Health promoting effects of friends and family on health outcomes in older adults

Combined effects of social isolation and loneliness on patient-reported outcomes in older adults with HIV

Social isolation exists when one has limited contact with others and is distinct from loneliness, an affective state on the perception of isolation. Less is known about the combined effects of social isolation and loneliness (SI/L) in older persons with HIV (OPWH). Using cross-sectional data on OPWH (age ≥50; N = 146), we assessed the overlap between SI/L and the separate and combined effects of SI/L on patient-reported outcomes (quality-of-life [QoL], HIV-related stigma, and depressive symptoms). Social isolation and loneliness were assessed using Social Network Index and the PROMIS-Social Isolation Scale, respectively, and based on each score, participants were grouped into four categories: "lonely only", "isolated only", "lonely+isolated", or "neither". Among participants (mean age = 56.53), 26.7% were considered "lonely only", 12.3% were "isolated only", 15.1% were "lonely+isolated", and 45.9% were "neither". Adjusted regression models showed that lonely+isolated group had more depressive symptoms and lower QoL than those considered "neither" or "isolated only" (p < .001) and that. The adjusted proportional odds model showed that the odds of stigma were 1.22 and 6.06 higher than those considered "neither" (p < .001) or "lonely only" (p = .016). Results demonstrate the combined effects of SI/L on patient-reported outcomes among OPWH. Findings highlight the need for approaches targeting OPWH who are lonely and isolated.

Social network tie functions of social support and social influence and adult smoking abstinence

Adults' social network ties serve multiple functions and play prominently in quitting smoking. We examined three types of adults' egocentric social networks, including family, friends, and friends online to investigate how two network characteristics with major relevance to health behavior, network size and tie closeness, related to the emotional and confidant support and to pro- and anti-smoking social influence these ties may transmit. We also examine whether the social support and social influence constructs related to smoking abstinence. We utilized baseline and 7-day abstinence survey data from 123 adult current smokers attempting to quit prior to the start of a randomized controlled quit-smoking trial of a social support intervention for quitting smoking on Twitter. To examine study relationships, we estimated Negative Binomial Regression models and Logistic Regression models. For all networks, network size and tie closeness related positively to most of the social support and social influence constructs, with tie closeness related most strongly, especially for online friends. Family pro-smoking social influence related negatively to smoking abstinence, and there were marginally negative relationships for family emotional support and family confidant support. Online friend emotional support had a marginally positive relationship with smoking abstinence. Overall, our findings indicated the importance of the social support and social influence functions of each type of network tie, with larger networks and closer ties related to higher levels of social support and social influence. Moreover, family network pro-smoking social influence may compromise abstinence while emotional support from online friend network ties may reinforce it.

Hearing loss and dementia in older adults: A narrative review

The prevalence of hearing loss is high among older adults; globally, 65% of adults over 60 years have hearing loss. Over the past decade, evidence from epidemiologic studies has linked hearing loss to nearly two times greater risk of dementia. The hypothesized mechanistic pathways through which hearing loss could contribute to increased dementia risk include the effects of hearing on greater cognitive load, changes in brain structure and function, and decreased social engagement. These mechanistic pathways may be modified by management of hearing loss using existing intervention (eg, hearing aids). Hearing treatment may be an effective intervention for slowing cognitive decline in some older adults. In this review, we update existing reviews of the current epidemiologic research on the association between hearing loss and dementia risk and discuss hypothesized mechanisms of this association. We also discuss management of hearing loss as a potential intervention for slowing cognitive decline and reducing dementia risk.

Age-related decline in social interaction is associated with decreased c-Fos induction in select brain regions independent of oxytocin receptor expression profiles

Social behavior decreases with aging, and we have previously found a substantial decline in social investigative behavior of old female rats. In this study we examined the neural activation pattern (c-Fos mRNA) of young (3 month) and old (18 month) female rats after brief 10 min exposure to a novel female rat in order to identify forebrain regions that show selective age-related alterations in their neural response to social investigation. We also measured relative oxytocin receptor expression (Oxtr mRNA) as a possible factor in age-related declines in c-Fos induction after social interaction. Young rats exposed to a social partner had a greater c-Fos mRNA response than those exposed to novel context alone in the lateral septum and septohypothalamic area, with blunted increases evident in old rats. In addition, c-Fos mRNA levels in the lateral septum were positively correlated with social investigative behavior. Interestingly, age-related differences in c-Fos gene induction were unrelated to the local amount of Oxtr expression within specific brain regions, although we found an age-related decline in Oxtr expression in the ventromedial hypothalamus. This functional neuroanatomical characterization may point to certain brain regions that are especially sensitive to age-related declines associated with social interaction behavior.

Staying connected: An umbrella review of meta-analyses on the push-and-pull of social connection in depression

BACKGROUND

Depression affects approximately 4 % of the global population and has huge social and economic implications. Social factors, including support, engagement, and stigma, play a crucial role in the development and severity of depression.

METHODS

We provide a synthesis of the consistency and magnitude of the association between measures of social connection and depression. We searched PubMed, PsycINFO, Cochrane Library, and EMBASE and 47 meta-analyses were included in the umbrella review. The strength of the associations was extracted and compared among different populations. The quality/certainty of evidence was assessed using AMSTAR-2 and GRADE tool.

RESULTS

Results indicate that social support serves as a protective factor against depression, particularly in peripartum populations, while its impact is weaker in clinical populations. No association was found between social support and depression in post-disaster populations. Stigma and discrimination favour the development and maintenance of depressive symptoms in clinical populations, but have a weaker effect in ethnic minorities.

LIMITATIONS

The quality and certainty of evidence should be taken into account when interpreting our findings. Further research with more rigorous methodology and higher-quality evidence is needed to better understand the complex relationship between depression and social connection across various populations and contexts.

CONCLUSIONS

Our findings confirm the role of social determinants in the emergence and severity of depression, particularly in the case of vulnerable populations. Efforts to counteract disconnection at the societal and individual levels and to reduce stigma should be central to an effective depression prevention agenda.

DNA methylation of the oxytocin receptor interacts with age to impact neural response to social stimuli

Introduction

Social isolation is one of the strongest predictors of increased risk of mortality in older adulthood. The ability to form and maintain the social relationships that mitigate this risk is partially regulated by the oxytocinergic system and one's ability to attend to and process social information. We have previously shown that an epigenetic change to the DNA of the oxytocin receptor gene (OXTR methylation) affects the salience of social information in young adults. Little is known about how the oxytocinergic system ages and what effect this aging system has on social cognitive abilities throughout the lifespan.

Methods

Here we explored age-related differences in the association between neural response during selective social attention and OXTR DNA methylation in young (age 18-31) and older (age 58-81) adults. Participants underwent fMRI during a selective social attention task and provided a DNA sample for the assessment of OXTR methylation.

Results and Discussion

We found that older adults activated diffuse areas of visual cortex and dorsolateral prefrontal cortex during selective social attention, consistent with the dedifferentiation and compensatory neural activation commonly reported in aging. We found a significant age-by-OXTR methylation interaction on neural response when attending to social stimuli in a complex display; young adults displayed a positive association between OXTR methylation and neural activation, replicating our prior finding that young adults with presumed diminished endogenous access to oxytocin recruit regions of the attentional cortex to a greater extent. This association did not hold for older adults. Instead, perceived social support interacted with OXTR methylation to influence neural response during selective social attention. These data suggest that environmental factors like social support moderate biological processes in aging and highlight the importance of a lifespan perspective for understanding associations between individual differences in the oxytocinergic system, neural function, and social behavior.

