Associations between the objective and perceived food environment and eating behavior in relation to socioeconomic status among adults in peri-urban settings: results from the CIVISANO study in Flanders, Belgium

Obesity, a significant public health concern, disproportionately affects people with lower socioeconomic status (SES). Food environments have been identified as part of the causal chain of this disparity. This study investigated variations in the food environment across groups with different SES profiles residing in peri-urban municipal settings. In addition, it examined the association of the perceived and objective food environments with eating behaviour and assessed if these associations were moderated by SES. Utilizing GIS and survey data (n = 497, aged 25-65), results showed differences in the objective and perceived food environments based on SES. Respondents with higher SES perceived their food environments as better but resided farther from all food outlets compared to respondents with lower SES. However, there was no difference in outlet density or mRFEI between SES groups. SES moderated associations between the objective and perceived food environments and most eating behavior outcomes except fast food consumption frequency. For fruits and vegetables, SES moderated the association between neighborhood availability and consumption frequency (β0.23,CI0.03;0.49). Stratified analysis revealed a positive association for both lower (β0.15, CI0.03;0.27) and higher (β0.37, CI 0.12;0.63) SES groups. For snack foods, SES moderated the association between healthy outlet density and consumption frequency (β-0.60, CI-0.94; -0.23), showing statistical significance only for respondents with higher SES (β0.36,CI 0.18;0.55). Similarly, for sugar-sweetened beverages, a statistically significant interaction was observed between unhealthy outlet density in the 1000m buffer and consumption frequency (β 0.06, CI 0.02; 0.11). However, this association was only statistically significant for respondents with higher SES (β-0.02,CI -0.05;-0.0002). These results emphasize the significance of SES as a crucial element in comprehending the connection between the food environment and eating behaviour. Indicating the need for policymakers to take SES into account when implementing food environment interventions, particularly when focusing on the neighborhood food environment without considering residents' SES and their perceptions.

A compassionate university for serious illness, death, and bereavement: Qualitative study of student and staff experiences and support needs

Serious illness, death, and bereavement are common experiences within the work and study context. This study aims to explore the experiences and support needs of university students and staff confronted with serious illness, death, and bereavement. Semi-structured interviews and focus groups were conducted with 21 students and 26 staff. A thematic analysis resulted in three overarching themes: the university as a high-pressure environment; navigating the complex university information and support system; and disenfranchized grief. Four themes were identified in terms of what participants needed from the university: clear processes and procedures; flexibility in policy application; proactive support and recognition; and activities to enhance awareness and interpersonal communication skills. Findings from this study could enable higher education institutions to become more compassionate schools and workplaces.

How compassionate is your neighborhood? Results of a cross-sectional survey on neighborhood participation regarding serious illness, death, and loss

We conducted a cross-sectional survey measuring the extent and nature of neighborhood participation regarding serious illness, death and loss and the factors that are associated with it. We distributed the survey to 2324 adult citizens in two neighborhoods in Flanders, Belgium, to which 714 citizens responded (response rate 30.7%). Of the respondents, 42.4% participated in at least one action in their neighborhood around serious illness, death, or loss, for 30.8% of them this participation was sporadic. Most of the respondents participated by helping neighbors (32.4%) or by volunteering (10.3%). We found a positive association between perceived neighborhood social cohesion (β = 0.100; CI = 0.003-0.040), previous experiences with serious illness, death, and loss (β = 0.158; CI = 0.204-0.586) and neighborhood participation around serious illness, death and loss. Future research should investigate strategies on how to move from death literacy developed through illness, caregiving and bereavement experiences to neighborhood participation around these topics.

The role of the perceived environment for recreational walking among adults in socioeconomically disadvantaged situations: A study using walk-along interviews

Background

Persons in socioeconomically disadvantaged situations (PSEDS) are generally less likely to engage in recreational walking (RW) compared to higher socioeconomic groups and are often more dependent on their local environment. Studies on RW have primarily focused on the role of the built environment for the general adult population and the older population in urban areas. The aim of this study is to qualitatively identify the perceived environmental factors affecting RW among PSEDS in peri-urban areas.

Methods

In two peri-urban municipalities in Belgium, walk-along interviews were conducted until data saturation with a purposeful convenience sampling of 38 PSEDS (25-65y/o) to identify local environmental factors affecting RW. A subsample of 22 participants joined a focus group (n = 4) to categorize the identified factors into environmental types (physical, sociocultural, political, and economic) of the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. The interviews were transcribed and analyzed thematically using Maxqda 2022.0.

Results

The information environment (dissemination, retrieving and understanding of information) was added to the ANGELO framework, highlighting the importance of digital literacy. Availability and accessibility of well-maintained walking surfaces, toilets, street lighting and seating options (physical environment), social support, dog-ownership, stigmatization, social isolation, and a sense of belonging (sociocultural environment) and indirect costs (economic environment) were identified as important environmental factors in RW among PSEDS. The identified political and economic factors are intertwined with the other environments.

Conclusions

Perceived environmental factors affect RW among PSEDS and peri-urban settings offer specific challenges. Local governments should incorporate citizen perception into decision-making processes to create supportive environments that have the potential to promote RW among PSEDS in a peri-urban setting.

Civic engagement among foreign-born and native-born older adults living in Europe: a SHARE-based analysis

Civic engagement is one of the cornerstones of participatory democracy and fundamental to preventing old-age social exclusion. Even though civic engagement late-in-life has received considerable attention, there is a lacuna of research on older migrants' civic engagement. This study aims therefore to examine potential predictors of civic engagement in terms of formal volunteering and participation in political organisations among foreign-born and native-born older adults in Europe. Attention is hereby given to how socio-structural resources and social capital are associated with civic engagement, and whether these associations differ between foreign-born and native-born. Data from wave 7 of the Survey of Health, Ageing and Retirement in Europe [n = 74,150; 5710 of them are foreign-born] were used in multivariable logistic regression analyses. Results show that socio-structural and social capital variables are positively associated with volunteering and participation in political organisations, both in native-born and foreign-born older adults. The study also suggests that place of birth (in Europe vs. outside Europe) and age-upon-migration play a role in predicting civic engagement among foreign-born older adults, and are therefore features worth considering when studying older migrants' civic engagement.

