distress (Kessler Psychological Distress Scale score of ≥5) and self-reported memory loss (Yes/No). We carried out logistic regression analyses, adjusted for age, sex, smoking, alcohol, educational status, number of household members, household expenditure and number of clinical diagnoses requiring outpatient visits.

RESULTS

Among 137 723 older people (mean age 74.5 years [standard deviation 7.4 years], 45.1% men), 12 389 (9.0%) reported hearing loss. People with hearing loss showed a higher prevalence of outdoor activity limitations (28.9% vs 9.5%, P < 0.001), psychological distress (39.7% vs 19.3%, P < 0.001) and memory loss (37.7% vs 5.2%, P < 0.001) than those without. The adjusted odds ratios comparing people with and without hearing loss were 2.0 (95% confidence interval 1.9-2.1), 2.1 (95% confidence interval 2.0-2.1) and 7.1 (95% confidence interval 6.8-7.4) for outdoor activity limitations, psychological distress and self-reported memory loss.

CONCLUSIONS

This nationwide study suggested that older people with hearing loss were more likely to experience outdoor activity limitations, psychological distress and memory loss than those without. Early identification of and intervention in hearing loss might potentially reduce the risk of these poor health outcomes. Geriatr Gerontol Int 2019; 19: 747-754.

Prediction of Chronic Lower Back Pain Using the Hierarchical Neural Network: Comparison with Logistic Regression-A Pilot Study

Background: Many studies have reported on the causes of chronic lower back pain (CLBP). The aim of this study is to identify if the hierarchical neural network (HNN) is superior to a conventional statistical model for CLBP prediction. Linear models, which included multiple regression analysis, were executed for the analysis of the survey data because of the ease of interpretation. The problem with such linear models was that we could not fully consider the influence of interactions caused by a combination of nonlinear relationships and independent variables. Materials and Methods: The subjects in our study were 96 people (30 men aged 72.3 ± 5.6 years and 66 women aged 71.9 ± 5.4 years) who participated at a college health club from 20 July 2016 to 20 March 2017. The HNN and the logistic regression analysis (LR) were used for the prediction of CLBP and the accuracy of each analysis was compared and examined by using our previously reported data. The LR verified the fit using the Hosmer-Lemeshow test. The efficiencies of the two models were compared using receiver performance analysis (ROC), the root mean square error (RMSE), and the deviance (-2 log likelihood). Results: The area under the ROC curve, the RMSE, and the -2 log likelihood for the LR were 0.7163, 0.2581, and 105.065, respectively. The area under the ROC curve, the RMSE, and the log likelihood for the HNN were 0.7650, 0.2483, and 102.787, respectively (the correct answer rates were HNN = 73.3% and LR = 70.8%). Conclusions: On the basis of the ROC curve, the RMSE, and the -2 log likelihood, the performance of the HNN for the prediction probability of CLBP is equal to or higher than the LR. In the future, the HNN may be useful as an index to judge the risk of CLBP for individual patients.