Improving the implementation of family-centred care in adult audiology appointments: a feasibility intervention study

OBJECTIVE

There is mounting evidence for implementing family-centred care (FCC) in adult audiology services, however FCC is not typically observed in adult clinical practice. This study implemented an intervention to increase family member attendance and involvement within adult audiology appointments.

DESIGN

The study involved a mixed method design over three key phases: Standard Care, Intervention I (increasing family member attendance), and Intervention II (increasing family member involvement).

STUDY SAMPLE

Staff from four private audiology clinics within one organisation participated in the intervention. Data was collected from different clients in each phase (n = 27 Standard Care, n = 30 Intervention I, and n = 23 Intervention II).

RESULTS

Family member attendance increased from 26% of appointments in Standard Care to 40% at Intervention I, and 48% at Intervention II. Family member involvement also showed improvement on some measures (video analysis) although talk time did not significantly increase. Significant improvements in client satisfaction with services were found (Net Promoter Score and Measure of Processes of Care).

CONCLUSION

The implementation of FCC in audiology clinics needs to be an ongoing, whole-of-clinic approach, including staff in all roles. Increasing family member attendance at adult audiology appointments can lead to benefits to client satisfaction with services.

Older Adults’ Experiences in a Web-Based Intervention for Loneliness

Background: Older adults may be vulnerable to loneliness due to natural and age-related transitions. Lonely older adults are at an increased risk of adverse health outcomes due to their loneliness, including cognitive decline, cardiovascular disease, and mortality. Objective: The purpose of this study was to explore the experiences of vulnerable older adults in a web-based loneliness intervention. Methods: Older adult participants in a web-based loneliness intervention (n = 24) participated in semi-structured interviews eliciting feedback about their experience in the program and perceived outcomes. Participants’ responses were analyzed using qualitative content analysis. Results: Participants reported fewer negative perceptions of their social skills and future social interactions, gaining new social skills, improved relationships, and increased confidence to initiate and maintain social contact. Conclusions: Findings suggest the efficacy of combining a web-based loneliness intervention with cognitive behavioral therapy, and provide implications for future web-based interventions for older adult populations.

Social isolation as a risk factor for all-cause mortality: Systematic review and meta-analysis of cohort studies

BACKGROUND

Although several epidemiological studies have linked social isolation to increased risk of mortality, the magnitude of any effect is unclear, in part because of the use of different measures of social isolation.

OBJECTIVE

To examine the association between social isolation and all-cause mortality and investigate whether it differs in various subgroups or populations.

DATA SOURCES

We searched for relevant studies in electronic databases: MEDLINE (1946 to December 31, 2021), EMBASE (1974 to December 31, 2021), and PsycINFO (1806 to December 31, 2021).

SELECTION CRITERIA

We included both prospective and retrospective cohort studies that examined the association between social isolation and all-cause mortality among adults.

DATA COLLECTION AND ANALYSIS

Two reviewers screened and extracted data independently. We contacted study authors to obtain missing information whenever possible. Data were pooled using a random effect model to calculate estimates of the effects of social isolation on all-cause mortality.

RESULTS

Data from studies involving 1.30 million individuals were included. The pooled hazard ratio of social isolation for all-cause mortality was 1.33 (95% confidence interval; 1.26-1.41, heterogeneity: Chi² = 112.51, P < 0.00001, I² = 76%).

CONCLUSION

Social isolation is associated with increased risk for all-cause mortality.

REGISTRATION

PROSPERO (CRD42020152351).

Analyzing the use of videoconference by and for older adults in nursing homes: an interdisciplinary approach to learn from the pandemic

Introduction

During the Covid-19 pandemic and the resulting visitation restrictions, digital tools were used in many nursing homes in France to allow the older adults and their relatives to maintain social contact via videoconferencing. This article adopts an interdisciplinary approach to analyze the processes that affect the use of digital technologies.

Methods

Drawing on the concept of "mediation," it seeks to shed light on how individuals embrace these tools in a relational situation. The interviews and observations undertaken among residents, their relatives, professionals, and the management head of seven nursing homes in 2021, make it possible to outline the different forms of practices and uses and to identify the factors leading to the variations observed.

Results

While the key objective of these technical and technological tools is to compensate - on a functional level - for the communication problems and the isolation of individuals in order to promote residents' "quality of life" by maintaining "social contact," our study reveals that these tools' uses and practices largely differ. It also shows considerable inequalities in terms of residents' acquisition of subjective feelings of ownership of the tools. These are never attributed to isolated physical, cognitive, psychic, and social difficulties, but are influenced by specific organizational, interactional, and psychic configurations. Some of the structures analyzed revealed situations in which mediation failed, occasionally exposing the risk associated with seeking "ties at all costs," or revealing a disturbing strangeness when residents were placed in front of screens. Some configurations, however, showed that it was possible to set up an intermediate space for the experience to unfold, which in turn opened up a space where individuals, groups, and institutions could experiment, allowing them to develop subjective feelings of ownership of this experience.

Discussion

This article discusses how the configurations that failed to promote the mediation process reveal the need to assess the representations of care and assistance in the relationships between older adults, their loved ones, and nursing home professionals. Indeed, in certain situations, the use of videoconferencing, while seeking to produce a positive effect, risks displacing and increasing the effects of the "negative" associated with dependency, which may worsen individuals' difficulties within nursing homes. The risks associated with the failure to take into account residents' requests and consent explain why it is important to discuss how certain uses of digital tools may renew the dilemma between concerns for protection, on the one hand, and respect for autonomy on the other.

Behavior in fulfilling nutritional needs for Indonesian children with stunting: Related culture, family support, and mother’s knowledge

Background:

Stunting in children has adverse consequences such as a decrease in cognition, language, and academic performance. Most of the children in Indonesia were diagnosed with stunting. The aim of this study was to measure factors affecting behavior in fulfilling nutritional needs among children under the age of 5 years with stunting.

Design and method:

This study used a cross-sectional design. Data were collected from mothers who had children under the age of 5 years (6–48 months) in Talang village, Pamekasan Regency, Madura using a self-report questionnaire. The total sample in this study was 120, selected using a random sampling technique. The independent variables were maternal characteristics, culture, family support, and mother’s knowledge, while the dependent variable was the behavior in fulfilling nutritional needs among children. We used a self-report questionnaire to measure variables. Logistic regression was used to analyze factors affecting the behavior of fulfilling nutrition interventions. We used a statistical significance p < 0.05.

Results:

Culture, family support, and knowledge were factors that affecting behavior of fulfilling nutritional needs among children under the age of 5 years with stunting, 0.279 (OR = 0.279, 95% CI: 0.084-0.920, p = 0.036); (OR = 2.435, 95% CI: 1.270-4.667, p = 0.007; OR = 4.860, 95% CI: 1.548-15.261, p = 0.724), respectively.

Conclusion:

Behavioral in Fulfilling nutritional needs determines the health status of children. Therefore, the awareness of parents, knowledge, and multisectoral is needed to prevent stunting among children.

