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Loneliness and Risk of Dementia
Abstract
Objective:
The present study tests whether loneliness is associated with risk of dementia in the largest sample to date and further examines whether the association is independent of social isolation, a related but independent component of social integration, and whether it varies by demographic factors and genetic vulnerability.
Method:
Participants from the Health and Retirement Study (N = 12,030) reported on their loneliness, social isolation, and had information on clinical, behavioral, and genetic risk factors. Cognitive status was assessed at baseline and every 2 years over a 10-year follow-up with the modified Telephone Interview for Cognitive Status (TICSm). A TICSm score of 6 or less was indicative of dementia.
Results:
Cox proportional hazards regression indicated that loneliness was associated with a 40% increased risk of dementia. This association held controlling for social isolation, and clinical, behavioral, and genetic risk factors. The association was similar across gender, race, ethnicity, education, and genetic risk.
Discussion:
Loneliness is associated with increased risk of dementia. It is one modifiable factor that can be intervened on to reduce dementia risk.
... However, their 6-year longitudinal analyses indicated no significant relationship between loneliness and cognitive decline. Sutin et al. (2020) examined participants 50 years and older over a period of 10 years, where dementia (TICS score of less than six) was the outcome of interest. Their results indicated that for every one-point increase in loneliness, the risk of developing dementia increased by 40%. ...
... Further, we underscore that the impact of stigma and disclosure of loneliness may different and even be magnified in minoritized groups (Black and Latino groups). Despite these important theoretical differences, only one US study (Sutin et al., 2020) has explored the relationship between loneliness and cognitive functioning using both direct and indirect assessments. Sutin and colleagues found similar results using the 3-item UCLA scale and the one-item CES-D loneliness assessment. ...
... Additionally, our study was cross-sectional. Prior studies indicating loneliness (UCLA loneliness scale; De Jong-Giervald Loneliness Scale) is inversely associated with cognitive functioning followed samples over 6 to 10 years on average (Wilson et al., 2007(Wilson et al., , 2015Griffin et al., 2020;Sutin et al., 2020). Further, samples from Wilson et al. (2007Wilson et al. ( , 2015 had mean ages in the 80s. ...
Introduction
Few studies have examined the association of loneliness and cognitive functioning in the US. We used two common measures of loneliness and examined their association in a large sample of US Black, Latino, and White adults (ages ≥ 50).
Methods
We analyzed Wave 3 of the National Social Life, Health, and Aging Project (N = 2,757). We examined loneliness using one item from the CES-D and the Felt Loneliness Measure (NFLM); cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA) tool, where higher scores indicated better functioning. We used weighted ordinary least squares regressions to examine the effects of loneliness (CES-D loneliness and NFLM in separate models) on MoCA scores. In exploratory analyses, we examined if these relationships varied by race and ethnicity. We adjusted all models for sociodemographic and other salient factors (e.g., chronic disease, depressive symptoms, living alone).
Results
Mean age was 63.49 years, 52% were female, and 9% were Black and 6% Latino persons. Approximately 54% endorsed feeling lonely on at least one measure; 31% (CES-D) and 46% (NFLM). The relationship between loneliness measures was positive and significant, X² (1, N = 2,757) = 435.493 p < 0.001. However, only 40% of lonely individuals were identified as lonely on both assessments. CES-D loneliness was inversely (βˆ = −0.274, p = 0.032) associated with MoCA scores and this association did not vary by race and ethnicity. Greater NFLM loneliness was positively associated (βˆ = 0.445, p < 0.001) with higher MoCA scores for Latino participants only.
Discussion
Loneliness appears to be an important predictor of cognitive functioning. However, the association of loneliness and cognitive functioning varied when using the CES-D loneliness item or the NFLM. Future work is needed to understand how loneliness and its clinically relevant dimensions (social, emotional, existential, chronicity) relate to global and individual cognitive domains. Research is needed with racially and ethnically diverse midlife and older adults, particularly to understand our counterintuitive finding for Latino participants. Finally, findings also support the need for research on interventions to prevent cognitive decline targeting loneliness.
... Consequently, the composite score ranges from 0 to 27, with participants scoring 6 or below classified as having dementia. Previous studies have validated the TICS-m for dementia screening [34][35][36]. ...
... Second, the onset of dementia was identified through the composite objective scale rather than multidimensional geriatric assessment, including clinical syndrome with specific criteria and loss of independence in everyday task, which might undermine the clinical implication of our findings. However, previous studies have indicated that TICS-m was validated for the screening of dementia [34][35][36]. Third, despite that our sensitivity analysis concerning different ways to measure three life-course stages cognitive reserve-enhancing factors showed similar results, other variables, such as job complexity, social participation could also reflect cognitive reserve. Comprehensive evaluation on cognitive reserve with more kinds of enhancing factors during the life course will be conducted in the future. ...
Purpose
To explore the relationship between adverse childhood experiences (ACEs) and incident dementia, and examine the mediating effect of cognitive reserve-enhancing factors from life course perspective. Further, we verified the heterogeneities of associations of ACEs, enhancing factors, and dementia by dementia genetic risk.
Methods
Data was from the US Health and Retirement Study, involving 51,327 observations (50+) with a 10-year follow-up. Dementia was determined by the modified Telephone Interview for Cognitive Status. Six ACEs were assessed from two dimensions namely financial adversity and childhood trauma. Cognitive reserve-enhancing factors were rated during three periods of life-course, namely early-life stage (educational attainment,), adulthood (household income) and late-life stage (weekly physical activity). Genetic risk was evaluated by polygenic risk score for Alzheimer’s disease. Cox regression models were conducted to examine the association between ACEs and dementia risk where ACEs were deemed as a continuous variable. “Mediation” package in R was used to test the mediating effect. Subgroup analysis was conducted to verify the heterogeneity of dementia genetic risk.
Results
Participants with one additional number of ACEs was associated with increased risk of dementia (HR = 1.08, 95% CI: 1.02, 1.16). The correlation of the number of ACEs and dementia was fully mediated by early-life stage enhancing factor and partially mediated by adulthood enhancing factor. The above mediating roles only exist among those with moderate and high dementia genetic risk.
Conclusion
Exposure to a larger number of ACEs is significantly linked to dementia, and cognitive reserve-enhancing factors might mediate this association. Early interventions on the adverse life condition and emphasis on older adults with moderate and high genetic dementia risk were recommended.
... A 3-year cohort study conducted in China indicated that lonely men were at an increased risk of dementia compared with lonely women [53]. Another study conducted in the United States found a significant interaction with the age of the participants; interestingly, the results suggested that advanced age may displace the negative impact of loneliness, and the results revealed a stronger association between loneliness and dementia among younger participants compared with that among older participants [54]. Similarly, a previous literature review revealed a stronger association between social deficit and mortality in individuals younger than 65 years [55]. ...
This narrative review focused on research investigating the impact of loneliness on the prevalence of dementia and its relationship with other risk factors. A comprehensive and rigorous search was conducted using a variety of scientific databases with specific keywords to identify all prior studies that examined the correlation between dementia and loneliness. The inquiry was confined to articles published in English from January 2017 to March 2024. The narrative review identified a consensus regarding the role of loneliness in enhancing the risk of all‐cause dementia, with a particular emphasis on the subjective perception of loneliness. This phenomenon may be caused by the sensations of exclusion, discrimination, and alienation that are typically associated with low self‐esteem and low life satisfaction, which may contribute to cognitive impairment and depressive symptoms. This finding was obtained despite the absence of robust evidence regarding the involvement of loneliness in the pathogenesis of dementia. Existing research has not yet identified a correlation between hereditary factors that influence the development of dementia and feelings of loneliness. However, loneliness is strongly associated with depression, which is a potential risk factor for dementia. Previous studies have reported a moderate correlation between depression and loneliness, as individuals who are isolated and lack a sense of community exhibit higher levels of depression. Meditation, social cognitive training, and social support are three strategies that have been implemented to address loneliness and are reported to be the most effective interventions. A strong correlation exists between dementia and loneliness. Although such strategies are unlikely to impede the progression of the disease if cognitive deterioration is already underway, understanding these associations can assist in the development of strategies to alleviate the effects of loneliness on vulnerable individuals.
... Social isolation, limited physical activity, poor health, and psychological factors contribute to feelings of loneliness, which can lead to a range of adverse health outcomes (Dahlberg et al., 2018, Rico-Uribe et al., 2018, Domenech-Abella et al., 2019. Loneliness is associated with depression, anxiety, cardiovascular issues, cognitive decline, and unhealthy behaviors, such as smoking and poor sleep (Hedley et al., 2018, Domenech-Abella et al., 2019, Hajek and Konig, 2019, Lee et al., 2019, Peltzer and Pengpid, 2019, Park et al., 2020, Rafnsson et al., 2020, Sutin et al., 2020. In addition, social isolation and a lack of social networks are linked to poor life satisfaction and reduced well-being, making loneliness a significant concern for the aging population. ...
Introduction: Loneliness presents a significant threat to the mental and physical health of older adults in Indonesia, constituting a pressing public health concern. The study aims to determine the prevalence of loneliness and identify the factors associated with loneliness among older adults in Indonesia. Methods: A cross-sectional analysis was conducted using data from the fifth wave of the Indonesian Family Life Survey (IFLS-5). Sociodemographic, loneliness, and health-related variables were examined through multivariate logistic regression to identify factors associated with loneliness. Results: High levels of loneliness were reported by 11.2% of participants, while 88.8% experienced low levels. Significant factors included lower educational attainment (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [CI] = 1.43–2.93, p < 0.001), life dissatisfaction (AOR = 1.55, 95% CI = 1.16–2.06, p = 0.003), and poor sleep quality (AOR = 2.32, 95% CI: 1.72–3.39, p < 0.001). Geographic location also emerged as a significant factor; participants residing in Sumatra were less likely to report loneliness (AOR = 0.64, 95% CI = 0.42–0.99, p = 0.049). Other variables, such as self-rated health, chronic conditions, religious participation, and cell phone ownership, showed significance in unadjusted models but were no longer statistically significant after adjustments were made. Conclusion: The findings underscore the necessity for targeted interventions to mitigate loneliness among older adults in Indonesia. Such interventions should focus on improving health, enhancing social support, and fostering connectivity, with the aim of elevating the quality of life and alleviating loneliness within this vulnerable population.