Loneliness in Older Migrants: Exploring the Role of Cultural Differences in Their Loneliness Experience

INTRODUCTION AND BACKGROUND

The scientific literature suggests the necessity of studying loneliness from a broader social perspective. This article aims to broaden the research on loneliness in older migrants by exploring the role of cultural differences through the lens of the social environment (as measured in social capital, discrimination, and ageism) and social situation (as measured in relational mobility, childness, and marital status). Based on Hofstede's Individualism Index, older migrants involved in the BBC Loneliness Experiment (N = 2164) were classified into three groups: cultural migrants (i.e., from a collectivist to individualist culture) (N = 239), migrants with a similar culture (i.e., within an individualist culture) (N = 841), and ageing non-migrants (N = 1084).

OBJECTIVES

The two main objectives were (1) to compare the levels of loneliness among these three groups, and (2) to unravel how different influencing factors, such as the social environment, social situation, coping strategies, and personal characteristics, are related to loneliness.

METHODS

Bivariate analyses were performed to determine the differences in the loneliness, social environment, social situation, and personal characteristic variables between the groups, with adjusted p-values according to the Bonferroni correction to limit the potential for type I errors (α = 0.005). Multiple linear regressions were performed to unravel the relationships between loneliness and the different influencing factors, namely the social environment, social situation, coping strategies, and personal characteristics.

RESULTS

The bivariate analyses show no significant difference in loneliness across the three groups. The multiple linear regressions demonstrate that the social environment (i.e., social capital, discrimination, and ageism) is significantly associated with loneliness. Social capital acts as a protective factor for cultural migrants (β = -0.27, p < 0.005, 95% CI [-0.48, -0.05]), similar-culture migrants (β = -0.13, p < 0.005, 95% CI [-0.25, -0.03]), and non-migrants (β = -0.21, p < 0.001, 95% CI [-0.28, -0.12]). Discrimination and ageism are both risk factors for loneliness across the three groups. Social situation, as measured in married/cohabitation status and relational mobility, shows a significant association with loneliness in the non-migrants and similar-culture migrants but not the cultural migrants. In terms of individual resources for coping strategies, engagement in active coping is protective for all three groups. Non-coping, the unawareness of any coping strategies, is a risk factor, while passive coping shows no significant association.

DISCUSSION

The results show that the structural factor of the social environment in which older migrants' find themselves, rather than their culture of origin, is more important for older migrants' feelings of loneliness in later life. A favorable social environment with high social capital and low levels of discrimination and ageism protects against loneliness in the ageing population across cultures. Practical implications for loneliness interventions for older migrants are put forward.

Dyspnea assessment in myotonic dystrophy type 1

In myotonic mystrophy type 1 (DM1), combining respiratory symptom screening and respiratory function testing, is crucial to identify the appropriate time for ventilatory support initiation. Dyspnea has been little investigated in DM1. To provide a multidimensional description of dyspnea, questionnaires assessing dyspnea were administered to 34 consecutive adult patients with DM1 (median (25th-75th centile) age of 36 (28-49), Vital Capacity (VC) of 74 (64-87)% of predicted value). Dyspnea scores were low whatever the questionnaire used: Multidimensional Dyspnea Profile score of 2(0-4.7)/50 for dyspnea sensory descriptor and of 0 (0-4.7)/60 for the emotional descriptor, Visual Analogue Scale score of 0 (0-0)/10 in sitting and supine position and Borg score after six-minute walk test (6MWT) of 2.2 (1.8-4.2)/10. Eleven patients (32%) reported disabling dyspnea in daily living (modified Medical Research Council (mMRC) score ≥ 2). In comparison with patients with mMRC score < 2, patients with mMRC score ≥ 2 had a more severe motor handicap (Muscular Impairment Rating score of 4.0 (4.0-4.0) vs 3.0 (2.0-3.5), p<0.01), a lower 6MWT distance (373 (260-424) vs 436 (346-499)m, p = 0.03) and a lower VC (64 (48-74)% vs 75 (69-89)%, p = 0.02). These data suggest that the mMRC scale might be an easy-to-use and useful tool to assess dyspnea in daily living in DM1 patients. However, the interest of integrating the mMRC dyspnea scale in clinical practice to guide therapeutic management of DM1 patients remains to be assessed in further studies.

Researching Compassionate Communities: Identifying theoretical frameworks to evaluate the complex processes behind public health palliative care initiatives

BACKGROUND

Compassionate Communities have been put forward as a new model for community-based palliative care to positively impact the health and wellbeing of those experiencing challenges of serious illness, death, dying, and loss. Despite the growing international movement to develop these public health initiatives to end-of-life care, only a handful of initiatives have undergone some form of evaluation.

AIM

To provide guidance on designing evaluation research by identifying theoretical frameworks to understand the development, implementation, and underlying mechanisms of Compassionate Communities.

METHODS

To identify suitable theoretical frameworks for the study of Compassionate Communities, we applied two steps. The first step examined the characteristics of Compassionate Communities and translated them into assessment criteria for the selection of theoretical frameworks. The second step consisted of applying the identified assessment criteria to a list of widely used and highly cited theoretical frameworks.

RESULTS

Three well-established theoretical frameworks were identified as being most suitable to study the development, implementation, and underlying mechanisms of Compassionate Communities: The Consolidated Framework for Implementation Research (CFIR), the integrated-Promoting Action on Research Implementation in Health Services framework (i-PARIHS), and the Extended Normalization Process Theory (ENPT).