Intersectional social identities and loneliness: Evidence from a municipality in Switzerland

We examined the extent to which intersectional social identities combine to shape risks of loneliness and identified the specific social clusters that are most at risk of loneliness for more precise and targeted interventions to reduce loneliness in a Swiss municipality. Based on data collected using participatory action research, we used the novel multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to estimate the predictive power of intersectional social attributes on risk of loneliness. We found that 56% of the between-strata variance was captured by intersectional interaction but was not explained by the additive effect of social identities. We also found that nationality and education had the strongest predictive power for loneliness. Interventions to reduce loneliness may benefit from understanding the resident population's intersectional identities given that individuals with the same combinations of social identities face a common set of social exposures relating to loneliness.

The importance of executive functioning for social skills in college students: a relative weights analysis

STATEMENT OF RELEVANCE

Social interaction is one of the most important things that humans do on a day-to-day basis, impacting both mental and physical wellness. College is a particularly important period where social interaction becomes increasingly important as well as complex. While there is no currently agreed upon cognitive basis of social interaction, the executive function (EF) system is believed to play a central role. The current study provides further evidence of the role of the EF system across different social skills in addition to highlighting the complexity of these relationships.

Everyday discrimination in later life: A social network approach

What factors shape everyday discrimination among older adults? Existing perspectives focus on individual identities and social group membership (e.g., race/ethnicity, age) as key determinants of perceived discrimination. This paper examines the idea that individuals' broader social contexts - including their personal social networks - also shape perceived discrimination, and in ways that may differ across racial groups. Using data from Round 3 of the National Social Life, Health, and Aging Project (N = 3312), I consider how properties of personal networks are associated with how frequently older adults report everyday discrimination. Results indicate that more kin-centric personal networks protect against more frequent everyday discrimination, but that this protective effect may be stronger among White older adults. I propose why more kin-centric networks may play a different role in the perceived discrimination of White and Black older adults, and close by suggesting that social network composition may be a source of heterogeneity in the link between everyday discrimination and inequality in later life outcomes such as health.

Stunting Prevention in Coastal Family with Health-Promoting Family Approach

BACKGROUND: Stunting is a chronic nutritional problem that occurs worldwide, including in Indonesia. The impact of the COVID-19 pandemic has increasingly caused stunting to increase in coastal areas in particular. AIM: This study aimed to obtain a stunting prevention model with a Health-Promoting Family model approach in coastal families. METHODS: This study was quantitative research. The population in this study was mothers of toddlers aged 6–48 months in the coastal areas of Pamekasan. The sample in this study was mothers of 135 toddlers in Tlanakan and Talang villages who were selected using a simple random sampling technique. The independent variables are the history of present illness, mother’s knowledge, care patterns, literacy, cultural aspects, and family support—while the dependent variable is family prevention behavior regarding the incidence of stunting. Data collection was carried out by interview method using a questionnaire. Statistical analysis was carried out using the Logistic Regression test (=0.05) RESULTS: The factors that affect stunting prevention are knowledge p = 0.008 (CI: 1.438–11.780), literacy p = 0.000 (CI: 2.136–17.003), cultural aspects p = 0.00 (CI: 0.039–0.366) and family support p = 0.000 (CI: 1.273–20.498). CONCLUSION: Knowledge, family support, literacy, and culture affect stunting prevention in families. It takes the collaboration of the community, the government participation in strengthening maternal and child health programs that support the achievement of stunting prevention in families. There are opportunities to research what appropriate forms of literacy in families support the success of stunting prevention in toddlers for further studies.

A Randomized Controlled Trial of the Effects of Group Conversation Treatment on Monologic Discourse in Aphasia

PURPOSE

Evidence has shown that group conversation treatment may improve communication and reduce social isolation for people with aphasia. However, little is known about the impact of conversation group treatment on measures of discourse. This project explored the impact of conversation treatment on measures of monologic discourse.

METHOD

In this randomized controlled trial, 48 participants with chronic aphasia were randomly assigned to dyadic, large group, or control conditions. Conversation group treatment was provided for 1 hr, twice per week, for 10 weeks. Discourse samples were collected and coded at pretreatment, posttreatment, and 6-week maintenance. There were three narrative tasks: (a) Comprehensive Aphasia Test (CAT) picture description, (b) Cat Rescue Picture, and (c) Cinderella retell. All narratives were coded using the percent correct information units (percent CIUs), the CAT standardized narrative analysis method, and the complete utterance (CU) method.

RESULTS

No significant changes were observed on percent CIU, which was the primary outcome measure. The treated groups demonstrated improvement on aspects of the CU method following treatment, whereas the control group did not. Significant changes were observed for other CIU measures and the CAT standardized narrative analysis in both the treated and control groups.

CONCLUSIONS

The results suggest that the CU measures were more sensitive to the effects of conversation treatment in monologic discourse compared to CIU and CAT measures. Changes were more common in absolute rather than relative values, suggesting that conversation treatment impacts the overall amount of language produced rather than efficiency of production.

Safety Concerns and Travel Behavior of Generation Z: Case Study from the Czech Republic

Generation Z has been online since the beginning, the online space is an integral part of their lives and personalities, and they make up about 30% of the world’s population. It is claimed that this youngest cohort is already the most numerous generation on the Earth. The most important holiday parameters for them are price and location. They want to explore new places and be active while abroad. The study examines the impact of safety concerns on changes in travel behavior during the COVID-19 pandemic. We focused on members of Generation Z who study the Tourism and the Recreation and Leisure Studies programs, so these students have a positive attitude towards traveling. Data were collected via internal university systems at two periods of time connected to different stages of the pandemic outbreak. The sample was chosen randomly. The sample of Period 1 (n = 150) was composed in 2020, after the lifting of restrictions at the end of the first wave of the COVID-19 pandemic in the Czech Republic. The sample of Period 2 (n = 126) was collected one year later, after the lifting of restrictions at the end of the third wave of the COVID-19 pandemic in the Czech Republic. Correspondence analysis was used for better understanding and representation. This is a unique research study on Generation Z in the Czech Republic and Central Europe. As a result of the contemporary demographic changes in the world, this generation will shape future travel demand. Hence, understanding these youngest travelers will be key to predicting how tourism trends could evolve in the next few years and how these could influence worldwide tourism. The respondents thought they would not change their travel habits in the next five years because of the pandemic. When Periods 1 and 2 were compared after one year of the pandemic, the respondents preferred individual trips to group trips and individual accommodation to group accommodation facilities. On the other hand, our findings revealed a significant increase in safety concerns related to changes in travel behavior when the above-mentioned periods were compared. The research contributes to mapping young people’s attitudes towards travel in the constrained and changing conditions resulting from the COVID-19 pandemic. The findings help analyze the consumer behavior of the target group.