... Social well-being holds particular significance in older age, as feelings of loneliness and disconnection can lead to various health risks (Jaremka et al., 2013;Steptoe et al., 2013). These include an increased risk of developing symptoms of dementia and mild cognitive impairment in older adults (Sutin et al., 2018), as well as depressive symptoms in people with dementia (Tsai et al., 2020). Further, challenges of social well-being are particularly exacerbated when transitioning to nursing homes as relocating to a nursing home involves accepting the loss of familiar surroundings and adapting to a new environment (Altıntaş et al., 2017). ...
Background: This study aimed to explore stakeholders’ perspectives on implementing non-digital leisure activities to promote social interaction in dementia and eldercare settings. Methods: A secondary analysis of online semi-structured interviews was conducted, focusing on nine stakeholders with expertise in dementia and eldercare. The data collected were analyzed using inductive qualitative thematic analysis to identify key themes and insights. Results: Three key themes emerged, emphasizing inclusivity, usability, and context. Stakeholders highlighted the importance of tailored activities, ease of use, and privacy. Challenges included resource allocation and availability. The findings underscore the significance of supporting innovations in both digital and non-digital leisure activities within dementia and eldercare settings. Clinicians and policymakers should consider integrating inclusive activities into care plans to enhance social interaction for older adults. Future research should focus on identifying optimal levels of engagement and evaluating the effectiveness of leisure activities in promoting well-being among older adults in diverse settings. Conclusion: Despite current limitations, stakeholders affirmed the value of non-digital leisure activities, such as board games, for enhancing social interaction and well-being in dementia and eldercare settings. Integrating non-digital and digital activities was seen as promising for meeting diverse needs.
... In recent years, there has been increasing interest in understanding the relationship between loneliness and cognitive function. Four systematic reviews ( 13 , 30-32 ) and more recent cross-sectional (33)(34)(35) and longitudinal (36)(37)(38)(39)(40) studies have found a significant inverse relationship between loneliness and cognitive function. To date, most of the literature on loneliness and cognitive function in older adults has focused on samples from high-income coun-tries, and it has been mostly published in English ( 13 , 30-32 ). ...
... Loneliness is the distressing experience associated with a cognitive discrepancy between perceived and desired social connection [1][2][3]. The health impacts of loneliness are profound and varied, including heightened risk of cardiovascular disease, weakened immune function, anxiety, depression, cognitive decline, and even premature mortality [4][5][6]. While loneliness is an inherently personal experience, it results from a complex interplay of factors across different levels of analysis (e.g., family/household membership, cultural/societal norms, and policies/legislation). ...
Loneliness, a significant public health issue, was exacerbated during the COVID-19 pandemic, particularly in disaster-prone regions like the U.S. Gulf Coast. This study examined how social and built environmental factors were associated with pandemic-related disruptions and loneliness among respondents from the third wave of the Survey of Trauma, Resilience, and Opportunity among Neighborhoods in the Gulf (STRONG). Using a retrospective measure of loneliness (pre-pandemic vs. during pandemic), we found that loneliness increased significantly during the pandemic. Using a measure of routine behavior disruptions and measures of both objective (e.g., parks, walkability, etc.) and subjective (e.g., neighborhood safety, social cohesion, etc.) environmental factors, we found that disruptions to daily routines strongly predicted higher loneliness, and subjective measures, such as neighborhood safety, social cohesion, and lacking post-disaster social support, were more salient predictors of loneliness than objective factors such as the number of parks in one’s neighborhood. Difficulty accessing green spaces and housing distress were linked to greater COVID-19 disruptions, indirectly contributing to loneliness. These findings highlight the importance of safe, supportive, and accessible social and physical environments in mitigating loneliness and enhancing community resilience during crises.
... This percentage increased to 12.7% among those aged 40-50 and to 17.9% among individuals aged 50-59 (Röhr et al., 2021). Moreover, people who experience social isolation later in life are up to 40% more likely to develop dementia (Sutin et al., 2020). Due to the increased perception and incidence of social isolation in older adults, it is imperative to further understand the effect of social isolation on cognitive and metabolic function in this population. ...
The effects of social isolation (SI) during middle age remain unclear, so we tested the hypothesis that SI would lead to an increase in impulsive choice (IC), anxiety‐like behavior, and metabolic dysfunction in middle‐aged rats. Male and female rats were housed individually or in groups of four with same‐sex housing mates at 11 months of age. Two months later, IC behavior was assessed using a delay‐discounting task and anxiety‐like behavior through a novelty‐suppressed feeding (NSF) task. Lastly, glucose tolerance and insulin sensitivity following exposure to a high‐fat diet were assessed using an oral glucose tolerance test (OGTT) and an insulin tolerance test (ITT). The results showed that socially isolated rats displayed more IC behavior than did group‐housed rats of both sexes. However, no significant effect of housing was evident in the NSF task, OGTT, or ITT. Male rats had a higher plasma insulin concentration and insulin resistance index compared to females. Our findings demonstrate that SI in middle age is sufficient to increase IC behavior and highlight inherent sex‐specific differences in metabolic profiles. These findings underscore the importance of investigating mechanisms that underlie the effects of social isolation during different stages of life.
... During a multi-year study of data from the Health and Retirement Study, loneliness was associated with a 40% increased risk of dementia regardless of race, gender, ethnicity, education, or genetic risk factors. 65 A 2018 meta-analysis indicated that loneliness was linked to all-cause mortality. 66 Furthermore, a recent report, listed rural residents, among others, as at-risk groups in terms of social disconnection. ...
Older adults face distinct challenges related to aging, including social connectedness and isolation. Solutions, such as age-friendly community designs, can mitigate these issues. Older rural residents experience health disparities, compounded by factors like race, ethnicity, and socioeconomic status. Analyzing these experiences is complex due to intersecting factors (e.g., race, rurality). Tailored evidence-based programs and policies are essential. Embedding interventions sensitive to individual experiences and ongoing public health surveillance are crucial for improving outcomes among rural older adults.
... Several studies have shown that in older adults experiencing loneliness, there was an association between loneliness and reduced cognitive functioning across multiple cognitive domains, as well as a heightened risk of dementia compared to non-lonely individuals [10,11]. It was shown that only chronic loneliness was associated with these negative outcomes, in contrast to transient loneliness, which might be considered protective against the development of dementia [12][13][14]. Loneliness may also be associated with poor health behaviours, such as decreased physical activity and more rapid motor decline in older age, as well as increased disability [15]. Furthermore, chronic loneliness, rather than transient loneliness, was an independent risk factor for functional disability in middle-aged and older adults [16]. ...
Background:
Neurocognitive disorders (NCDs) have a variable decline in cognitive function, while loneliness was associated with cognitive impairment and increased dementia risk. In the present study, we examined the associations of loneliness with functional and cognitive status in patients with minor (mild cognitive impairment) and major NCDs (dementia).
Methods:
We diagnosed mild NCD (n = 42) and major NCD (n = 164) through DSM-5 criteria on 206 participants aged > 65 years using the UCLA 3-Item Loneliness Scale (UCLA-3) to evaluate loneliness, the activities of daily living (ADL) and the instrumental activities of daily living (IADL) scales to measure functional status, and Mini-Mental State Examination (MMSE) to assess cognitive functions.
Results:
In a multivariate regression model, the effect of loneliness on cognitive functions was negative in major (β = -1.05, p < 0.0001) and minor NCD (β = -0.06, p < 0.01). In the fully adjusted multivariate regression model (sex-age-education-multimorbidity-depressive symptoms-antidementia drug treatment), the effect of loneliness remained negative for major NCD and became positive for minor NCD (β = 0.09, p < 0.001). The effect of loneliness on IADL (β = -0.26, p < 0.0001) and ADL (β = -0.24, p < 0.001) showed a negative effect for major NCD across the different models, while for minor NCD, the effect was positive (IADL: β = 0.26, p < 0.0001; ADL: β = 0.05, p = 0.01). Minor NCD displayed different levels of MMSE (β = 6.68, p < 0.001) but not ADL or IADL, compared to major NCD for the same levels of loneliness. MANOVA pill test suggested a statistically significant and different interactive effect of loneliness on functional and cognitive variables between minor and major NCDs.
Conclusions:
We confirmed the relationships between loneliness and cognitive and functional status in major NCD, observing a novel trend in minor NCD.
... This association held controlling for social isolation and clinical, behavioural, and genetic risk factors. The association was similar across gender, race, ethnicity, education, and genetic risk (Sutin et al., 2020). Iden et al. (2015) found that loneliness was caused by health problems, functional impairment, dependency on care, urinary incontinence, and care related to that condition as a humiliating and significant cause of loneliness. ...
Loneliness and social isolation, which are significant determinants of both mortality and illness, demand immediate attention. They are critical public health and policy subjects, particularly for older people in long-term care institutions. This review delves into the profound impact of these feelings, such as loneliness, depressive symptoms, and social isolation, on their overall well-being. The objective of this study is to present a comprehensive examination of the characteristics associated with these feelings among older people residing in long-term facilities, drawing attention to this frequently disregarded subject matter. Following PRISMA guidelines, a comprehensive scoping review of articles published between 2010 and 2023 was conducted. Six databases (CINAHL, PubMed, Web of Science, Scopus, Google Scholar, and Oxford Academic) were searched for relevant articles about loneliness in nursing homes and long-term facilities. The final review, a comprehensive examination of 71 qualitative and quantitative studies, has resulted in seven main themes: sociodemographic factors, physical and mental health well-being, social network, the COVID-19 pandemic, meaningful activities, and loss of autonomy. These findings provide a robust foundation for understanding and addressing loneliness and social isolation among older people in long-term facilities. This scoping review has highlighted six themes, providing evidence and incentive for you, as healthcare professionals, researchers, and policymakers, to take a leading role in promoting person-centred care and educating your peers about the consequences of loneliness and social isolation. It is crucial to involve family, friends, and other multidisciplinary team members in care planning and decision-making, emphasizing the importance of collaborative efforts. Most importantly, it would be best to empower older adults to maintain their autonomy, engage in enjoyable activities, and socialise with other service users.