CONCLUSIONS

The article supports and encourages the use of theoretical frameworks to evaluate the complex processes behind public health palliative care initiatives. The complementary use of two determinant frameworks and an implementation theory provides theoretical grounding to gain rich insights into the emergent and shifting interplays between agency, social processes, and contextual factors that shape the development and implementation of Compassionate Communities.

Helping Behavior of Older Adults during the Early COVID-19 Lockdown in Belgium

This study aimed to understand whether older adults not only received but also provided help during the first COVID-19 lockdown in Belgium, which factors motivated them to help, and whether older adults differed from younger age groups in terms of helping behavior and motives. Bivariate analyses were performed using data generated from an online cross-sectional survey in Belgium (N = 1892).The results showed that older adults who received help also provided it. This "interdependence" - mutual or reciprocal dependence - occurred regardless of age. In terms of motives for providing help, both older adults and their younger peers were primarily motivated by present-oriented and emotion-related motivation: older people were motivated to provide help by altruistic values and humanism, and enhancement motives linked to self-development.Policy implications of these results entail: during crisis situations, make use of the bond between older adults and their neighbors, such as caring communities.

Civic Engagement in Neighbourhoods regarding serious illness, death and loss (CEIN): a study protocol for a convergent-parallel mixed-methods process and outcome evaluation that balances control and flexibility

Background

New public health approaches in palliative care attribute an active role to civic society in providing care for those who are seriously ill, caring, or bereaved. Accordingly, Civic Engagement In Neighbourhoods regarding serious illness, dying and loss (CEIN) are emerging worldwide. However, study protocols that advise on how to evaluate the impact and complex social change processes underlying these civic engagement initiatives are lacking.

Objectives

The main objective of this study is to describe the study protocol for the evaluation of civic engagement initiatives in serious illness, dying, and loss in two neighbourhoods in Flanders, Belgium.

Design

A convergent-parallel mixed-method process and outcome evaluation for the CEIN study.

Methods & analysis

We look at the evaluation of CEIN through a critical realist lens, thereby including the social, political, and economic determinants of social change in CEIN, the mechanisms to achieve this social change, the outcomes, and the mutual connection between these three aspects. We will conduct a convergent-parallel mixed-method process and outcome evaluation in which qualitative (i.e. observations, interviews, group discussions, and ego network mapping) and quantitative data (i.e. a pre-post survey) are simultaneously but separately collected and analysed and in the last stage combined by narrative synthesis.

Discussion

This protocol illustrates the difficulty of operationalising the desired long-term impact of social changes regarding serious illness, dying, and loss into more manageable outcomes. We recommend a well-cogitated logic model that connects the outcomes of the study to its potential actions. Applying this protocol in practice is a constant exercise between providing sufficient flexibility to meet feasibility, desirability, and context-specific needs in the CEIN study and providing sufficient guidelines to structure and control the evaluation process.

Researching Compassionate Communities From an Interdisciplinary Perspective: The Case of the Compassionate Communities Center of Expertise

Compassionate Communities are places and environments in which people, networks, and institutions actively work together and are empowered to improve the circumstances, health, and well-being of those facing serious illness, death, dying, and loss. The study of their development, implementation, and evaluation requires an interdisciplinary research approach that has hitherto been lacking. In 2020, 8 research groups from 4 faculties at Vrije Universiteit Brussel united in the interdisciplinary Compassionate Communities Center of Expertise (COCO) to investigate Compassionate Communities. This article describes the first results of COCO: (a) an interdisciplinary mode of collaboration, (b) a shared conceptual understanding and definition of Compassionate Communities, and (c) a shared research agenda on Compassionate Communities.

Recreational walking and the perceived local environment among socioeconomic disadvantaged adults

Background

Insufficient physical activity (PA) is a risk factor for obesity and non-communicable diseases and seems more prevalent among socioeconomically disadvantaged (SED) adults. Recreational walking (RW) is an important type of leisure time PA which can be done for free and without specific equipment or facilities. Environmental factors influencing PA may be particularly important for SED adults who are more reliant on their direct environment. The objectively measured environment is not always congruent with the perception of residents, and this may differ by socioeconomic group. This study aims to identify the local environmental factors important for RW as perceived by SED adults.

Methods

This study is part of the CIVISANO project. Purposeful convenience sampling was used to recruit 38 SED adults (25-65 y/o) in two Flemish semi-urban municipalities. Individual walk-along interviews have been performed in the participants’ neighborhood. 20 participants joined the focus group discussion (n = 4) that were intended for member checking, to categorize identified environmental factors and to identify local actions to promote recreational walking. MaxQDA was used for content analysis.

Results

The way the environment is perceived by SED adults plays an important role in their RW behavior. Results demonstrate the interrelation of different environmental types (physical, sociocultural, economic, political and information) and sizes (micro, meso, macro). Improving communication and knowledge transfer, stimulation of physical, sociocultural, and economic accessibility, and promotion of physical and social safety are identified most important action points for the local government to facilitate RW.

Conclusions

Our findings indicate that the perceived local environment can play an important role in promoting RW among SED adults. Future studies should investigate if changes in these environments and in residents’ perception lead to changes in RW behavior of SED adults.

Key messages

Individual and food environment factors associated with the diet of disadvantaged adults in Flanders

Background

Health inequalities partially remain due to differences in diet between socioeconomic groups. Examining the association between socio-ecological factors and the diet of socioeconomically disadvantaged (SED) individuals can enhance the development of interventions to decrease health inequalities.

Methods

In total, 278 SED adults residing in two Flemish municipalities completed a survey addressing sociodemographics, diet, health and their perceptions of the food environment. The objective food environment was examined by assessing food retailer information in street network-based buffers of 500m and 1000m around participants’ addresses. Linear regression was used to test assumptions.