Communication About Chronic Pain in Older Persons' Social Networks: Study Protocol of a Qualitative Approach

A lack of social relations appears to impact on health and life expectancy among the older persons. The quality and diversity of social relations are correlated with good health and well-being in later life. Chronic pain is a crucial issue in aging population. Effective communication between the older persons with chronic pain, their relatives and the actors of the healthcare system facilitates the management of this condition. Studies on communication in later life generally do not consider the older persons' social network as a whole, focusing only a specific segment (e.g., family or medical staff). This lack of scientific data prevents the actors of the healthcare system from offering solutions to bridge clinically relevant communication gaps. As a consequence, our study has three objectives: (1) to identify how the older persons perceive communication about chronic pain with their social network; (2) to identify their unmet communication needs; (3) to develop recommendations that improve communication about chronic pain in later life. The study will be divided into two phases. The first phase will meet objectives 1 and 2. It will involve individual interviews with about 50 people over 75 years old suffering from chronic pain and without major cognitive or auditory troubles. In this phase, we will apply a multi-layered analysis. We will map the older persons' personal network and identify their communication practices and needs, by combining content and discourse analysis with social network theories. The second phase of the study will aim at recommendations based on the results of the first phase (objective 3). It will require focus groups with different sets of stakeholders (older persons, relative caregivers, health professionals, decision-makers). In the second phase, we will use content analysis to pinpoint the concerns and suggestions for action. The results will be disseminated on three levels: (1) to the scientific world (specialists in the field of health and aging and health communication); (2) to health practitioners working with older persons; (3) to society at large, with a focus on institutions and groups directly concerned by the issue.

Perceptions of community among suburban and urban-dwelling adults aging in place

Community is important for late-midlife adults, offering a sense of belonging and opportunities for social engagement during the transition to older age. The current study examines perceptions of community and geographical ties among a sample of older adults aging in place. Using data from the Foley Longitudinal Study of Adulthood (FLSA; N = 163; aged 61-64) and a qualitative GIS approach, major themes were categorized and mapped to create a comprehensive picture of how perceptions of community varied among respondents and neighborhoods. Core themes were connections to place, space, people, and relational benefits gained from community involvement. Residents of a suburban enclave more frequently noted connections to people as being important to community, compared to residents in more densely-populated areas. Implications for future research are discussed.

Loneliness: An Immunometabolic Syndrome

Loneliness has been defined as an agonizing encounter, experienced when the need for human intimacy is not met adequately, or when a person’s social network does not match their preference, either in number or attributes. This definition helps us realize that the cause of loneliness is not merely being alone, but rather not being in the company we desire. With loneliness being introduced as a measurable, distinct psychological experience, it has been found to be associated with poor health behaviors, heightened stress response, and inadequate physiological repairing activity. With these three major pathways of pathogenesis, loneliness can do much harm; as it impacts both immune and metabolic regulation, altering the levels of inflammatory cytokines, growth factors, acute-phase reactants, chemokines, immunoglobulins, antibody response against viruses and vaccines, and immune cell activity; and affecting stress circuitry, glycemic control, lipid metabolism, body composition, metabolic syndrome, cardiovascular function, cognitive function and mental health, respectively. Taken together, there are too many immunologic and metabolic manifestations associated with the construct of loneliness, and with previous literature showcasing loneliness as a distinct psychological experience and a health determinant, we propose that loneliness, in and of itself, is not just a psychosocial phenomenon. It is also an all-encompassing complex of systemic alterations that occur with it, expanding it into a syndrome of events, linked through a shared network of immunometabolic pathology. This review aims to portray a detailed picture of loneliness as an “immunometabolic syndrome”, with its multifaceted pathology.

Associations between accessibility to health care service, social support, and Korean Americans' mental health status amid the COVID-19 pandemic

Background

While previous studies have examined the relationships between social support and health care accessibility among ethnic minority populations, studies on Korean Americans remain scarce. Therefore, this study aims to assess the relationship between Korean Americans’ mental health, accessibility to health care, and how they perceive the level of social support during the COVID-19 pandemic.

Method/result

We distributed online surveys to Korean Americans from May 24, 2020, to June 14, 2020, generating 790 responses from participants residing in 42 states. Binary Logistic and Ordinary Least Square regression analyses revealed that poor mental health was associated with language barriers inhibiting Korean Americans’ access to COVID-19-related information. Their perceived social support from family members and close friends was positively associated with mental health.

Conclusion

Our findings recommend that equipping community health care services with translators or interpreters is necessary. Additionally, health practitioners and staff should be trained to utilize telehealth tools to effectively treat individuals with mental health problems. American policymakers and health care professionals need to understand and address the unique hardships Korean Americans experience amid COVID-19.

Factors Associated With Health-Related Quality of Life Among Older People Exposed to the Jeju 4·3 Incident

OBJECTIVE

We explored factors associated with health-related quality of life (HRQOL), including socio-demographic and clinical characteristics, in among older people exposed to the Jeju 4·3 incident, and aimed to determine the effects of depression, posttraumatic stress disorder (PTSD) and perceived social support on HRQOL.

METHODS

We obtained data from 110 survivors and 1,011 immediate family members of the victims of the Jeju April 3 incident (mean age, 75.1 years), and evaluated the relationships of HRQOL with sociodemographic and clinical characteristics including posttraumatic and depressive symptoms, and perceived social support.

RESULTS

Poorer physical health, psychological health, social relationships, and environment HRQOL domain scores were strongly associated with older age, being a woman, poor socioeconomic status, and symptoms of depression and PTSD. The regression analyses indicated that, when relevant factors were controlled for, perceived social support moderated the negative association between HRQOL and psychiatric symptoms.

CONCLUSION

Our results suggest the importance of sociodemographic characteristics, in addition to psychiatric symptoms, for understanding HRQOL in older people exposed to the Jeju 4·3 incident. These results have important implications for interventions aiming to improve the HRQOL of the victims of the Jeju 4·3 incident.

Enabling social participation for older people: The content of reablement by age, gender, and level of functioning in occupational therapists' interventions

BACKGROUND

Social participation and the ability to build and maintain social relationships is emphasized as important for older people's health and well-being.

AIM

To explore if social participation is addressed and whether age, gender and level of functioning are associated with the composition of occupational therapy interventions within the context of reablement.

METHOD

In this cross-sectional study, invitations to participate were sent to 60 municipalities in Sweden. 318 occupational therapists participated and described the character of initiated interventions made during 3 weeks through web-based surveys.

RESULT

1392 cases were reported in the age span of 19-103 years, 61.7% were women. A higher proportion of persons having no home care and minor functional dependency got interventions with a focus on social participation to a higher extent than persons with major functional dependency. Occupational therapists' interventions vary as related to functional limitation, age, and gender.

CONCLUSION

The results indicate that the severity of functional limitation impacts the focus of the intervention whereas age and gender do not. There is a need for social participation to be more clearly addressed within the context of reablement.

SIGNIFICANCE

To develop a person-centred intervention, one needs to consider aspects of age, gender, and functions.

Lived experiences of Indian Youth amid COVID-19 crisis: An interpretative phenomenological analysis

BACKGROUND

COVID-19 and the resultant lockdowns have caused a global discomposure. Out of a plethora of ramifications of this unusual state, mental health problems are becoming a serious concern. Considering the peculiarity of the situation, encapsulation of the lived experiences of people affected by COVID-19 may lead us towards a better understanding and control of the situation.

AIM

The aim of the present study was to get an in-depth analysis of the lived experiences of Indian youth amid COVID-19 crisis and its impact on their mental health.

METHOD

Ten college going students were telephonically interviewed using a semi-structured interview schedule to elicit participants' experiences with COVID-19 and the impact it has posed on their mental health. Transcripts were analysed using Interpretative Phenomenological Analysis (IPA).