... In addition, loneliness could also play a role. It is well known that loneliness is a risk factor in the incidence of dementia [44][45][46]. Consequently, the fear of a lack of care from the environment in the case of dementia appears to be plausible. Furthermore, the loss of quality of life that people with depressive symptoms may experience [47] is associated with subjective cognitive impairment [48]. ...
Introduction: The objective of this study was to clarify the frequency of fear of dementia and the factors associated with it. Methods: Data were taken from a nationally representative sample (n=4,000; average age was 54.9 years, SD: 8.5 years, age ranges from 40 to 70 years, 49.6% of the respondents were women). Similar to prior research, fear of dementia was quantified using a tool ranging from 1 (no fear of dementia) to 4 (severe fear of dementia). Results: In sum, 19.0% reported no fear of dementia, 34.6% reported a little fear of dementia, 33.8% reported some fear of dementia, and 12.7% reported severe fear of dementia. Regressions showed that greater fear of dementia was significantly associated with being female, being younger, poorer self-rated health, the presence of at least one chronic disease, not living in the same household with a partner or not being in a relationship at all, having depressive symptoms and anxiety symptoms. Conclusion: Study findings showed that fear of dementia is particularly associated with health-related factors, age and gender. Lifestyle factors and other socioeconomic factors were only occasionally significant. Future research should explore the reasons for such a higher frequency of people's fear of dementia. It would also be interesting to find out new factors associated with the fear of dementia. Furthermore, further research could focus on cross-country comparisons and could stratify the results by important groups e.g., by sex or education, but also cultural and ethnic aspects.
... Various risk factors of AD manifestation have been established in the literature, including female sex, advancing age, traumatic brain injury, smoking, and obesity [7]. In addition, mental health (MH) conditions, such as anxiety, depression, psychological distress, and loneliness, have been found to elevate the risk of AD [7][8][9]. ...
Background
Despite several studies having correlated Alzheimer’s disease with mental health conditions, the extent to which they have been incorporated into Alzheimer’s disease clinical trials remains unclear.
Objective
This study aimed to assess the temporal trends in mental health-related terminology in Alzheimer’s disease clinical trials as a proxy measure of research interest. Additionally, it sought to determine the effect of the COVID-19 pandemic on the frequency of these terms through pre-pandemic and post-pandemic trend assessment.
Methods
In this retrospective descriptive analysis, we included 2243 trials with a start date between 1988 and 2022 by searching for the keyword “Alzheimer Disease” in the U.S. National Library of Medicine ClinicaTrials.gov database. A Python program was created to extract and count the frequency of four mental health terms (loneliness, depression, anxiety, and distress) by year and trial status (e.g., completed, active, recruiting). Binary logistic regression analyses were conducted to examine the yearly patterns in the appearance of the four mental health terms. A multivariable logistic regression analysis was performed to identify trial characteristics associated with each mental health term.
Results
Our results depicted a statistically significant increasing trend in three (i.e., loneliness, anxiety, distress) of the four mental health conditions by year. A comparison between pre-pandemic and post-pandemic trials showed an increase in the mention of the same three words over time.
Interpretation
These results may suggest a growing awareness of mental health conditions and a greater interest in considering these conditions in Alzheimer’s disease trials, particularly after the onset of COVID-19. Future researchers should conduct more in-depth analyses to examine how mental health variables are operationalized in these trials, with consideration for their subsequent success.
... The prevalence of dementia increases with age, doubling about every 5 years from 60 years until 85 years of age [11]. Similarly, loneliness is also reported to increase risk of dementia [12]. Recently, there have been massive changes in family dynamics in Nepal, with an increasing number of older people living alone or without their immediate family; circumstances that may have triggered older people to suffer from loneliness, depression and contribute poor health outcomes [13] and to increase the risk of dementia. ...
Introduction
Globally dementia is a growing public health problem, with over 135,000 people in Nepal living with dementia. Nepal lacks national and community-based data on dementia prevalence. This study aims to determine the dementia risk in Nepal and assess the effects of age, sex, and geographical location on disease prevalence. It also intends to inform policy makers about the burden of dementia, prompting them to plan and prepare appropriate health and social care services for individuals affected by dementia.
Methods
A cross-sectional survey with total 1152 individuals (933 older people, aged 60 and over and 219 carers of 60 years and older people) was conducted to determine the prevalence of dementia risk in three geographical regions of Nepal. The Rowland Universal Dementia Assessment Scale (RUDAS) and Memory First Aid Informant Questionnaire adapted from Community Screening Interview for Dementia (CSI-D) for informant were used to measure cognitive impairment. The study evaluated the overall prevalence of cognitive impairment or risk of dementia and subgroups by region, age group, and sex. Chi-squared tests and multiple logistic regression analyses were conducted to assess the effects.
Results
For the RUDAS test, 53.7% (501) participants had cognitive impairment, with slightly higher rates in women (56.5%) than men (51.7%). For the Memory First Aid Informant Questionnaire/CSI-D for informant, 155 participants had cognitive impairment at a rate of 70.8%, with slightly higher rates in men. Cognitive impairment prevalence increases with age and region, with hilly and mountainous areas and low-lying regions having a greater geographic effect.
Conclusions
There is high risk of dementia in Nepal. The risk is influenced by age and geographical regions, necessitating early diagnosis and tailored interventions for older people and who are residing in higher altitude areas. National-level studies and exploration of factors affecting early dementia diagnosis are needed.
... In individual meetings, the social interaction with peers, in contrast, to exercise classes, might be somewhat limited. In this context, it is worth noting that in older adults' social factors such as loneliness are associated with worse cognitive functioning [116][117][118][119] and increased risk of dementia [8,[120][121][122][123]. Furthermore, in a cross-sectional study of older adults with MCI, a higher level of perceived loneliness was observed as compared with age-, sex-, and education-matched controls with slightly less pronounced cognitive deficits [124]. ...
UNSTRUCTURED
A healthy lifestyle can be an important prerequisite to prevent or at least delay the onset of dementia. However, the large number of physically inactive adults underscores the need for developing and evaluating intervention approaches aimed at improving adherence to a physically active lifestyle. In this regard, hybrid physical training, which usually combines center- and home-based physical exercise sessions and has proven successful in rehabilitative settings, could offer a promising approach to preserving cognitive health in the aging population. Despite its potential, research in this area is limited as hybrid physical training interventions have been underused in promoting healthy cognitive aging. Furthermore, the absence of a universally accepted definition or a classification framework for hybrid physical training interventions poses a challenge to future progress in this direction. To address this gap, this article informs the reader about hybrid physical training by providing a definition and classification approach of different types, discussing their specific advantages and disadvantages, and offering recommendations for future research. Specifically, we focus on applying digital technologies to deliver home-based exercises, as their use holds significant potential for reaching underserved and marginalized groups, such as older adults with mobility impairments living in rural areas.
... In individual meetings, the social interaction with peers, in contrast, to exercise classes, might be somewhat limited. In this context, it is worth noting that in older adults' social factors such as loneliness are associated with worse cognitive functioning [116][117][118][119] and increased risk of dementia [8,[120][121][122][123]. Furthermore, in a cross-sectional study of older adults with MCI, a higher level of perceived loneliness was observed as compared with age-, sex-, and education-matched controls with slightly less pronounced cognitive deficits [124]. ...
A healthy lifestyle can be an important prerequisite to prevent or at least delay the onset of dementia. However, the large number of physically inactive adults underscores the need for developing and evaluating intervention approaches aimed at improving adherence to a physically active lifestyle. In this regard, hybrid physical training, which usually combines center-and home-based physical exercise sessions and has proven successful in rehabilitative settings, could offer a promising approach to preserving cognitive health in the aging population. Despite its potential, research in this area is limited as hybrid physical training interventions have been underused in promoting healthy cognitive aging. Furthermore, the absence of a universally accepted definition or a classification framework for hybrid physical training interventions poses a challenge to future progress in this direction. To address this gap, this article informs the reader about hybrid physical training by providing a definition and classification approach of different types, discussing their specific advantages and disadvantages, and offering recommendations for future research. Specifically, we focus on applying digital technologies to deliver home-based exercises, as their use holds significant potential for reaching underserved and marginalized groups, such as older adults with mobility impairments living in rural areas.
... 3 Alongside, and often overlapping with NPS, are relevant contextual factors, which include loneliness, poor sleep, and weight loss. Previous research has shown loneliness to be associated with a 40% increased risk of dementia 6 and sleep disturbance has been linked to a subsequent diagnosis of dementia and increased mortality. 7 There however remains uncertainty which neuropsychiatric symptoms or contextual factors would be the most promising targets for intervention and whether antidepressant prescription accelerates or delays dementia development. ...
Background
While some people with mild cognitive impairment (MCI) progress to dementia, many others show no progression. The aim of this study was to identify factors associated with risk of dementia development in this population.
Method
A large naturalistic retrospective cohort study was assembled from mental healthcare records in a south London catchment. Patients were selected at first recorded diagnosis of MCI and subsequent dementia diagnosis was ascertained from case notes or death certificate, excluding those with dementia diagnoses and deaths within 6 months of MCI diagnosis. A range of demographic and clinical characteristics were ascertained around MCI diagnosis and Cox proportional hazards models were used to investigate independent predictors of dementia, focussing on neuropsychiatric symptoms, contextual factors, and antidepressant treatment.
Results
Of 2250 patients with MCI, 236 (10.5%) developed dementia at least 6 months after MCI diagnosis. Aside from older age, lower cognitive function, and activities of daily living impairment, impaired social relationships and recorded loneliness were associated with a higher risk of developing dementia. Patients of Black (compared to White) ethnicity were at a lower risk. For depression and antidepressant receipt, only tricyclic use compared to no antidepressant use was associated with an increased dementia risk.
Conclusions
No evidence was found for co‐morbid affective disorders or different antidepressant classes as risk factors for dementia development following MCI diagnosis, but loneliness and social impairment were independent predictors and would be worth evaluating as targets for interventions to delay progression.