Results

Individual factors such as poor subjective health (OR0.58;CI 0.34-0.97), food insecurity (OR0.60;CI 0.38-0.94) and living alone (OR0.86;CI 0.75-0.98) were negatively associated with healthy dietary habits such as daily fruit and vegetable (FV) consumption. Positive perceptions on the availability of FV were positively associated (OR1.09;CI 1.02-1.17) with daily FV consumption. Objective food environmental factors showed a stronger association with unhealthy dietary habits. A greater amount of retailers within 1000m walking distance was negatively associated with fast-food (OR0.96;CI 0.94-0.99) and sugar-sweetened beverages (SSB) consumption (OR0.93; CI 0.88-0.98). More supermarkets within 500m distance was negatively associated (OR0.77;CI 0.58-0.97) with SSB consumption, while more convenience stores within a 1000m distance was positively associated (OR1.48;CI 1.17-1.88) with SSB consumption.

Conclusions

Our findings suggest that factors associated with the diet of SED adults differ according to food and drink items. Interventions focused on this population should take these differences into account.

Key messages

The CIVISANO protocol: a mixed-method study about the role of objective and perceived environmental factors on physical activity and eating behavior among socioeconomically disadvantaged adults

BACKGROUND

Overweight and obesity have a strong socioeconomic profile. Unhealthy behaviors like insufficient physical activity and an unbalanced diet, which are causal factors of overweight and obesity, tend to be more pronounced in socioeconomically disadvantaged groups in high income countries. The CIVISANO project aims to identify objective and perceived environmental factors among different socioeconomic population groups that impede or facilitate physical activity and healthy eating behavior in the local context of two peri-urban Flemish municipalities in Belgium. We also aim to identify and discuss possible local interventions and evaluate the participatory processes of the project.

METHODS

This study (2020-2023) will use community-based participatory tools, involving collaborative partnerships with civic and stakeholder members of the community and regular exchanges among all partners to bridge knowledge development and health promotion for socioeconomically disadvantaged citizens. Furthermore, a mixed-methods approach will be used. A population survey and geographic analysis will explore potential associations between the physical activity and eating behaviors of socioeconomically disadvantaged adults (25-65 years old) and both their perceived and objective physical, food and social environments. Profound perceptive context information will be gathered from socioeconomically disadvantaged adults by using participatory methods like photovoice, walk-along, individual map creation and group model building. An evaluation of the participatory process will be conducted simultaneously.

DISCUSSION

The CIVISANO project will identify factors in the local environment that might provoke inequities in adopting a healthy lifestyle. The combination of perceived and objective measures using validated strategies will provide a robust assessment of the municipality environment. Through this analysis, the project will investigate to what extent community engagement can be a useful strategy to reduce health inequities. The strong knowledge exchange and capacity-building in a local setting is expected to contribute to our understanding of how to maximize research impact in this field and generate evidence about potential linkages between a health enhancing lifestyle among socioeconomically disadvantaged groups and their physical, food and social environments.

Exploring the demographic and situational characteristics of older British people experiencing loneliness as positive within the BBC loneliness experiment

OBJECTIVES

The aim of this study is to increase the understanding of loneliness experienced as positive, by exploring the demographic and situational characteristics of older people who experience loneliness as positive.

METHOD

Two binary logistic regressions were conducted using data from those aged 60+ from the BBC Loneliness Experiment (N = 5250).

RESULTS

The first binary logistic regression compared participants who experience loneliness always as positive (N = 219) to those participants who never experience loneliness as positive (N = 3004). Spending time alone did not emerge as relevant to experiencing loneliness as positive, but enjoying time alone was important (OR = 1.561 (95% CI = 1.313 - 1.856)). The lonelier older people were, the less likely they experienced loneliness as positive (OR = 0.708 (95% CI =0.644 - 0.779)). Men were more likely to experience loneliness as positive compared to women (OR = 1.734 (95% CI = 1.269 - 2.370)). Lastly, the experience of loneliness as positive was likely to decrease when older people had more years of education (OR = 0.887 (95% CI = 0.853 - 0.921)) but increased with age (OR = 1.067 (95% CI = 1.037 - 1.098)). The results of the second binary logistic regression comparing participants who indicated loneliness purely as positive with those participants indicate to experience loneliness sometimes as positive (N = 2027), are in line with the first regression analyses.

CONCLUSION

The results are critically discussed by emphasizing the role of norms and cultures, gerotranscendence, and severity of loneliness, which might influence the experiences of loneliness. Further qualitative research is needed to elucidate the meanings of these positive experiences of loneliness.

Civic engagement in serious illness, death, and loss: A systematic mixed-methods review

BACKGROUND

New public health approaches to palliative care such as compassionate communities aim to increase capacity in serious illness, death, and loss by involving civic society. Civic engagement has been described in many domains of health; a description of the characteristics, processes, and impact of the initiatives in palliative care is lacking.

AIM

To systematically describe and compare civic engagement initiatives in palliative care in terms of context, development, impact, and evaluation methods.

DESIGN

Systematic, mixed-methods review using a convergent integrated synthesis approach. Registered in Prospero: CRD42020180688.

DATA SOURCES

Six databases (PubMed, Scopus, Sociological Abstracts, WOS, Embase, PsycINFO) were searched up to November 2021 for publications in English describing civic engagement in serious illness, death, and loss. Additional grey literature was obtained by contacting the first authors. We performed a quality appraisal of the included studies.

RESULTS

We included 23 peer-reviewed and 11 grey literature publications, reporting on nineteen unique civic engagement initiatives, mostly in countries with English as one of the official languages. Initiatives involved the community in their development, often through a community-academic partnership. Activities aimed to connect people with palliative care needs to individuals or resources in the community. There was a variety of evaluation aims, methods, outcomes, and strength of evidence. Information on whether or how to sustain the initiatives was generally lacking.