RESULTS

The analysis revealed three master themes: (1) 'Impact on mental health', (2) 'Positive experiences' and (3) 'Ways of coping amid the crisis'.

CONCLUSION

The study draws attention to the mental health concerns of Indian youth amid the current crisis. The findings also highlight the positive outcomes of the crisis as well as the different ways of coping adopted by young individuals in India.

Geriatric depression and quality of life in North Shoa Zone, Oromia region: a community cross-sectional study

INTRODUCTION

Depression and low quality of life are severe conditions that lead to disability and mortality, common in high and low-resourced countries. Therefore, this study aimed to assess geriatric depression, quality of life, and associated factors among elderly persons in the low-resource country.

METHODS

A community-based cross-sectional study was used from March to April 2020. The depression and quality of life were assessed using the standardized and pre-tested geriatric depression scale (GDS) and the World Health Organization Quality Of Life (WHOQOL)-BREF, respectively. A multi-stage sampling technique was employed to select woreda and study participants. For data input and analysis, Epi-data version 4.3 and SPSS version 23 were utilized, consecutively. Bivariable and multivariable in the logistic regression analysis were done, and significance was determined at the odds ratio with a 95% confidence interval and P value < 0.05.

RESULTS

A total of 822 elderly persons participated in face to face interviewed-administered questionnaire. More than half 54.5% (n = 448) of elderly persons had depression and 51.8% (n = 426) of elderly participants had low quality of life. Advanced age, single participants, not having a formal education, living alone, and having chronic diseases were significantly associated with both the depression symptoms and low overall WHOQOL-BREF. Depression was correlated with low quality of life.

CONCLUSION

We found that elderly persons have a high risk of depression symptoms and a low quality of life. The Ethiopian Ministry of Health should develop psychological interventions, providing ongoing education for the elderly, and monitoring the health of the elderly population to address the specific needs of elderly persons who have been impacted by the aging process.

Specific features of the oldest old from the Longevity Blue Zones in Ikaria and Sardinia

Human longevity may be found in single individuals as well as in the population as a whole ("population longevity"). Longevity Blue Zones (LBZs), which are areas with an unusually high number of oldest old, have been identified in Sardinia and the Greek island of Ikaria. We compared the lifestyle, health status and some genetic markers of the LBZ populations with those of reference populations from Italy and Greece; the data were extracted from the GEHA database. In the LBZs, the proportion of individuals who never married or were married and still living with their spouse was significantly greater. Nonagenarians males and females with a high self‒perception of optimism and/or a high score for self-rated health were also found in larger proportions in LBZs. Among the variables with lower frequency were the proportion of the widowed, the percentage of subjects who had suffered a stroke and the frequency of Apoε4 and Apoε2 and the TT genotype of FOXO3A gene. Compared to behavioral and health indicators, the impact of genetic factors might be relatively less important in the LBZs. Nevertheless, further research is needed to identify potential epigenetic traits that might play a predominant role due to the interaction between genetics and the human and physical environments.

Impact of social isolation on mortality and morbidity in 20 high-income, middle-income and low-income countries in five continents

Objective

To examine the association between social isolation and mortality and incident diseases in middle-aged adults in urban and rural communities from high-income, middle-income and low-income countries.

Design

Population-based prospective observational study.

Setting

Urban and rural communities in 20 high income, middle income and low income.

Participants

119 894 community-dwelling middle-aged adults.

Main outcome measures

Associations of social isolation with mortality, cardiovascular death, non-cardiovascular death and incident diseases.

Results

Social isolation was more common in middle-income and high-income countries compared with low-income countries, in urban areas than rural areas, in older individuals and among women, those with less education and the unemployed. It was more frequent among smokers and those with a poorer diet. Social isolation was associated with greater risk of mortality (HR of 1.26, 95% CI: 1.17 to 1.36), incident stroke (HR: 1.23, 95% CI: 1.07 to 1.40), cardiovascular disease (HR: 1.15, 95% CI: 1.05 to 1.25) and pneumonia (HR: 1.22, 95% CI: 1.09 to 1.37), but not cancer. The associations between social isolation and mortality were observed in populations in high-income, middle-income and low-income countries (HR (95% CI): 1.69 (1.32 to 2.17), 1.27 (1.15 to 1.40) and 1.47 (1.25 to 1.73), respectively, interaction p=0.02). The HR associated with social isolation was greater in men than women and in younger than older individuals. Mediation analyses for the association between social isolation and mortality showed that unhealthy behaviours and comorbidities may account for about one-fifth of the association.

Conclusion

Social isolation is associated with increased risk of mortality in countries at different economic levels. The increasing share of older people in populations in many countries argues for targeted strategies to mitigate its adverse effects.

Different Discussion Partners and Their Effect on Depression among Older Adults

Although the multidimensionality of core discussion networks has been well established and widely studied, studies of the effects of social support on depression rarely consider the multifaceted aspects of dyadic discussion partner ties. This article proposes defining dyadic social relationships as a construct comprising several tie-level attributes and differentiating multiple forms of support relationships by assessing the configuration pattern of multiple attributes. The current study examines various forms of older adults’ discussion partners and identifies which form of discussion partner relationship is effective at buffering the negative effects of adverse life events on depression symptoms. Results from the University of California Social Network Survey show that older adults’ discussion partners can be classified into five distinct types of dyadic ties: spouse/romantic partners, close neighbors, remote type, social companions, and acquaintances. The discussion network with more close neighbor confidants is more effective at buffering the negative effects of adverse life events. These results offer an alternative way of investigating the differential significance of various social support relationships in mental well-being.

Peer-to-Peer Support and Changes in Health and Well-being in Older Adults Over Time

IMPORTANCE

Literature on peer-to-peer (P2P) programs suggests they improve health and well-being of older adults. Analysis from a previous study showed P2P to be associated with higher rates of hospitalization and no significant differences in rates of emergency department or urgent care visits; however, it is not known whether measures of health and well-being varied by group over time.

OBJECTIVE

To compare the association between receiving P2P support and secondary outcomes (ie, health status, quality of life, and depressive and anxiety symptoms) with receiving standard community services (SCS) over time.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study was conducted among a volunteer sample of older adults (≥65 years) who were new to P2P or were already receiving P2P and a corresponding control group. Participants were matched between groups on age, sex, and race/ethnicity. The study was conducted from March 2015 to December 2017 at 3 community-based organizations that delivered P2P in California, Florida, and New York. Data analysis was performed from October 2018 through May 2020.

EXPOSURES

P2P support, provided by trained older adult volunteers.

MAIN OUTCOMES AND MEASURES

Mental and physical components of the health status and quality of life measure and depressive and anxiety symptoms were collected over 12 months. The hypothesis was that older adults receiving P2P support would maintain higher health status and quality of life than the SCS group.

RESULTS

A total of 503 participants were screened, 456 participants were enrolled and had baseline data, and 8 participants only had baseline information with no follow-up data, leaving 448 participants (231 [52%] in the SCS group; 217 [48%] in the P2P group; 363 [81%] women; mean [SD] age, 80 [9] years). The P2P group had improvements in mental health (change at 12 months, 1.1 points; 95% CI, -0.8 to 3.0 points) and physical health (change at 12 months, 1.0 points; 95% CI, -0.7 to 2.8 points). However, the difference of differences between the 2 groups did not differ significantly from baseline to 12 months (mental health: 0.2 points; 95% CI -2.3 to 2.7 points; physical health: 1.7 points; 95% CI, -0.6 to 3.9 points). The P2P and SCS groups had a statistically significant difference of differences in anxiety symptoms of 0.36 points (95% CI, 0.04 to 0.61 points). There were no significant differences in depressive symptoms or mental and physical components of the health status and quality of life.