... Loneliness has been observed to impact older adults' experience of depressive symptoms and lead to functional limitations [2,3]. In addition, loneliness has been found to impact older adults' cognition, with loneliness positively associated with dementia [4][5][6]. Individuals who score high on loneliness visit physicians more frequently [7]. Loneliness has also been associated with cardiovascular risk and risk of mortality [3,[8][9][10]. ...
In this article, we will provide a rationale for a web-assisted acceptance and commitment therapy (ACT) approach to loneliness among older adults, drawing upon theories from the literature on adult development and aging, emotion regulation, and loneliness. The intervention program was developed using the principles of ACT, which is a cognitive behavioral approach and unified model of human behavior change and psychological growth. The ACT intervention focuses on developing nonjudgmental present-focused awareness of internal experiences (thoughts, emotions, and memories) through strategies such as acceptance and mindfulness rather than directly modifying or removing them per se. The ACT intervention appears well-suited to assist older adults in coping with the challenges of aging, as the focus is on an individual’s willingness to sit with internal experiences out of one’s control (ie, acceptance), stepping back from negative or critical thoughts and developing greater kindness toward oneself (ie, defusion), discerning what is most important to one’s true self (ie, values), and building larger patterns of effective action based on such values (ie, committed action). The ACT intervention was developed as a resource for older adults who are socially isolated or having difficulty with social connectedness. Eight modules comprise the web-assisted ACT intervention program, which includes reading materials, video clips, and activities. Each module is followed by a summary, a homework assignment, a short quiz to assess learning, and a moderated discussion with a coach. The intervention program begins with reconnecting participants with their values. The goal of the ACT intervention program is to foster flexibility in a participant’s behavior so they can behave consistently with their chosen values, rather than becoming locked into a pattern of behavior that is driven by avoiding distress or discomfort. The ACT intervention approach is both novel and innovative, as it is based on ACT and leverages a behavioral health web platform that is flexible and inclusive in its design. The ACT intervention aims to help older adults become more socially connected, less lonely, and more satisfied with their relationships with other people. The emphasis that ACT places on values and living life in accordance with one’s values renders it an approach ideally suited to older adults. Finally, recommendations for future research regarding this approach to addressing loneliness among older adults is addressed.
... Recent research shows that over 40% of those aged 60 and older report feeling lonely [1]. Social isolation and loneliness have been found to strongly link to the development and exacerbation of depression, which, in turn, can contribute to cognitive decline and dementia [1][2][3][4]. Currently, Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD) rank as the fifth leading cause of death among adults aged 65 years and older [5]. ...
Loneliness, depression, and cognitive decline are pressing concerns among older adults. This study examines the association between leisure travel participation and these health outcomes in older adults, aiming to provide further evidence of the benefits of leisure travel. Using nationally representative historical data from the 2006 household survey of the Health and Retirement Study, this study conducted a series of regression analyses to investigate the relationship between traveling and the three health outcomes, adjusting for age, sex, race, marital status, education, total wealth, annual income, and difficulty with daily activities. The results reveal that travel patterns in terms of distance are significantly associated with loneliness, depression, and cognitive function. Long-distance travel is positively related to higher cognitive function and a reduction in depressive symptoms, along with lower levels of loneliness, reinforcing the notion that leisure travel can potentially act as a catalyst for improved cognitive and mental health by offering opportunities for enhancing social connections and forming new relationships. The findings on the relationships between participation in leisure travel and mental and cognitive health contribute to the body of evidence supporting the therapeutic value of leisure travel in promoting healthy aging and enhancing the overall well-being in older adults.
Background
A systematic review/meta-analysis synthesising the existing evidence regarding the prevalence of loneliness and social isolation among individuals with mild cognitive impairment (MCI) or dementia is lacking.
Aims
A systematic review and meta-analysis was conducted to investigate the prevalence and factors associated with loneliness and social isolation among individuals with MCI or dementia.
Method
A search was conducted in five established electronic databases. Observational studies reporting prevalence and, where available, factors associated with loneliness/isolation among individuals with MCI and individuals with dementia, were included. Important characteristics of the studies were extracted.
Results
Out of 7427 records, ten studies were included. The estimated prevalence of loneliness was 38.6% (95% CI 3.7–73.5%, I ² = 99.6, P < 0.001) among individuals with MCI. Moreover, the estimated prevalence of loneliness was 42.7% (95% CI 33.8–51.5%, I ² = 90.4, P < 0.001) among individuals with dementia. The estimated prevalence of social isolation was 64.3% (95% CI 39.1–89.6%, I ² = 99.6, P < 0.001) among individuals with cognitive impairment. Study quality was reasonably high. It has been found that living alone and more depressive symptoms are associated with a higher risk of loneliness among individuals with dementia.
Conclusions
Social isolation, and in particular loneliness, are significant challenges for individuals with MCI and dementia. This knowledge can contribute to supporting successful ageing among such individuals. Future research in regions beyond Asia and Europe are clearly required. In addition, challenges such as chronic loneliness and chronic social isolation should be examined among individuals with MCI or dementia.
Background:
There has been contradictory evidence on the prospective associations between social isolation/loneliness (SI/L) and cognitive decline (CD). There is also a scarcity of large and diverse population-based cohort studies examining SI/L that have confirmed clinical diagnoses of Alzheimer's Disease (AD). Notably, beyond individual associations, whether the effects of SI/L compound and accelerate CD and incident AD are not known.
Objectives:
We hypothesized that SI and L, independently, would be associated with CD and incident AD to a similar extent, and the association of SI with CD and incident AD would be higher in lonely older adults.
Design:
Prospective cohort study.
Setting:
Urban Chicago areas.
Participants:
We analyzed data in the Chicago Health and Aging Project (CHAP), which comprised 7,760 biracial community-dwelling older adults [mean age (standard deviation (SD))=72.3 (6.3); 64 % Black & 63 % women; mean (SD) of follow-up=7.9 (4.3) years].
Intervention (if any):
NA MEASUREMENTS: Linear mixed and logistic regression models were used to regress CD and incident AD separately on the SI index/L.
Results:
SI index and L were significantly associated with CD, with one-point increase of beta estimate (SE, p-value) = -0.002 (0.001,0.022) and -0.012 (0.003,<0.001), respectively. Given that the SI index ranges from 0 to 5 and the L from 0 to 1, they had similar effect sizes. Similarly, there were significant associations between SI index and incident AD, odds ratio (95 % CI, p-value) = 1.183 (1.016-1.379,0.029), and between L and incident AD, 2.117 (1.227-3.655,0.006). When stratified by loneliness status, compared to older adults who were not isolated and not lonely, older adults who reported being socially isolated and not lonely experienced accelerated CD, -0.003 (0.001,0.004), despite no significantly increased odds of incident AD.
Conclusions:
SI/L had significant associations with CD and incident AD. Notably, socially isolated older adults who reported not being lonely appeared to be most socially vulnerable to CD. These findings suggest a specific at-risk subgroup of socially vulnerable older adults for future targeted interventions to improve cognitive health.
Psychosocial function is associated with cognitive performance cross-sectionally and cognitive decline over time. Using data from the COMPASS-ND study, we examined associations between psychosocial and cognitive function in 126 individuals with mild cognitive impairment, an at-risk group for Alzheimer’s disease (AD). Psychosocial function was measured using questionnaires about mental health, social support, and social engagement. Composite scores for five cognitive domains were derived using principal component analysis. Multiple linear regression models were used to test the effects of various psychosocial factors on cognitive performance, controlling for age, sex, education, MoCA scores, and living circumstances. We found that low current participation in one’s social networks, over other psychosocial factors, was associated with worse verbal fluency and processing speed scores than those endorsing normal or high social participation. Our findings provide groundwork for further psychosocial-cognitive analyses in individuals at-risk for AD to better understand the role of poor social engagement in cognitive decline.
The use of community services in the UK rose significantly during the COVID-19 pandemic while capacity and demand issues have worsened. With nursing in the community setting being seen as varied, complicated and challenging, it is important to bring order to the chaos when dealing with the demands on these services. This chapter explores the dynamic and constantly changing care environment, demand and capacity and strategies for managing workload and caseloads in this context. With practitioners needing to be responsive to routinely fluctuating workload demands as well as less predictable crises such as epidemics, the discussion centres on being able to practically apply tools or methods for care organisation and the minimisation of risk. Topics relating to the organisation and management of care covered in this chapter include work organisation in the community setting, service design and referral criteria; skill mix, educating for competence; and caseload/workload management.
Objectives: This study aimed to examine the differential impacts of two forms of social isolation on depressive symptoms and investigate the mediating role of activity engagement among older Chinese immigrants. Methods: Data were from four waves of the Population Study of Chinese Elderly in Chicago Study (PINE) ( N = 2,075). Social disconnectedness was measured by social network size and range, living arrangement, and marital status. Perceived isolation was measured by loneliness and lack of social support. Activity engagement was assessed by engagement with various social and cognitive activities. Results: The latent growth curve models indicated that social disconnectedness and perceived isolation were associated with a higher initial level of depressive symptoms. However, perceived isolation predicted a faster decline in depressive symptoms. Activity engagement had significant mediating effects on the relationships. Discussion: Efforts should focus on reducing social isolation and providing opportunities for activity engagement to mitigate depression among older Chinese immigrants.
Background
Early‐life social experiences significantly influence later‐life health, yet the association between childhood peer relationships and dementia, as well as the underlying mechanisms, remains underexplored. This study aimed to investigate this association and the mediating roles of social disengagement and loneliness.
Methods
Leveraging data from 7574 adults aged ≥ 60 in the China Health and Retirement Longitudinal Study (2011–2018), we employed marginal structural models to assess the associations between childhood peer relationships and dementia risk in later life. Inverse odds ratio weighting was used to examine the mediating roles of formal and informal social disengagement and loneliness.
Results
Individuals with deficits in childhood peer relationships had a higher risk of dementia (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.10–1.34) compared with those with more positive experiences. This association was partially mediated by formal social disengagement (proportion mediated, 21.44%; 95% CI, 12.20%–40.94%), loneliness (proportion mediated, 22.00%; 95% CI, 13.42%–33.82%), and their combination with informal social disengagement (proportion mediated, 41.50%; 95% CI, 30.76%–66.07%). Informal social disengagement alone did not show a significant mediating effect.