CONCLUSIONS

This is the first review to systematically describe and compare reported civic engagement initiatives in the domain of palliative care. Future studies would benefit from improved evaluation of impact and sustainability.

The perceived obesogenic environment survey in the Flemish municipal context – the CIVISANO project

Background

The prevalence of obesity worldwide has been steadily increasing. This has generated an uptake in research determining the cause of obesity. One of the primary drivers that have been identified is the “obesogenic environment', which is an environment that contains features that increase excess weight in individuals or populations. Obesogenic environments are unevenly distributed with socio-economically disadvantaged neighbourhoods being more affected.

Methods

This survey is part of the CIVISANO (‘Community-based participatory research to tackle the disparities in health-enhancing lifestyle within the municipality environment') project, which will be conducted in two municipalities. Respondents will be socio-economically disadvantaged adults between 25- and 65-years old. To gain information on individual characteristics and perceptions of the obesogenic environment, residents will be invited to complete a survey. Since it is known that socio-economically disadvantaged respondents are difficult to reach a non-random active recruitment approach will be applied. The following variables are included in the survey: sociodemographic information, subjective health and anthropometrics, dietary habits, food security and physical activity. Items from the SPOTLIGHT project survey and NEMS-P survey were added to assess respondent's perceptions of features of the obesogenic environment. Additional variables on individual characteristics were based on items from the Belgian National Health Interview Survey of 2019.

Results

Through the survey, we expect to gain insight into the perceptions of socio-economically disadvantaged adults on obesogenic features of their local environment. Initial results from the survey will be available in the upcoming months.

Conclusions

The construction of instruments to assess the context-specific features, which can be compared with objective measurements, can increase our knowledge of contextual determinants of the obesogenic environment.

Key messages

The first Flemish survey that focuses on perceptions of socio-economically disadvantaged adults on obesogenic features of their local environment in the municipal context. Gaining a better understanding of the local obesogenic environment creates an opportunity to promote and strengthen the development of effective local interventions to build healthier environments.

'It's like a double-edged sword': understanding Confucianism's role in activity participation among first-generation older Chinese migrants in the Netherlands and Belgium

While activity participation in later life has attracted considerable attention from policymakers and scholars, indoor and outdoor engagement among older Chinese migrants in Europe is understudied. Using in-depth interviews with 21 older Chinese migrants in the Netherlands and seven in Belgium, this study is among the first to explore older Chinese migrants' activity participation experiences from the perspective of Confucianism, the cornerstone of Chinese culture. More specifically, the impact of four acknowledged principles of Confucianism are considered: hierarchical relationships, family system, benevolence and emphasis on education. The findings show that, like a double-edged sword, these four principles have positive and negative effects on older Chinese migrants' activity participation. Hierarchical relationships promote formal organisational participation, yet concurrently dividing the Chinese community into smaller subgroups and endangering solidarity within the community. With regard to family system, which emphasizes intergenerational responsibility and obligation, older Confucianist migrants prioritise taking care of their grandchildren, resulting in less time to participate in outdoor activities. Benevolence, the third principle of Confucianism, restrains older Chinese migrants from political participation while encouraging them to attend community meetings where food is shared. Lastly, emphasis on education, of which self-cultivation is an important aspect, helps older Chinese migrants overcome feelings of loneliness and makes them prefer self-learning activity above formal learning settings (e.g. language learning) organised by the government. The article ends with policy recommendations on how to increase older Chinese migrants' outdoor activities.

The relation between age of retirement and frailty in later life? A cross-sectional study in Flemish older adults

BACKGROUND

Policymakers in several European countries, concerned about the sustainability of their pension system, have raised the statutory retirement age. While several studies investigated the effect of retirement on health, the relationship between retirement and frailty is neglected. Notwithstanding, frailty is associated with adverse outcomes.

OBJECTIVE

The aim of this study was to examine the relationship between age of retirement and frailty in later life.

METHODS

Data of the Belgian Ageing Studies, a cross-sectional research project was used. The present study includes N=12659 participants (>60y) in 83 Flemish municipalities. To address reverse causality, only participants not retired because of health-related reasons were included. The Comprehensive Frailty Assessment Instrument, a multidimensional frailty scale with four domains (physical, psychological, social and environmental) was used to operationalize frailty. Univariate general linear regression analyses (GLM) were performed for scores on the total frailty scale and the four subdomains separately. The analysis was done for men and women separately, since both groups have different labor trajectories.

RESULTS

The present study found a negative association between age of retirement and physical frailty for both men and women in later life, and total frailty for men, although the differences were small. No evidence was found for a relation between age of retirement and the other subdomains of frailty.

CONCLUSIONS

The results suggest that age of retirement is not a clinically relevant predictor for frailty in later life. Differences within and between subpopulations (e.g., profession) can shed a new light on this relation.

Older Chinese migrants in coronavirus pandemic: exploring risk and protective factors to increased loneliness

Older migrants may be one of the most vulnerable populations during the coronavirus pandemic, yet the degree of impact remains largely unknown. This study explores (1) the consequences of the coronavirus pandemic for older Chinese migrants in Belgium and the Netherlands in terms of increased loneliness and its risk factors (reduced in-person contact, decreased social participation, feelings of existential threat) and protective factors (increased non-in-person contact, more individual activities), and (2) which risk and protective factors have contributed to the incidence and prevention of higher loneliness levels. Using quantitative data of a survey among 98 Chinese migrants aged 50 years and older in Belgium (n = 84) and the Netherlands (n = 14), the findings first indicate that the coronavirus pandemic has a significant impact on older Chinese migrants' lives. One in five experienced more loneliness. Second, reduced social participation (measured as less frequent participation in outdoor group activities) and financial insecurity (measured as experiencing financial difficulties) lead to higher than pre-pandemic loneliness levels. Problem-focused coping strategies (measured as increased non-in-person contact, via telephone or social media) and emotion-focused coping (measured as finding distraction through increased participation in individual activities) were not found to protect against increased loneliness in the pandemic. Two practical implications for loneliness interventions for older Chinese migrants are put forward. Organizing COVID-19-safe social participation activities and paying more attention to older Chinese migrants' financial situation can be beneficial when addressing higher levels of loneliness due to the coronavirus pandemic.