CONCLUSIONS AND RELEVANCE

These findings suggest that receiving P2P support did not slow the decline of health and well-being in older adults compared with those who received SCS. Baseline imbalance in key characteristics, even after adjusting for the imbalance using the propensity score method, may explain the results. Randomized trials are needed.

Coping With COVID-19: The Benefits of Anticipating Future Positive Events and Maintaining Optimism

In early 2020, the COVID-19 pandemic forced a large portion of the world into quarantine, leading to an extensive period of stress making it necessary to explore regulatory techniques that are effective at stimulating long-lasting positive emotion. Previous research has demonstrated that anticipating positive events produces increases in positive emotion during discrete stressors. We hypothesized that state and trait positive anticipation during the COVID-19 pandemic would be associated with increased positive emotions. We assessed how often participants thought about a future positive/negative/neutral event, activity, or goal through a daily reconstruction method that represented a "day in the life" of people in the United States during the early stages of the COVID-19 pandemic. The results of multi-level modeling and mediational analyses demonstrated that higher optimism, one form of trait positive anticipation, was related to higher state positive anticipation, which was in turn related to higher positive emotions during the current episode, which persisted to the next episode. In addition, both optimism and state positive anticipation were related to adaptive responses to the pandemic. These findings suggest that anticipation of future emotional experiences and hopefulness for the future can be a powerful predictor of positive emotions during global pandemics and perhaps other similar chronic stressors.

Home and Neighborhood Context of Falls Among Black and White Older Americans

Objectives: To examine social and physical environmental fall-risk factors in a nationally representative sample of community-living older adults overall and by racial group. Methods: We used data from the 2015 and 2016 rounds of the National Health and Aging Trends Study (n = 5581) linked to census tract measures from the American Community Survey. Recurrent falls are defined as 2+ self-reported falls over 12 months. Results: Older adults with recurrent falls were more likely to have lower education, lower income, financial hardship, live in homes with disorder and disrepair and in neighborhoods without sidewalks, with high social deprivation, and in nonmetropolitan counties. Home disrepair, lack of sidewalks, and residence in a nonmetropolitan county were important fall-risk factors among White older adults only. Financial hardship was an important risk factor among Black older adults. Discussion: Environmental factors are associated with recurrent falls among older Americans and should be incorporated into fall-risk profiles and prevention efforts.

Loneliness and social isolation is associated with sleep problems among older community dwelling women and men with complex needs

Sleep problems, loneliness and social isolation often increase with age, significantly impacting older adults’ health and wellbeing. Yet general population health empirical evidence is surprisingly scant. Using the largest national database to date, cross-sectional and longitudinal analyses was undertaken on 140,423 assessments from 95,045 (women: 61.0%) community living older adults aged ≥ 65 years having standardised home care assessments between 1 July 2012 and 31 May 2018 to establish the prevalence and relationships between insufficient sleep, excessive sleep, loneliness and social isolation. At first assessment, insufficient sleep (women: 12.4%, men: 12.7%) was more commonly reported than excessive sleep (women: 4.7%, men: 7.6%). Overall, 23.6% of women and 18.9% of men reported feeling lonely, while 53.8% women and 33.8% men were living alone. In adjusted longitudinal analyses, those who were lonely and socially isolated were more likely to experience insufficient sleep. Respondents with excessive sleep were more likely to live with others. Both loneliness and social isolation contributed to insufficient sleep, synergistically. Loneliness, social isolation and health-concerns may affect the restorative properties of sleep over and above the effects of ageing. Further research is warranted.

Psychological correlates of arbovirus preventive health behaviour

BACKGROUND

Current arbovirus preventive health interventions do not take social and personality variables into account. Social cognition models posit that people engage in preventive health behaviour (PHB) after an assessment of the perceived risk of disease, an analysis of potential consequences and an evaluation of self-efficacy.

METHODS

In a sample of 385 undergraduate and medical students, we examined the association between social relationships, conscientiousness and mosquito repellent use. Data were analysed in a series of stepwise regression analyses.

RESULTS

Social relationships influenced the association between conscientiousness and mosquito repellent use. As expected, perceptions of positive social relationships and conscientiousness are positively linked with mosquito repellent use. Conversely, perceptions of negative social relationships are linked to an inverse association between conscientiousness and mosquito repellent use.

CONCLUSIONS

Future interventions designed to increase perceptions of social relationships might be helpful in increasing arbovirus preventive health behaviour such as using mosquito repellents. Since the present study was concurrent correlational in nature, future research would benefit from experimental interventions designed to directly examine the effect of enhancing positive relations and social support on arbovirus preventive health behaviour.

Double Jeopardy Versus Double Benefit: The Role of Age and Leisure Activities in the Incidence of Disability Among Chinese Older Adults

Objectives: This paper analyzes the double jeopardy effect of age and double benefit of leisure activities in the incidence of disability. Methods: This study uses data from the Chinese Longitudinal Healthy Longevity Survey between 2002 and 2014. Disability status is measured by activities of daily living. Leisure activities include physical and social activities. A generalized linear mixed model with a time-lag design is used to analyze the trajectory of being disabled. Results: Older ages are associated with double jeopardy of disability: higher initial probability and faster pace. The double benefit of leisure activities is confirmed: lower initial probability and a slower pace of change in disability over time. The age pattern is substantially alleviated when leisure activities and other covariates are present. Discussion: Although the risk of disability rises with advancing age, the over-time trajectory can be flattened by engagement in leisure activities and other factors.

Social capital in retirement villages: a literature review

Retirement villages are a model of extra-care housing, offering purpose-designed housing that incorporates both care services and a range of non-care-related facilities and activities. These generate opportunities for formal and informal social activity, and promote community engagement, solidarity between residents, and active and independent ageing. Providers suggest that retirement villages are able to foster an environment rich in social capital. This study's purpose is to review and summarise key findings on the topic of social capital in retirement villages in the gerontological literature. Social capital is defined as both an individual attribute of single actors and a feature of communities as a whole. A clear conceptualisation of social capital is used to organise the reviewed studies along different dimensions: on an individual level, social networks, trustworthiness and obligations are differentiated, while the collective level distinguishes between system control, system trust and system morality. Thirty-four studies are reviewed. While retirement villages are generally described as friendly places with widespread helping behaviour where new friends are made, research has also highlighted the difficulty of socially integrating the frail and very old. While, in particular, social networks and system morality have received much attention, there is a clear need for future research into the other domains of social capital.

Differentiating objective and subjective dimensions of social isolation and apprasing their relations with physical and mental health in italian older adults

Background

International research shows that social isolation is harmful for health, especially for the elderly. Its objective and subjective dimensions are important to distinguish as each stands in a different relation with health. The first aim of the present study is the validation of three scales measuring objective and subjective isolation in an Italian elderly population. The second aim is to analyze subjective and objective social isolation and to appraise their association with health among seniors.