Conclusions
In this cohort study of older Chinese adults, negative childhood peer relationship experiences were associated with an elevated risk of dementia in later life. Formal social disengagement and loneliness partially mediated this association. These findings underscore the importance of fostering positive social relationships in early life and suggest potential psychosocial strategies to mitigate dementia risk in older adults due to childhood peer relationship deficits.
Background
Older adults with cognitive impairment can experience poor oral health due to reduced self-care ability, yet the impact of various oral health indicators on the cognitive ability remains unclear. We investigated the relationship between oral health indicators and mild cognitive impairment (MCI) in older adults.
Methods
A cross-sectional study of 234 older adults aged 65 years or over was performed form January to March 2023 at health screening departments of hospitals. This study used the Mini-mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Activities of Daily Living (ADL), Clinical Dementia Rating (CDR), and Hachinski Ischemic Score (HIS) to measure MCI. Two qualified dentists performed clinical oral examinations (number of teeth lost, dental caries, removable dentures, periodontitis). The other oral health status was measured by subjective assessment questionnaires, and the oral health-related quality of life (OHRQoL) was assessed by Geriatric Oral Health Assessment Index (GOHAI).
Results
Of the 234 older adults, 166 had MCI and 68 had normal cognitive ability. The univariate analyses revealed that older adults with poor oral health indicators of dental caries, mastication ability, oral and maxillofacial pain, self-perceived oral health status and OHRQoL had lower cognitive levels. The stepwise logistic regression analysis observed that higher education level (OR = 0.06, 95%CI = 0.007, 0.567) and OHRQoL score (OR = 0.92, 95%CI = 0.878, 0.963) were negatively associated with the presence of MCI. The area under the ROC curve (AUC) of MCI was 0.675 (95% CI: 0.600, 0.749) with a low sensitivity of 41.6% and a moderate specificity of 86.8%.
Conclusion
OHRQoL was found to be associated with MCI, implying that OHRQoL may be important in cognitive decline. The GOHAI scale can be used to more easily assess the oral health of older adults, which is important for the timely detection of poor oral status to delay cognitive decline.
Background
Even if we are not aware of it, machine learning techniques are part of our daily lives. It is of the utmost interest that citizens become familiar with the use of these techniques and discover their potential to solve everyday problems.
Objective and Methods
In this article, we describe the methodology and results of a highly replicable citizen science project that allows citizens to get closer to the scientific process and understand the potential of machine learning to solve a social problem of interest to them. For this purpose, we have chosen a problem of social relevance in contemporary societies, namely the detection of loneliness in older adults. Citizens are challenged to apply machine learning techniques to identify levels of loneliness from natural language.
Results
The results of this project suggest that citizens are willing to engage in science when the challenges posed are of social interest to them. A total of 1517 citizens actively engaged in the project. A database containing 1112 texts about loneliness expressions was collected. An accuracy of 83.12% using the logistic regression algorithm and 62.23% accuracy when using the Naïve Bayes algorithm was reached in detecting loneliness from texts.
Conclusions
Detecting loneliness using machine learning techniques is an attractive and relevant topic that allows citizens to be involved in science and introduces them to machine learning practices. The methodology of this project can be replicated in other places around the world.
AIMS: Social isolation has been implicated in the development of cognitive impairment, but research on this association remains limited among racial-ethnic minoritized populations. Our study examined the interplay between social isolation, race–ethnicity and dementia.
METHODS: We analyzed 11 years (2011–2021) of National Health and Aging Trends Study (NHATS) data, a prospective nationally representative cohort of U.S. Medicare beneficiaries aged 65 years and older. Dementia status was determined using a validated NHATS algorithm. We constructed a longitudinal score using a validated social isolation variable for our sample of 6,155 community-dwelling respondents. Cox regression determined how the interaction between social isolation and race–ethnicity was associated with incident dementia risk.
RESULTS:
Average longitudinal frequency of social isolation was higher among older Black (27.6%), Hispanic (26.6%) and Asian (21.0%) respondents than non-Hispanic White (19.1%) adults during the 11-year period ( t = −7.35, p < .001). While a higher frequency of social isolation was significantly associated with an increased (approximately 47%) dementia risk after adjusting for sociodemographic covariates (adjusted hazard ratio [aHR] = 1.47, 95% CI [1.15, 1.88], p < .01), this association was not significant after adjusting for health covariates (aHR = 1.21, 95% CI [0.96, 1.54], p = .11). Race–ethnicity was not a significant moderator in the association between social isolation and dementia.
CONCLUSIONS:
Older adults from racial-ethnic minoritized populations experienced a higher longitudinal frequency of social isolation. However, race–ethnicity did not moderate the positive association observed between social isolation and dementia. Future research is needed to investigate the underlying mechanisms contributing to racial-ethnic disparities in social isolation and to develop targeted interventions to mitigate the associated dementia risk.
Objectives
Loneliness is a significant public health concern associated with adverse mental and physical health outcomes in older adults. This study examined the nature and correlates of predominant loneliness trajectories in a nationally representative sample of older U.S. military veterans.
Methods
Participants included 2,441 veterans (mean age = 63, 8% female, 80% white) from the National Health and Resilience in Veterans Study, a 3-year longitudinal cohort study. Growth mixture modeling (GMM) was used to identify distinct trajectory classes of loneliness based on self-reported ratings. Multinomial logistic three-step regression analyses examined potential psychosocial risk and protective factors associated with loneliness trajectories.
Results
GMM revealed three distinct loneliness trajectories: Low-decreasing loneliness (61.2%), moderate-increasing loneliness (31.6%), and high-increasing loneliness (7.2%). Being married/partnered and perceiving greater purpose in life emerged as protective factors against elevated levels of loneliness. Worse cognitive functioning was a risk factor for the moderate-increasing loneliness trajectory, while greater psychological distress and more adverse childhood experiences were risk factors for the high-increasing loneliness trajectory.
Discussion
Nearly 40% of older U.S. veterans exhibited trajectories characterized by moderate to high levels of loneliness, with both groups showing increases over time. Targeted interventions that promote social connectedness, enhance purpose in life, and address mental health concerns and early life adversities may help mitigate the negative health consequences associated with chronic loneliness in this vulnerable population.
Background
In recent decades, there has been a widespread adoption of digital devices among the non-disabled population. The pervasive integration of digital devices has revolutionized how the majority of the population manages daily activities. Most of us now depend on digital platforms and services to conduct activities across the domains of communication, finance, healthcare, and work. However, a clear disparity exists for people who live with severe quadriplegia, who largely lack access to tools that would enable them to perform daily tasks digitally and communicate effectively with their environment.
Objectives
The purpose of this piece is to (i) highlight the unmet needs of people with severe quadriplegia (including cases for medical necessity and perspectives from the community), (ii) present the current landscape of assistive technology for people with severe quadriplegia, (iii) make the case for implantable BCIs (how they address needs and why they are a good solution relative to other assistive technologies), and (iv) present future directions.
Results
There are technologies that are currently available to this population, but these technologies are certainly not usable with the same level of ease, efficiency, or autonomy as what has been designed for the non-disabled community. This hinders the ability of people with severe quadriplegia to achieve digital autonomy, perpetuating social isolation and limiting the expression of needs, opinions, and preferences.
Conclusion
Most importantly, the gap in digital equality fundamentally undermines the basic human rights of people with severe quadriplegia.
Objective
This study aimed to identify factors that hinder or facilitate the implementation of an exergaming technology, SilverFit Mile, which offers virtual cycling, for nursing home residents with dementia in and its potential impact on feelings of loneliness.
Methods
The study followed a descriptive qualitative approach using semi structured interviews with eight care professionals in nursing homes in the Netherlands and based on the Consolidated Framework for Implementation Research (CFIR). Thematic text analysis was used to analyze the interviews.
Results
We identified three main themes and twelve subthemes based on the CFIR. The main themes were residents’ personal characteristics, implementation factors, and loneliness. SilverFit Mile was more suitable for those familiar with cycling and those who enjoyed more solitary activities. Organizational factors such as staff's low digital literacy, lack of time, and need for training were found barriers to implementation, while facilitators included fostering social interaction.
Conclusions
SilverFit Mile was considered positively by care staff based on observations of persons living with dementia. We identified loneliness as a relevant outcome of SilverFit Mile implementation. We argue that SilverFit Mile can foster social interaction between residents and staff through reminiscence or the physical aspect of cycling. However, a better understanding of the connection between loneliness and the use of SilverFit Mile is needed. Overall, our research provides initial ideas about how exergaming technology might address loneliness in dementia.
Abstract
Marital stress has been identified as a significant factor influencing the cognitive health of older adults, with emerging evidence suggesting a potential link between marital discord and the risk of developing dementia. This study will review the existing literature on the relationship between chronic stress, depression, marital discord, and the development of cognitive impairment which can increase the risk of developing dementia in older adults. However, the purpose of studying how marital stress affects the onset of dementia is to deepen our understanding of the complex interplay between psychosocial factors and cognitive health in older adults, with the ultimate goal of improving prevention, intervention, and support strategies.
Numerous studies have highlighted the adverse effects of chronic marital stress on cognitive function, neurobiological processes, and brain health. Marital conflicts, lack of social support, and emotional distress within spousal relationships have been associated with increased levels of stress hormones, such as cortisol, which can contribute to neuroinflammation and neuronal damage over time.
Moreover, there is a higher chance of cognitive decline and dementia among individuals experiencing long-term marital dissatisfaction or conflict. Mechanisms underlying this association include depression, impaired cardiovascular health, disrupted sleep patterns, and heightened psychological distress, all of which have been implicated in the pathogenesis of dementia.
Furthermore, the impact of marital stress on dementia risk extends beyond psychological factors, encompassing physiological changes, lifestyle behaviors, social engagement, and access to healthcare. Older adults experiencing persistent marital strain may be less likely to engage in protective health behaviors, such as regular exercise, healthy diet maintenance, and seeking 8 timely medical interventions, thereby amplifying their vulnerability to cognitive impairment and dementia.