[Treatment of GERD in asthma]

Gastro-oesophageal reflux disease (GORD) is one of the most frequent conditions associated with asthma. GORD has an impact on asthma control and quality of life of asthmatic patients. Its treatment relies on lifestyle modifications, anti-acidic treatment with proton pump inhibitors (PPI) and/or surgical management by fundoplication in some situations. The impact of lifestyle modifications has not been analysed on asthma outcomes alone. Several randomised controlled trials assessed the efficacy of PPI on asthma control, peak expiratory flow and/or quality of life. The impact of fundoplication in asthma has mainly been analysed in retrospective or prospective observational studies. This review highlights the limited impact of GORD treatment on asthma control. Current guidelines are to restrict GORD treatment in asthma to asthmatic patients with actual symptomatic GORD. Given the lack of controlled studies, the place of surgical management of GORD in asthma is currently not defined.

The association between perceived social and physical environment and mental health among older adults: mediating effects of loneliness

Objectives: Despite growing interest in the impact of physical and social environment on mental health, data are lacking on the potential mediating effects of loneliness. We examined it in the association of several social and physical environmental characteristics with mental health among older adults in three municipalities in Flanders (Belgium).Methods: A total of 869 people aged 60 and over were interviewed. Loneliness was assessed through the De Jong Gierveld short scales for emotional and social loneliness. Social participation and social cohesion were assessed following the Neighborhood scales whereas physical environment characteristics were selected from the Neighborhood Environment Walkability Scale. Mental health was assessed through subscale psychological frailty of the Comprehensive Frailty Assessment Instrument plus (CFAI-plus). Linear regression models, including mediation analysis, were used to analyze the survey data.Results: After adjusting for individual characteristics, physical and social environment factors were significantly related to mental health with the significant mediation of emotional and social loneliness. Percentages mediated by both dimensions together were 61% for social cohesion, 43% for social participation, 35% for safety and 25% for mobility. Compared with social loneliness, emotional loneliness was a stronger mediating factor, particularly for mobility and safety. No significant associations between traffic density or basic service availability and mental health were found.Discussion: Improving the social and physical environment might result in a reduction in the prevalence of loneliness and in consequent improvement of mental health among older adults. Special attention should be paid to different types of loneliness.

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.

Gender-related differences in the relationship between social and activity participation and health and subjective well-being in later life

A growing body of work suggests that social and activity participation (SAP) may contribute to health and well-being. Studies examining the effects of these activities largely focused on healthy older adults and older adults with more resources, not on frail older adults. On the latter, there is a lack of information about which activities contribute most and whether their effects vary between men and women given the gender-differentiated social roles. To address these gaps we extracted longitudinal data from the D-SCOPE frailty program for 380 participants aged 60 years or older residing in Belgium. Structural equation models tested the relationships between six levels of SAP based on a taxonomy of social activities (Levasseur et al., 2010) - from level 1 (for oneself) to level 6 (for others) - on longitudinal changes in physical and mental deterioration, well-being, and gender differences within these relationships. Results first show that older adults at risk of frailty benefit longitudinally from participating in activities in terms of their physical deterioration and well-being. Second, socially oriented activities were significantly associated with lower levels of physical deterioration and higher levels of subjective well-being (SWB), and volunteering with higher levels of SWB. Heterogeneity of activities, regardless of level on the taxonomy of social activities, seems to benefit SWB and counteract physical deterioration. Third, gender differences were confirmed by two activities for women (alone, task-oriented) and three activities for men (alone, being with others, task-oriented e.g. associational membership). Results imply that the activity itself may play a more important role than the nature of social involvement and social interaction in relation to health and wellbeing.

[Obesity and asthma: Mechanisms and therapeutic options]

Asthma and obesity are both common conditions, which lead to a substantial public health burden. The obese-asthma phenotype is characterized by poor asthma control, impaired lung function and decreased efficacy of inhaled treatment. However, this phenotype is highly heterogeneous and involves numerous mechanisms, including systemic inflammation and adipokines. A role for microbiota modifications and genetics has been suggested. Obese-asthma patient management currently consists in weight loss and usual anti-asthmatic treatment. New therapeutic options are being evaluated.

ARE LEISURE AND CIVIC ACTIVITIES REINFORCING WELL-BEING IN OLDER ADULTS AT RISK OF FRAILTY?

A growing body of work suggest that leisure and civic activities may contribute to the understanding of healthy aging. Yet, only a limited number of studies have examined a less healthy population. Moreover, a broad array of leisure and civic activities tend to be lacking. This paper gives insight into the mechanisms underlying the associations between multidimensional frailty, and well-being with the moderating roles of leisure and civic activities. A two-wave interview survey from the D-SCOPE frailty program was derived using 441 participants aged 60 years and older residing in the Flanders region of Belgium. This study offers evidence that leisure and civic activities buffered the negative relationship between multidimensional frailty and well-being. Moreover, our study identified that for different frailty domains the buffering/moderating role of leisure and civic activities differs in relation to well-being.

A BELGIAN VIEW ON BEING RETIRED BUT NOT OUT OF WORK

Retirement is no longer merely the end of a productive life. This changing nature of retirement challenges the common definitions of retirement – that define retirement primarily by what it is not (i.e. no longer working). The aim of this paper is to gain insight into the activity patterns of individuals who recently retired from a full-time job in relation with their well-being. We use data from a qualitative study in which we conducted semi-structured interviews with 45 individuals who retired one to two years ago in Belgium. We used a hybrid approach of inductive and deductive thematic analysis. Our findings demonstrate that most of the people who are retired from their full-time job remain active within society. First, productive activities, including work and civic engagement. Second, consumer-oriented activities comprising leisure and social contacts. The results suggest that being active, regardless of the type of activity, contributes to well-being.