Methods

This cross-sectional survey collected data from 306 over 65 s participants. Questionnaires were administered face-to-face by one author and encompassed: social disconnectedness scale; perceived isolation scale; abbreviated Lubben Social Network Scale; measures of general and mental health, and depression.

Results

The three scales measuring social isolation demonstrated acceptable psychometric properties and validity. Objective and subjective social isolation were not directly associated with physical health, whereas subjective isolation is strongly linked to worse mental health and depression. Higher level of subjective isolation was associated with lower level of physical health through the mediation of mental health. Subjective isolation served as a mediator in the relation between objective isolation and health. Moderation analysis demonstrated that low values of objective isolation predicted high values of mental health but only when subjective isolation was low. None of these relations were moderated by socio-demographic variables.

Conclusion

Subjective and objective isolation are clearly two separate dimensions and the scales validated in this paper showed to be potentially culturally invariant. Researchers should work to find instruments able to depict the complexity of the construct of social isolation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-020-01864-6.

An Assessment of the Novel COVISTRESS Questionnaire: COVID-19 Impact on Physical Activity, Sedentary Action and Psychological Emotion

Globally the COVID-19 pandemic outbreak has triggered an economic downturn and a rise in unemployment. As a result, global communities have had to face physical, health, psychological and socio-economical related stressors. The purpose of this study was to assess and report the impact of isolation and effect of coronavirus on selected psychological correlates associated with emotions. Following ethical approval, a mixed methods observational study was conducted using the validated COVISTRESS questionnaire. Two observational study scenarios were evaluated namely "Prior" to the COVID-19 outbreak and "Currently", i.e., during the COVID-19 pandemic. 10,121 participants from 67 countries completed the COVISTRESS questionnaire. From the questionnaire responses only questions that covered the participant's occupation; sociodemographic details, isolation and impact of coronavirus were selected. Further analyses were performed on output measures that included leisure time, physical activity, sedentary time and emotions. All output measures were evaluated using the Visual Analogue Scale (VAS) with an intensity ranging from 0-100. Descriptive statistics, Wilcoxon signed-rank test and Spearman correlational analysis were applied to the leisure time, physical activity, sedentary time and emotional feeling datasets; p = 0.05 was set as the significance level. Both males and females displayed similar output measures. The Wilcoxon signed rank test showed significant differences with respect to "Prior" COVID-19 and "Currently" for sedentary activity (Z = -40.462, p < 0.001), physical activity (Z = -30.751, p < 0.001) and all other emotional feeling output measures. A moderate correlation between "Prior" COVID-19 and "Currently" was observed among the Males (r = 0.720) in comparison to the Females (r = 0.639) for sedentary activity while weaker correlations (r < 0.253) were observed for physical activity and emotional feeling measurements, respectively. Our study reported incremental differences in the physical and psychological output measures reported, i.e., "Prior" COVID-19 and "Currently". "Prior" COVID-19 and "Currently" participants increased their sedentary habits by 2.98%, and the level of physical activity reduced by 2.42%, depression levels increased by 21.62%, anxiety levels increased by 16.71%, and stress levels increased by 21.8%. There were no correlations (r) between leisure, physical activity and sedentary action (i.e., "Prior" = -0.071; "Currently" = -0.097); no correlations (r) between leisure physical activity and emotion (i.e., -0.071 > r > 0.081) for "Prior"; and poor correlations (r) between leisure, physical activity and sedentary action (i.e., -0.078 > r > 0.167) for "Current". The correlations (r) between sedentary action and emotion for "Prior" and "Currently" were (-0.100 > r > 0.075) and (-0.040 > r > 0.041) respectively. The findings presented here indicate that the COVISTRESS project has created awareness in relation to the physical and psychological impact resulting from the COVID-19 pandemic. The findings have also highlighted individual distress caused by COVID-19 and associated health consequences for the global community.

A stronger relationship between reward responsivity and trustworthiness evaluations emerges in healthy aging

Older adults (OA) evaluate faces to be more trustworthy than do younger adults (YA), yet the processes supporting these more positive evaluations are unclear. This study identified neural mechanisms spontaneously engaged during face perception that differentially relate to OA' and YA' later trustworthiness evaluations. We examined two mechanisms: salience (reflected by amygdala activation) and reward (reflected by caudate activation) - both of which are implicated in evaluating trustworthiness. We emphasized the salience and reward value of specific faces by having OA and YA evaluate ingroup male White and outgroup Black and Asian faces. Participants perceived faces during fMRI and made trustworthiness evaluations after the scan. OA rated White and Black faces as more trustworthy than YA. OA had a stronger positive relationship between caudate activity and trustworthiness than YA when perceiving ingroup, but not outgroup, faces. Ingroup cues might intensify how trustworthiness is rewarding to OA, potentially reinforcing their overall positivity.

Social housing promotes cognitive function through enhancing synaptic plasticity in APP/PS1 mice

Previous studies have shown that loneliness increases the risk of AD (Alzheimer's disease) onset, while active and frequent social housing delays the onset of cognitive impairment. The mechanism of how this occurs remains unclear. In this study, we investigated how social interaction affected cognitive function and AD pathology in APP/PS1 (amyloid precursor protein/presenilin-1) mice. APP/PS1 mice were divided into either a social isolation (SI) group, a social contact with one mouse (SCO) group, or a social contact with five mice (SCF) group. Our results demonstrated that social housing improved the behavioral performance of APP/PS1 mice in Morris Water Maze testing, without significantly altering the rates of amyloid plaque deposition or amyloidogenic APP processes. Furthermore, the synaptic function, dendritic spine density, and complexity of neuronal network were notably increased in the SCF group, as compared to the SI and SCO groups. Additional protein and mRNA analyses of isolated astrocyte and microglia revealed that several glial genes related to regulation and anti-inflammatory progression were significantly upregulated, while pro-inflammatory markers were decreased. These findings highlight the important role of quality social communication (five mice not one mice) on maintaining neuronal function during AD pathogenesis and provide evidence to place great emphasis of family care of AD patients.

An Embodied Neurocomputational Framework for Organically Integrating Biopsychosocial Processes: An Application to the Role of Social Support in Health and Disease

OBJECTIVE

Two distinct perspectives-typically referred to as the biopsychosocial and biomedical models-currently guide clinical practice. Although the role of psychosocial factors in contributing to physical and mental health outcomes is widely recognized, the biomedical model remains dominant. This is due in part to (a) the largely nonmechanistic focus of biopsychosocial research and (b) the lack of specificity it currently offers in guiding clinicians to focus on social, psychological, and/or biological factors in individual cases. In this article, our objective is to provide an evidence-based and theoretically sophisticated mechanistic model capable of organically integrating biopsychosocial processes.

METHODS

To construct this model, we provide a narrative review of recent advances in embodied cognition and predictive processing within computational neuroscience, which offer mechanisms for understanding individual differences in social perceptions, visceral responses, health-related behaviors, and their interactions. We also review current evidence for bidirectional influences between social support and health as a detailed illustration of the novel conceptual resources offered by our model.

RESULTS

When integrated, these advances highlight multiple mechanistic causal pathways between psychosocial and biological variables.