However, there are a number of well-establish risk factors for developing dementia such as age, family history and genetics, cardiovascular diseases, diabetes, head injuries, poor lifestyle, low levels of education, sleep disorders, and exposure to environmental toxins and pollutants. Another of these risk factors is depression, which often results in experiencing stressful life events and it is one significant stressor for many individuals suffering from marital stress. There is very little empirical research on the association between marital stress and the development of dementia hence, future research is needed to study on the impact of marital stress on dementia risk in older adults and understand that long-term marital stress can severely impact cognitive functions.
Conclusion: Further research, including longitudinal studies and neurobiological investigations, are needed to elucidate the complex interplay between marital stress, neurobiological processes, and dementia risk, leading to a better understanding of preventive strategies and targeted interventions.
Pathological processes of cognitive ageing can lead to cognitive impairment and dementia. As a global public health priority, significant attention is placed on risk reduction and prevention of dementia, particularly through the management of modifiable risk factors. Psychological factors have been identified as potential targets to delay the onset of dementia but are often underrecognized as compared to other risk factors. This chapter provides an overview of the influence of both psychological disturbances, such as depression, chronic stress and social isolation, and positive psychological factors, including psychological well-being, social connection, and positive self-perception of ageing, on the risk of cognitive decline and development of dementia. Drawing current evidence from meta-analyses, systematic reviews and epidemiological studies, longitudinal associations between psychological functioning and risk of cognitive decline are summarized. Mechanistic pathways underlying these associations are examined and clinical implications for early detection of psychiatric symptoms and implementation of psychosocial approaches for cognitive health are discussed.
The recent Special Issue of Affective Science considered “The Future of Affective Science,” offering new directions for the field. One recurring theme was the need to consider the social nature of emotional experiences. In this article, we take an interdisciplinary approach toward studies of social connection that builds upon current theoretical foundations to address an important public health issue – loneliness. Loneliness is an affective state that is characterized by feelings of isolation and has widespread adverse effects on mental and physical health. Recent studies have established links between loneliness, social connection, and well-being, but most of this work has been siloed in separate fields. We bridge these themes, leveraging advances in technology, such as artificial intelligence-based voice assistants (e.g., Alexa), to illuminate new avenues for detecting and intervening against loneliness “in the wild.” Recognizing the power of connection among individuals as social beings and among researchers with shared goals, affective science can advance our understanding of loneliness and provide tangible benefits to society at large.
Loneliness refers to the negatively perceived mismatch between one’s desired and actual engagement in social relations. Besides the individual suffering it implies, epidemiological evidence has suggested that loneliness is a critical determinant of mental health in late life. In this chapter, we provide definitions, operationalisations, prevalence estimates, and risk factors of loneliness in older people. Further, we summarise epidemiological evidence on the association between loneliness and depression, anxiety, suicide, and cognitive disorders and cover their potential underlying mechanisms. Despite an existing link between loneliness and mental health disorders, more evidence is needed to disentangle causality, bidirectionality and underlying mechanisms. Last, we discuss intervention strategies to reduce loneliness in older adults, focusing on their individual goals, challenges, and potential future development, as well as on the importance of inclusive communities and neighbourhoods. Interventions to facilitate social interactions and improve one’s social cognition seem promising yet challenging to implement and assess. Addressing loneliness remains a critical task to promote health in an ageing society.
Loneliness confers a significant risk to numerous health outcomes, including cognitive impairment. This study assessed the relationship between loneliness subtypes (social and emotional) and cognition in older people with HIV (OPWH ≥ 50 years). Forty-two participants (STET = 61.5 years; 48% male; 74% Black) completed the six-item De Jong Gierveld Loneliness Scale and measures assessing objective and subjective cognition and depressive symptoms (Patient Health Questionnaire [PHQ-9]). Loneliness–cognition associations were examined using linear regression. Models were first adjusted for age, sex, race, and education, and then PHQ-9 score. Mean emotional and social loneliness scores were 1.24 ( SD = 1.22) and 1.21 ( SD = 1.14), respectively. After sociodemographic and PHQ-9 adjustment, emotional, but not social, loneliness was associated with poorer objective cognitive performance on processing speed (Digit Symbol) and executive function (CalCAP™). Findings have potential clinical importance for interventions that target specific loneliness subtypes to optimize cognitive performance in OPWH.
Objectives
Loneliness is common and becoming a public health concern. Although there is the clear evidence of the variable effect of temporal differences in loneliness (transient/situational and persistent/chronic) on health, their effect on dementia risk is unclear. This study aims to assess the effect of transient/situational and persistent/chronic loneliness on dementia risk.
Method
Participants aged 55 years and older from the Hunter Community Study were recruited. Loneliness was measured using a single item measure. Dementia was defined as per International Classification of Disease—10 (ICD 10) codes. The Fine‐Gray subdistribution hazard model was performed to calculate dementia risk.
Results
Of 1968 total participants with mean age of 66 years, (3%) 57 developed dementia and (7%) 135 died over the mean follow up of 10 years. Both persistent/chronic and transient/situational loneliness significantly increased the risk of all cause dementia in adjusted models (HR 2.74, 95% CI 1.11–6.88, p 0.03 and HR 2.35, 95% CI 1.21–4.55, p 0.01 respectively) with mean time to event of 9.7 years. Feeling lonely below the age of 70 years elevated the risk of dementia in later life (HR 4.01, 95% CI 1.40–11.50, p 0.01).
Conclusions
Loneliness (both persistent/chronic and transient/situational) was associated with increased risk of all cause dementia, especially if loneliness was experienced before the age of 70 years. These results suggest that promoting coping strategies for loneliness especially in persons 70 years and younger may play a role in preventing dementia.
Objectives:
We performed a systematic review and meta-analysis to examine the prevalence and antecedents/consequences of chronic loneliness and social isolation (i.e. enduring or persistent experience that extends over a certain period of time) among older adults. Moreover, we conducted a meta-regression to explore sources of heterogeneity.
Method:
A search was conducted in four electronic databases. We included observational studies that reported prevalence and, where available, antecedents/consequences of chronic loneliness or chronic social isolation amongst older adults. Key characteristics of the studies were extracted.
Results:
Across 17 studies included in the meta-analysis, the estimated prevalence of chronic loneliness was 20.8% (95% CI: 16.1-25.5%), including 21.7% among women (95% CI: 16.1-27.4%) and 16.3% among men (95% CI: 10.6-21.9%). One study reported chronic social isolation (13.4%) and found that chronic social isolation predicted higher depression scores. Meta-regressions indicated that loneliness was less prevalent when assessed with single-item measures. Regarding antecedents/consequences, spousal loss can contribute to chronic loneliness which in turn may contribute to adverse health-related outcomes.
Conclusion:
About one in five older adults experiences chronic loneliness reflecting the need to address chronic loneliness. More longitudinal research is needed on chronic loneliness and social isolation, particularly from low and middle-income countries.
Loneliness significantly contributes to cognitive impairment and dementia in older adults. Loneliness is a distressing feeling resulting from a perceived lack of social connection (i.e., a discrepancy between desired and actual social relationships), while social isolation is a related term that can be defined by number and type of social relationships. Importantly, loneliness is distinct from social isolation in that it is associated with a distressing self-perception. The primary focus of this narrative review is the impact of chronic loneliness on cognitive impairment and dementia among older adults. Loneliness has a significant association with many factors that are related to worse cognition, and therefore we include discussion on health, mental health, as well as the physiological effects of loneliness, neuropathology, and potential treatments. Loneliness has been shown to be related to development of dementia with a hazard ratio (HR) risk comparable to having a single APOE4 gene. The relationship of dementia to loneliness appears to be at least partially independent of other known dementia risk factors that are possibly associated with loneliness, such as depression, educational status, social isolation, and physical activity. Episodic memory is not consistently impacted by loneliness, which would be more typically impaired if the mild cognitive impairment (MCI) or dementia was due to Alzheimer’s disease (AD) pathology. In addition, the several longitudinal studies that included neuropathology showed no evidence for a relationship between loneliness and AD neuropathology. Loneliness may decrease resilience, or produce greater cognitive change associated with the same level of AD neuropathology. Intervention strategies to decrease loneliness in older adults have been developed but need to consider key treatment targets beyond social isolation. Loneliness needs to be assessed in all studies of cognitive decline in elders, since it significantly contributes to the variance of cognitive function. It will be useful to better define the underlying mechanism of loneliness effects on cognition to determine if it is similar to other psychological factors related to excessive stress reactivity, such as neuroticism or even depression, which are also associated with cognitive decline. It is important from a health perspective to develop better strategies to decrease loneliness in older adults.
In this analysis of data from the Canadian Longitudinal Study on Aging, vision loss (in men) and dual sensory loss (in 65- to 85-year-olds) were independently associated with low social network diversity. Vision loss and dual sensory loss (in 65- to 85-year-olds) were independently associated with low social participation. Hearing, vision,
and dual sensory losses were each independently associated with loneliness and reduced availability of social support, respectively. These findings are concerning because social support facilitates positive coping mechanisms that mitigate the effects of sensory loss and other chronic disabling conditions. Living with a chronic
health condition often entails relying on others for help with instrumental tasks and emotional support. Unfortunately, individuals with clinically diagnosed sensory loss typically receive little, if any, relationship and communication counseling.
Loneliness is a stressful experience that appears to interfere with health and social integration (SI). Recently, researchers proposed that both antecedents and consequences of loneliness may change across the life span. To fully understand the processes related to loneliness it may thus be crucial to adopt an age-differentiated perspective. This study contributes to the literature by investigating how the interrelationship between loneliness and SI and that between loneliness and physical health changes as people move from middle adulthood into old age. We also investigate the extent to which a person’s level of negative affect (NA) may serve as age-differentiated mediator on the pathway that leads from loneliness to impaired physical health. The data for our study were gathered over up to 15 years of study from 11,010 participants in the German Ageing Survey (DEAS [Deutscher Alterssurvey]). We examined all interrelations of interest over a broad age range of 40 to 84 years by using an accelerated longitudinal data design. Autoregressive structural equation models were applied for statistical analyses. The results suggest a reciprocal relationship between loneliness and SI that appears to strengthen as people get older. The reciprocal relationship between loneliness and NA, in contrast, appears to grow weaker with increasing age. As a consequence, the NA-mediated effect that loneliness exerts on physical health may actually decrease as people grow older. We conclude that the processes related to loneliness are best understood using a developmental perspective that takes age-specific resources, roles, and living conditions into account.