THE IMPORTANCE OF LOW SOCIAL LONELINESS FOR MAINTAINING GOOD WELL-BEING

Older people are often confronted with dependence, death of spouse and other loss experience. Nevertheless, older adults generally experience a good well-being. This lack of age-related decline of subjective well-being has been named the ‘paradox of ageing’. One possible explanation for this paradox can be found in the socio-emotional selectivity theory of Carstensen. Thus, we hypothesize that low emotional and/or low social loneliness can act as a buffer for the negative relationship between negative life events and well-being. We use data of the D-SCOPE project that includes 869 older community-dwelling adults at risk of frailty residing in Flanders. By means of regression moderating analyses the research gains insights into the relationships between older people and well-being where the absence of social loneliness is detected as a possible buffer against negative outcomes. The discussion develops the argument that the absence of loneliness is a crucial facet for maintaining a good well-being.

Randomized controlled trial to evaluate a prevention program for frail community-dwelling older adults: a D-SCOPE protocol

BACKGROUND

Frail community-dwelling older adults, whom might experience problems regarding physical, cognitive, psychological, social and environmental factors, are at risk for adverse outcomes such as disability, institutionalization and mortality. People in need of help do not always find their way to care and support services and are left undetected. The aim of the D-SCOPE project is to detect frail community-dwelling older adults who previously went unnoticed and to improve their access to care and support. Goal is to increase their frailty-balance, quality of life, meaning in life, life satisfaction, mastery, community inclusion and ageing well in place.

METHODS/DESIGN

The study is a prospective, longitudinal randomized four-armed controlled trial with follow-up at 6 months. The study group aims to include 900 community-dwelling older adults aged 60 years and over from 3 municipalities in Flanders (Belgium). While selecting the study group, risk profiles for frailty will be taken into account. Participants will be randomly selected from the census records in each municipality. Data will be collected prospectively at baseline (T0) and at follow-up, 6 months after baseline (T1). At baseline, participants who are at least mild frail on one of the 5 domains of frailty (CFAI-plus) or feel frail based on the subjective assessment of frailty will be randomly assigned to (1) the study group or (2) the control group. A mixed method design with the inclusion of quantitative and qualitative data analyses will be used to evaluate the efficacy and experiences of the detection and prevention program on frailty.

DISCUSSION

The study will contribute to an innovative vision concerning the organization of care and support, and a timely and accurate detection and support of community-dwelling older adults at risk for frailty.

TRIAL REGISTRATION

This trial was registered at ClinicalTrials.gov, on May 26, 2017, identifier: NCT03168204 .

CFAI-Plus: Adding cognitive frailty as a new domain to the comprehensive frailty assessment instrument

OBJECTIVES

Cognitive frailty is characterized by the presence of cognitive impairment in exclusion of dementia. In line with other frailty domains, cognitive frailty is associated with negative outcomes. The Comprehensive Frailty Assessment Instrument (CFAI) measures 4 domains of frailty, namely physical, psychological, social, and environmental frailty. The absence of cognitive frailty is a limitation.

METHOD

An expert panel selected 6 questions from the Informant Questionnaire on Cognitive Decline that were, together with the CFAI and the Montreal cognitive assessment administered to 355 older community dwelling adults (mean age = 77).

RESULTS

After multivariate analysis, 2 questions were excluded. All the questions from the original CFAI were implemented in a principal component analysis together with the 4 cognitive questions, showing that the 4 cognitive questions all load on 1 factor, representing the cognitive domain of frailty. By adding the cognitive domain to the CFAI, the reliability of the adapted CFAI (CFAI-Plus), remains good (Cronbach's alpha: .767).

CONCLUSIONS

This study showed that cognitive frailty can be added to the CFAI without affecting its good psychometric properties. In the future, the CFAI-Plus needs to be validated in an independent cohort, and the interaction with the other frailty domains needs to be studied.

Frailty differences in older adults' use of informal and formal care

OBJECTIVES

This study examines different combinations of informal and formal care use of older adults and investigates whether these combinations differ in terms of need for care (physical and psychological frailty) and enabling factors for informal and formal care use (social and environmental frailty).

METHODS

Using cross-sectional data from the Belgian Ageing Studies (survey, N = 38,066 community-dwelling older adults), Latent Class Analysis (LCA) is used to identify combinations of informal and formal care use. Bivariate analyses are used to explore the relationship between the different combinations of care use and frailty.

RESULTS

Latent Class Analysis (LCA) identified 8 different types of care use, which vary in combinations of informal and formal caregivers. Older adults who are more likely to combine care from family and care from all types of formal caregivers are more physically, psychologically and environmentally frail than expected. Older adults who are more likely to receive care only from nuclear family, or only from formal caregivers are more socially frail than expected.

CONCLUSIONS

Older adults with a higher need for care are more likely to receive care from different types of informal and formal caregivers. High environmental frailty and low social frailty are related with the use of care from different types of informal and formal caregivers. This study confirms that informal care can act as substitute for formal care. However, this substitute relationship becomes a complementary relationship in frail older adults. Policymakers should take into account that frailty in older adults affects the use of informal and formal care.

Detecting frail, older adults and identifying their strengths: results of a mixed-methods study

Background

The debate on frailty in later life focuses primarily on deficits and their associations with adverse (health) outcomes. In addition to deficits, it may also be important to consider the abilities and resources of older adults. This study was designed to gain insights into the lived experiences of frailty among older adults to determine which strengths can balance the deficits that affect frailty.