CONCLUSIONS

By highlighting these pathways, the resulting model has important implications motivating a more psychologically sophisticated, person-specific approach to future research and clinical application in the biopsychosocial domain. It also highlights the potential for quantitative computational modeling and the design of novel interventions. Finally, it should aid in guiding future research in a manner capable of addressing the current criticisms/limitations of the biopsychosocial model and may therefore represent an important step in bridging the gap between it and the biomedical perspective.

"When I Retire, I'll Move Out of the City": Mental Well-being of the Elderly in Rural vs. Urban Settings

This study examines the influence of risk factors on mental well-being at older ages focusing on the level of rurality of the living environment. We used cross-sectional, nationally representative survey data for Catalonia (Spain) from 2015 to 2017 to explain the mental well-being of the population aged 65 years and over. Based on a sample of 2621 individuals, we created a score of current mental well-being using the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). Using logistic regression and non-parametric tests, we identified the sociodemographic, health and lifestyle variables which, in combination with the features of the rural and urban settings of the living space, were associated with poor SWEMWBS scores. Our results reveal that adequate social support is linked to expectations of good mental well-being in later life. Poor self-perceived health and ageing limitations are associated with less deterioration of the well-being for the elderly living in rural areas, whereas living in urban areas is linked to a higher risk of suffering from emotional distress attributable to economic difficulties or low educational attainment. Incentivizing older people to live in rural environments could result in greater well-being in the last stages of life; appropriate prospective studies are needed to test this positive outcome.

Social connections and tertiary health-care utilization

The use of tertiary health care by socially proximate peers helps individuals learn about program and treatment procedures, signals that using such care is socially appropriate, and could support the use of formal health care, all of which could increase program utilization. Using complete administrative claims data from a publicly financed tertiary care program in India, we estimate that the elasticity of first-time claims with respect to claims by members of caste groups within the village is 0.046, with smaller effects of more socially distant individuals. The point elasticity of inpatient care expenditure with respect to claims filed by the same group in village peers in the previous quarter is - 0.035. We find support for an information channel as peers increase awareness of the program and its features. Our findings have implications for the development of network-based models to determine health-care demand, as well as in use of network-based targeting to boost tertiary health-care utilization.

Usefulness of Social Support in Older Adults After Hospitalization for Acute Myocardial Infarction (from the SILVER-AMI Study)

The availability of social support is associated with health outcomes after acute myocardial infarction (AMI), yet previous studies have largely considered social support as a single entity, rather than examining its discrete domains. Furthermore, few studies have investigated the impact of social support in older AMI patients, in whom it may be especially important. We aimed to determine the associations between 5 discrete domains of social support - emotional support, informational support, tangible support, positive social interaction, and affectionate support - with 6-month readmission and mortality in older patients hospitalized for AMI, adjusting for known predictors of post-AMI outcomes. Three thousand six participants 75 years and older were recruited from a network of 94 hospitals across the United States. A 5-item version of the Medical Outcomes Study Social Support Survey was used to measure perceived social support, and readmission and mortality were ascertained 6 months after initial hospitalization. Independent associations were determined using multivariable regression. Among 3,006 participants, mean age was 82 years, 44% were female, and 11% non-white. Participants who were female, non-white, less educated, and lived alone tended to report lower social support. In multivariable analyses, low informational support was associated with readmission (odds ratio 1.22; 95% confidence interval 1.01 to 1.47), and low emotional support with mortality (odds ratio 1.43; 95% confidence interval 1.04 to 1.97). In conclusion, individual domains of social support had distinct, independent associations with post-AMI outcomes, lending a more nuanced and precise understanding of this important social determinant of health. Understanding these distinct associations can inform the development of interventions and policies to improve post-AMI outcomes.

Elements of Social Convoy Theory in Mobile Health for Palliative Care: Scoping Review

BACKGROUND

Mobile health (mHealth) provides a unique modality for improving access to and awareness of palliative care among patients, families, and caregivers from diverse backgrounds. Some mHealth palliative care apps exist, both commercially available and established by academic researchers. However, the elements of family support and family caregiving tools offered by these early apps is unknown.

OBJECTIVE

The objective of this scoping review was to use social convoy theory to describe the inclusion and functionality of family, social relationships, and caregivers in palliative care mobile apps.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines, a systematic search of palliative care mHealth included (1) research-based mobile apps identified from academic searches published between January 1, 2010, and March 31, 2019 and (2) commercially available apps for app stores in April 2019. Two reviewers independently assessed abstracts, app titles, and descriptions against the inclusion and exclusion criteria. Abstracted data covered app name, research team or developer, palliative care element, target audience, and features for family support and caregiving functionality as defined by social convoy theory.

RESULTS

Overall, 10 articles describing 9 individual research-based apps and 22 commercially available apps were identified. Commercially available apps were most commonly designed for both patients and social convoys, whereas the majority of research apps were designed for patient use only.

CONCLUSIONS

Results suggest there is an emerging presence of apps for patients and social convoys receiving palliative care; however, there are many needs for developers and researchers to address in the future. Although palliative care mHealth is a growing field, additional research is needed for apps that embrace a team approach to information sharing, target family- and caregiver-specific issues, promote access to palliative care, and are comprehensive of palliative needs.

The Epidemiology of Social Isolation: National Health and Aging Trends Study

OBJECTIVES

Social isolation among older adults is an important but under-recognized risk for poor health outcomes. Methods are needed to identify subgroups of older adults at risk for social isolation.

METHODS

We constructed a typology of social isolation using data from the National Health and Aging Trends Study (NHATS) and estimated the prevalence and correlates of social isolation among community-dwelling older adults. The typology was formed from four domains: living arrangement, core discussion network size, religious attendance, and social participation.

RESULTS

In 2011, 24% of self-responding, community-dwelling older adults (65+ years), approximately 7.7 million people, were characterized as socially isolated, including 1.3 million (4%) who were characterized as severely socially isolated. Multinomial multivariable logistic regression indicated that being unmarried, male, having low education, and low income were all independently associated with social isolation. Black and Hispanic older adults had lower odds of social isolation compared with white older adults, after adjusting for covariates.

DISCUSSION

Social isolation is an important and potentially modifiable risk that affects a significant proportion of the older adult population.

The impact of social interactions and pain on daily positive and negative affect in adults with osteoarthritis of the knee

This study utilized experience sampling methodology (ESM) to examine the relationship of social interactions with daily pain and mood symptoms in people with osteoarthritis (OA) of the knee. Two hundred sixty-eight adults with physician-diagnosed OA of the knee underwent a baseline in-person interview and subsequent week-long ESM protocol to assess their daily activity patterns, pain, and mood via phone interview four times a day. A coding system was developed to assess presence and type of social interactions based on subject self-report of activity patterns. Multilevel modeling was used to examine between- and within-subject variation in outcomes based on both global and momentary measures of social activities, pain, and mood, while controlling for key demographic and potentially confounding variables. Positive associations were demonstrated between the ratio of positive to negative affect and both global (β = 0.49, p < .001) and momentary, especially positive (β = 0.24, p < .05), social activity patterns. Additionally, the association between negative affect and pain (β = -0.07, p < .01) was attenuated in those with more baseline social interactions. Social interaction has the potential to influence mood in adults with OA of the knee, both on a global scale, and through daily variations in interactions. These interactions seem to be directly related to mood, as well as the apparently attenuating the relationship between pain and depression. Daily social interactions showed a robust positive association with contemporaneous positive affect.