Objectives:
Social relationships are important for the maintenance of cognitive function at older ages, with both objective features of social networks and perceived social connections (loneliness) being relevant. There is limited evidence about how different aspects of social experience predict diagnosed dementia.
Methods:
The sample comprised 6,677 dementia-free individuals at baseline (2004) from the English Longitudinal Study of Ageing. Baseline information on loneliness, number of close relationships, marital status, and social isolation (contact with family and friends and participation in organizations) was analyzed in relation to incident dementia over an average 6.25 years using Cox regression, controlling for potential confounding factors.
Results:
Two hundred twenty participants developed dementia during follow-up. In multivariable analyses, dementia risk was positively related to greater loneliness (hazard ratio 1.40, 95% confidence interval 1.09-1.80, p = .008), and inversely associated with number of close relationships (p < .001) and being married (p = .018). Sensitivity analyses testing for reverse causality and different criteria for diagnosing dementia confirmed the robustness of these findings. There was no association with social isolation.
Discussion:
Dementia risk is associated with loneliness and having fewer close relationships in later life. The underlying mechanisms remain to be elucidated, but efforts to enhance older peoples' relationship quality may be relevant to dementia risk.
Background
While loneliness has been regarded as a risk to mental and physical health, there is a lack of current community data covering a broad age range. This study used a large and representative German adult sample to investigate loneliness. Methods
Baseline data of the Gutenberg Health Study (GHS) collected between April 2007 and April 2012 (N = 15,010; 35–74 years), were analyzed. Recruitment for the community-based, prospective, observational cohort study was performed in equal strata for gender, residence and age decades. Measures were provided by self-report and interview. Loneliness was used as a predictor for distress (depression, generalized anxiety, and suicidal ideation) in logistic regression analyses adjusting for sociodemographic variables and mental distress. ResultsA total of 10.5% of participants reported some degree of loneliness (4.9% slight, 3.9% moderate and 1.7% severely distressed by loneliness). Loneliness declined across age groups. Loneliness was stronger in women, in participants without a partner, and in those living alone and without children. Controlling for demographic variables and other sources of distress loneliness was associated with depression (OR = 1.91), generalized anxiety (OR = 1.21) and suicidal ideation (OR = 1.35). Lonely participants also smoked more and visited physicians more frequently. Conclusions
The findings support the view that loneliness poses a significant health problem for a sizeable part of the population with increased risks in terms of distress (depression, anxiety), suicidal ideation, health behavior and health care utilization.
Background: Indicators of social isolation or support such as living alone, loneliness, being married, and life satisfaction are possible psychosocial risk and protective factors for dementia.
Objective: We investigate the associations of these overlapping psychosocial factors with incident MCI-dementia (neurocognitive disorder) in a population cohort.
Methods: Using data from 1601 participants of the Singapore Longitudinal Ageing Study (SLAS) who were free of MCI or dementia at baseline and followed up to 8 years, we estimated hazards ratio (HR) of association of living alone, loneliness, being married, and high life satisfaction with incident MCI-dementia.
Results: In univariate analyses, individual HRs of association with incident MCI-dementia for living alone was 1.86 [1.18 – 2.95], (p = 0.008), loneliness was 1.26 [0.86 – 1.84], (p = 0.23), being married was 0.54 [0.39 – 0.75] (p < 0.0001), and being very satisfied with life was 0.59 [0.38–0.91]), (p = 0.017). Adjusted mutually for other psychosocial variables, and for age, sex, education, ethnicity, smoking, alcohol, dyslipidemia, hypertension, diabetes, central obesity, history of stroke or heart disease, APOE-ɛ4, depression, physical, social, and productive activities, only being married (0.68 [0.47–0.99], p = 0.044), and being very satisfied with life (0.61 [0.39 – 0.96], p = 0.034) remained significant variables associated with lower risks of developing MCI-dementia.
Conclusion: Individuals who were married and those who were very satisfied with life are protected against the risk of developing MCI and dementia. Controlling for the adverse effects of being without spousal support and low life satisfaction, living alone or a feeling of loneliness were not associated with increased risk of MCI-dementia.
Background The influence of social relationships on morbidity is widely accepted, but the size of the risk to cardiovascular health is unclear.
Objective We undertook a systematic review and meta-analysis to investigate the association between loneliness or social isolation and incident coronary heart disease (CHD) and stroke.
Methods Sixteen electronic databases were systematically searched for longitudinal studies set in high-income countries and published up until May 2015. Two independent reviewers screened studies for inclusion and extracted data. We assessed quality using a component approach and pooled data for analysis using random effects models.
Results Of the 35 925 records retrieved, 23 papers met inclusion criteria for the narrative review. They reported data from 16 longitudinal datasets, for a total of 4628 CHD and 3002 stroke events recorded over follow-up periods ranging from 3 to 21 years. Reports of 11 CHD studies and 8 stroke studies provided data suitable for meta-analysis. Poor social relationships were associated with a 29% increase in risk of incident CHD (pooled relative risk: 1.29, 95% CI 1.04 to 1.59) and a 32% increase in risk of stroke (pooled relative risk: 1.32, 95% CI 1.04 to 1.68). Subgroup analyses did not identify any differences by gender.
Conclusions Our findings suggest that deficiencies in social relationships are associated with an increased risk of developing CHD and stroke. Future studies are needed to investigate whether interventions targeting loneliness and social isolation can help to prevent two of the leading causes of death and disability in high-income countries.
Study registration number CRD42014010225.
Background:
Research supports an association between smoking and negative affect. Loneliness is a negative affective state experienced when a person perceives themselves as socially isolated and is associated with poor health behaviors and increased morbidity and early mortality.
Objectives:
In this article, we systematically review the literature on loneliness and smoking and suggest potential theoretical and methodological implications.
Methods:
PubMed and PsycINFO were systematically searched for articles that assessed the statistical association between loneliness and smoking. Articles that met study inclusion criteria were reviewed.
Results:
Twenty-five studies met inclusion criteria. Ten studies were conducted with nationally representative samples. Twelve studies assessed loneliness using a version of the UCLA Loneliness Scale and nine used a one-item measure of loneliness. Seventeen studies assessed smoking with a binary smoking status variable. Fourteen of the studies were conducted with adults and 11 with adolescents. Half of the reviewed studies reported a statistically significant association between loneliness and smoking. Of the studies with significant results, all but one study found that higher loneliness scores were associated with being a smoker. Conclusions/Importance: Loneliness and smoking are likely associated, however, half of the studies reviewed did not report significant associations. Studies conducted with larger sample sizes, such as those that used nationally representative samples, were more likely to have statistically significant findings. Future studies should focus on using large, longitudinal cohorts, using measures that capture different aspects of loneliness and smoking, and exploring mediators and moderators of the association between loneliness and smoking.
Loneliness is a prevalent and global problem for adult populations and has been linked to multiple chronic conditions in quantitative studies. This paper presents a systematic review of quantitative studies that examined the links between loneliness and common chronic conditions including: heart disease, hypertension, stroke, lung disease, and metabolic disorders. A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 33 articles that measure loneliness in chronic illness populations. Loneliness is a significant biopsychosocial stressor that is prevalent in adults with heart disease, hypertension, stroke, and lung disease. The relationships among loneliness, obesity, and metabolic disorders are understudied but current research indicates that loneliness is associated with obesity and with psychological stress in obese persons. Limited interventions have demonstrated long-term effectiveness for reducing loneliness in adults with these same chronic conditions. Future longitudinal randomized trials that enhance knowledge of how diminishing loneliness can lead to improved health outcomes in persons with common chronic conditions would continue to build evidence to support the translation of findings to recommendations for clinical care.
Loneliness is a prevalent and global problem for adult populations and has been linked to multiple chronic conditions in quantitative studies. This paper presents a systematic review of quantitative studies that examined the links between loneliness and common chronic conditions including: heart disease, hypertension, stroke, lung disease, and metabolic disorders. A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 33 articles that measure loneliness in chronic illness populations. Loneliness is a significant biopsychosocial stressor that is prevalent in adults with heart disease, hypertension, stroke, and lung disease. The relationships among loneliness, obesity, and metabolic disorders are understudied but current research indicates that loneliness is associated with obesity and with psychological stress in obese persons. Limited interventions have demonstrated long-term effectiveness for reducing loneliness in adults with these same chronic conditions. Future longitudinal randomized trials that enhance knowledge of how diminishing loneliness can lead to improved health outcomes in persons with common chronic conditions would continue to build evidence to support the translation of findings to recommendations for clinical care.
Actual and perceived social isolation are both associated with increased risk for early mortality. In this meta-analytic review, our objective is to establish the overall and relative magnitude of social isolation and loneliness and to examine possible moderators. We conducted a literature search of studies (January 1980 to February 2014) using MEDLINE, CINAHL, PsycINFO, Social Work Abstracts, and Google Scholar. The included studies provided quantitative data on mortality as affected by loneliness, social isolation, or living alone. Across studies in which several possible confounds were statistically controlled for, the weighted average effect sizes were as follows: social isolation odds ratio (OR) = 1.29, loneliness OR = 1.26, and living alone OR = 1.32, corresponding to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. We found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.
© The Author(s) 2015.