Methods

Data from 121 potentially frail community-dwelling older adults in Flemish-speaking Region of Belgium and Brussels were collected using a mixed-methods approach. Quantitative data were collected using the Comprehensive Frailty Assessment Instrument (CFAI), Montreal Cognitive Assessment (MoCA), and numeric rating scales (NRS) for quality of life (QoL), care and support, meaning in life, and mastery. Bivariate analyses, paired samples t-tests and means were performed. Qualitative data on experiences of frailty, frailty balance, QoL, care and support, meaning in life, and mastery were collected using semi-structured interviews. Interviews were subjected to thematic content analysis.

Results

The “no to mild frailty” group had higher QoL, care and support, meaning in life, and mastery scores than the “severe frailty” group. Nevertheless, qualitative results indicate that, despite being classified as frail, many older adults experienced high levels of QoL, care and support, meaning in life, and mastery. Respondents mentioned multiple balancing factors for frailty, comprising individual-level circumstances (e.g., personality traits, coping strategies, resilience), environmental influences (e.g., caregivers, neighborhood, social participation), and macro-level features (e.g., health literacy, adequate financial compensation). Respondents also highlighted that life changes affected their frailty balance, including changes in health, finances, personal relationships, and living situation.

Conclusion

The findings indicate that frailty among older individuals can be considered as a dynamic state and, regardless of frailty, balancing factors are important in maintaining a good QoL. The study investigated not only the deficits, but also the abilities, and resources of frail, older adults. Public policymakers and healthcare organizations are encouraged to include these abilities, supplementary or even complementary to the usual focus on deficits.

Dynamics in motivations and reasons to quit in a Care Bank: a qualitative study in Belgium

The aim of this study was to contribute to the understanding of why volunteers in a time bank known as "NeighborhoodPension," which involves community-based care, are motivated to start, continue, and quit volunteering. The time bank started in 2013 and is the first time bank in Brussels, Belgium. A planned prospective longitudinal study involving qualitative focus group interviews was used to study a group of volunteers at four time points over 1 year. There were two main themes, the first of which pertains to older adults' motives for volunteering with the time bank. These motives are largely attributable to the volunteer organization's contextual factors. The second theme focuses on reasons for quitting volunteering. Factors for retaining volunteers relate strongly to the purpose of the volunteer organization. Co-production (i.e., engaging the volunteers in the design of the project) and having an attention officer (i.e., a confidant who listens to the volunteers' worries) are examples of retention strategies. Moreover, earning time credits did not appear to be a motive for continued volunteering. These theoretical perspectives could help to improve organizational support of volunteers and increase the participation of older citizens in community-based volunteering. The complexity associated with retaining volunteers stems from the fact that although initial motives for volunteering are generally clearly defined, other contextual factors (such as relationships with other volunteers and organizational structure) change the initial motives and can result in volunteer turnover.

[Detection and prevention in later life: risk profiles for physical, psychological, social and environmental frailty.]

In order to provide proactive care and support for older people attention is needed for the prevention of frailty among older adults. Subsequently, accurate case finding of those who are more at risk of becoming frail is crucial to undertake specific preventive actions. This study investigates frailty and risk profiles of frailty among older people in order to support proactive detection. Hereby, frailty is conceived not only as a physical problem, but also refers to emotional, social, and environmental hazards. Using data generated from the Belgian Ageing Studies (N = 21,664 home-dwelling older people), a multinomial logistic regression model was tested which included socio-demographic and socio-economic indicators as well as the four dimensions of frailty (physical, social, psychological and environmental). Findings indicate that for both men and women having moved in the previous 10 years and having a lower household income are risk factors of becoming multidimensional frail. However, studying the different frailty domains, several risk profiles arise (e. g. marital status is important for psychological frailty), and gender-specific risk groups are detected (e. g. non-married men). This paper elaborates on practical implications and formulates a number of future research recommendations to tackle frailty in an ageing society.

Identifying frailty risk profiles of home-dwelling older people: focus on sociodemographic and socioeconomic characteristics

OBJECTIVES

This paper investigates risk profiles of frailty among older people, as these are essential for detecting those individuals at risk for adverse outcomes and to undertake specific preventive actions. Frailty is not only a physical problem, but also refers to emotional, social, and environmental hazards.

METHODS

Using data generated from the Belgian Ageing Studies, a cross-sectional study (n = 28,049), we tested a multivariate regression model that included sociodemographic and socioeconomic indicators as well as four dimensions of frailty, for men and women separately.

RESULTS

The findings indicated that for both men and women, increased age, having no partner, having moved house in the previous 10 years, having a lower educational level and having a lower household income are risk characteristics for frailty. Moreover, when looking at the different frailty domains, different risk profiles arose, and gender-specific risk characteristics were detected.

DISCUSSION

This paper elaborates on practical implications, and formulates a number of future research recommendations to tackle frailty in an aging society. The conclusion demonstrates the necessity for a thorough knowledge of risk profiles of frailty, as this will save both time and money and permit preventive actions to be more individually tailored.

Does active ageing contribute to life satisfaction for older people? Testing a new model of active ageing

Several debates have emerged across the literature about the conceptualisation of active ageing. The aim of this study is to develop a model of the construct that is focused on the individual, including different elements of people's lives that have the potential to be modified by intervention programs. Moreover, the paper examines the contributions of active ageing to life satisfaction, as well as the possible predictive role of coping styles on active ageing. For this purpose, a representative sample of 404 Galician (Spain) community-dwelling older adults (aged ≥60 years) were interviewed using a structured survey. The results demonstrate that the proposed model composed of two broad categories is valid. The model comprises status variables (related to physical, psychological, and social health) as well as different types of activities, called processual variables. This model is tested using partial least squares (PLS) regression. The findings show that active ageing is a fourth-order, formative construct. In addition, PLS analyses indicate that active ageing has a moderate and positive path on life satisfaction and that coping styles may predict active ageing. The discussion highlights the potential of active ageing as a relevant concept for people's lives, drawing out policy implications and suggestions for further research.