Social isolation has been recognized as a major risk factor for morbidity and mortality in humans for more than a quarter century. The brain is the key organ of social connections and processes, however, and the same objective social relationship can be experienced as caring and protective or as exploitive and isolating. We review evidence that the perception of social isolation (i.e., loneliness) impacts brain and behavior and is a risk factor for broad-based morbidity and mortality. However, the causal role of loneliness on neural mechanisms and mortality is difficult to test conclusively in humans. Mechanistic animal studies provide a lens through which to evaluate the neurological effects of a member of a social species living chronically on the social perimeter. Experimental studies show that social isolation produces significant changes in brain structures and processes in adult social animals. These effects are not uniform across the brain or across species but instead are most evident in brain regions that reflect differences in the functional demands of solitary versus social living for a particular species. The human and animal literatures have developed independently, however, and significant gaps also exist. The current review underscores the importance of integrating human and animal research to delineate the mechanisms through which social relationships impact the brain, health, and well-being. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Social isolation has been recognized as a major risk factor for morbidity and mortality in humans for more than a quarter of a century. Although the focus of research has been on objective social roles and health behavior, the brain is the key organ for forming, monitoring, maintaining, repairing, and replacing salutary connections with others. Accordingly, population-based longitudinal research indicates that perceived social isolation (loneliness) is a risk factor for morbidity and mortality independent of objective social isolation and health behavior. Human and animal investigations of neuroendocrine stress mechanisms that may be involved suggest that (a) chronic social isolation increases the activation of the hypothalamic pituitary adrenocortical axis, and (b) these effects are more dependent on the disruption of a social bond between a significant pair than objective isolation per se. The relational factors and neuroendocrine, neurobiological, and genetic mechanisms that may contribute to the association between perceived isolation and mortality are reviewed. Expected final online publication date for the Annual Review of Psychology Volume 66 is November 30, 2014. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
The Health and Retirement Study (HRS) is a nationally representative longitudinal survey of more than 37 000 individuals over
age 50 in 23 000 households in the USA. The survey, which has been fielded every 2 years since 1992, was established to provide
a national resource for data on the changing health and economic circumstances associated with ageing at both individual and
population levels. Its multidisciplinary approach is focused on four broad topics—income and wealth; health, cognition and
use of healthcare services; work and retirement; and family connections. HRS data are also linked at the individual level
to administrative records from Social Security and Medicare, Veteran’s Administration, the National Death Index and employer-provided
pension plan information. Since 2006, data collection has expanded to include biomarkers and genetics as well as much greater
depth in psychology and social context. This blend of economic, health and psychosocial information provides unprecedented
potential to study increasingly complex questions about ageing and retirement. The HRS has been a leading force for rapid
release of data while simultaneously protecting the confidentiality of respondents. Three categories of data—public, sensitive
and restricted—can be accessed through procedures described on the HRS website (hrsonline.isr.umich.edu).
Background:
Known risk factors for Alzheimer's disease and other dementias include medical conditions, genetic vulnerability, depression, demographic factors and mild cognitive impairment. The role of feelings of loneliness and social isolation in dementia is less well understood, and prospective studies including these risk factors are scarce.
Methods:
We tested the association between social isolation (living alone, unmarried, without social support), feelings of loneliness and incident dementia in a cohort study among 2173 non-demented community-living older persons. Participants were followed for 3 years when a diagnosis of dementia was assessed (Geriatric Mental State (GMS) Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT)). Logistic regression analysis was used to examine the association between social isolation and feelings of loneliness and the risk of dementia, controlling for sociodemographic factors, medical conditions, depression, cognitive functioning and functional status.
Results:
After adjustment for other risk factors, older persons with feelings of loneliness were more likely to develop dementia (OR 1.64, 95% CI 1.05 to 2.56) than people without such feelings. Social isolation was not associated with a higher dementia risk in multivariate analysis.
Conclusions:
Feeling lonely rather than being alone is associated with an increased risk of clinical dementia in later life and can be considered a major risk factor that, independently of vascular disease, depression and other confounding factors, deserves clinical attention. Feelings of loneliness may signal a prodromal stage of dementia. A better understanding of the background of feeling lonely may help us to identify vulnerable persons and develop interventions to improve outcome in older persons at risk of dementia.
Objective: The present study aims to determine the impact of loneliness on hypertension in later life. Method: Data for this study are derived from a sample of 1,880 older Malaysians via a cross-sectional survey entitled “Patterns of Social Relationships and Psychological Well-Being Among Older Persons in Peninsular Malaysia.” Loneliness is assessed by the PGCMS item, “How much do you feel lonely?” Data analysis is carried out using the Statistical Package for Social Sciences (SPSS) version 19.0. Results: Nearly one third of respondents report high level of loneliness. The overall prevalence of hypertension is 39% (95% CI = 36.9-41.3). Logistic regression, controlling for sociodemographic factors and several chronic medical conditions, shows that loneliness significantly increases likelihood of hypertension in later life (OR = 1.31, p ≤ .05, 95% CI = 1.04-1.66). Discussion: The results show loneliness as a major risk factor for hypertension and call for health care professionals to be aware of the negative physiological effects of loneliness in old age.
This study examines the similarity of cognitive assessments using 1 interview in a large population study, the Health and Retirement Study (HRS), and a subsample in which a detailed neuropsychiatric assessment has been performed (Aging, Demographics, and Memory Study [ADAMS]).
Respondents are diagnosed in ADAMS as demented, cognitively impaired without dementia (CIND), or as having normal cognitive function. Multinomial logistic analysis is used to predict diagnosis using a variety of cognitive and noncognitive measures from the HRS and additional measures and information from ADAMS.
The cognitive tests in HRS predict the ADAMS diagnosis in 74% of the sample able to complete the HRS survey on their own. Proxy respondents answer for a large proportion of HRS respondents who are diagnosed as demented in ADAMS. Classification of proxy respondents with some cognitive impairment can be predicted in 86% of the sample. Adding a small number of additional tests from ADAMS can increase each of these percentages to 84% and 93%, respectively.
Cognitive assessment appropriate for diagnosis of dementia and CIND in large population surveys could be improved with more targeted information from informants and additional cognitive tests targeting other areas of brain function.
To determine whether hearing loss is associated with incident all-cause dementia and Alzheimer disease (AD).
Prospective study of 639 individuals who underwent audiometric testing and were dementia free in 1990 to 1994. Hearing loss was defined by a pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better-hearing ear (normal, <25 dB [n = 455]; mild loss, 25-40 dB [n = 125]; moderate loss, 41-70 dB [n = 53]; and severe loss, >70 dB [n = 6]). Diagnosis of incident dementia was made by consensus diagnostic conference. Cox proportional hazards models were used to model time to incident dementia according to severity of hearing loss and were adjusted for age, sex, race, education, diabetes mellitus, smoking, and hypertension.
Baltimore Longitudinal Study of Aging.
Six hundred thirty-nine individuals aged 36 to 90 years.
Incident cases of all-cause dementia and AD until May 31, 2008.
During a median follow-up of 11.9 years, 58 cases of incident all-cause dementia were diagnosed, of which 37 cases were AD. The risk of incident all-cause dementia increased log linearly with the severity of baseline hearing loss (1.27 per 10-dB loss; 95% confidence interval, 1.06-1.50). Compared with normal hearing, the hazard ratio (95% confidence interval) for incident all-cause dementia was 1.89 (1.00-3.58) for mild hearing loss, 3.00 (1.43-6.30) for moderate hearing loss, and 4.94 (1.09-22.40) for severe hearing loss. The risk of incident AD also increased with baseline hearing loss (1.20 per 10 dB of hearing loss) but with a wider confidence interval (0.94-1.53).
Hearing loss is independently associated with incident all-cause dementia. Whether hearing loss is a marker for early-stage dementia or is actually a modifiable risk factor for dementia deserves further study.
As a social species, humans rely on a safe, secure social surround to survive and thrive. Perceptions of social isolation, or loneliness, increase vigilance for threat and heighten feelings of vulnerability while also raising the desire to reconnect. Implicit hypervigilance for social threat alters psychological processes that influence physiological functioning, diminish sleep quality, and increase morbidity and mortality. The purpose of this paper is to review the features and consequences of loneliness within a comprehensive theoretical framework that informs interventions to reduce loneliness. We review physical and mental health consequences of loneliness, mechanisms for its effects, and effectiveness of extant interventions. Features of a loneliness regulatory loop are employed to explain cognitive, behavioral, and physiological consequences of loneliness and to discuss interventions to reduce loneliness. Loneliness is not simply being alone. Interventions to reduce loneliness and its health consequences may need to take into account its attentional, confirmatory, and memorial biases as well as its social and behavioral effects.
We present evidence from a 5-year longitudinal study for the prospective associations between loneliness and depressive symptoms in a population-based, ethnically diverse sample of 229 men and women who were 50-68 years old at study onset. Cross-lagged panel models were used in which the criterion variables were loneliness and depressive symptoms, considered simultaneously. We used variations on this model to evaluate the possible effects of gender, ethnicity, education, physical functioning, medications, social network size, neuroticism, stressful life events, perceived stress, and social support on the observed associations between loneliness and depressive symptoms. Cross-lagged analyses indicated that loneliness predicted subsequent changes in depressive symptomatology, but not vice versa, and that this temporal association was not attributable to demographic variables, objective social isolation, dispositional negativity, stress, or social support. The importance of distinguishing between loneliness and depressive symptoms and the implications for loneliness and depressive symptomatology in older adults are discussed.
Inflammation is suggested to be involved in the pathogenesis of Alzheimer's disease (AD). Serum interleukin-6 (IL-6) and high sensitivity serum reactive protein C (hsCRP) as markers of systemic inflammation were analyzed at two examinations of the ULSAM-study, a longitudinal, community-based study of elderly men (age 70, n = 1062 and age 77, n = 749). In addition, serum amyloid protein A (SAA) and urinary prostaglandin F2α (PGF2α) metabolite levels were analyzed at age 77 in this cohort. Two serial samples (at ages 70 and 77) were available from 704 individuals. Using Cox regression analyses, associations between serum IL-6, hsCRP, SAA and PGF2α metabolite levels and risk of AD, any type of dementia (all-cause dementia) and non-AD dementia were analyzed. On follow-up (median, 11.3 years) in the age 70 cohort, 81 subjects developed AD and 165 subjects developed all-cause dementia. Serum IL-6, hsCRP, SAA, or PGF2α levels were not associated with risk of AD. At age 70, high IL-6 levels were associated with an increased risk of non-AD dementia (Hazard ratio 2.21 for above vs. below/at median, 95% confidence interval 1.23–3.95, p-value = 0.008). A longitudinal change in CRP or IL-6 levels was not associated with AD or dementia. In conclusion, Serum IL-6, hsCRP, SAA, and PGF2α levels are not associated with the risk of AD. High serum IL-6 levels may be associated with increased risk of non-AD dementia.
Erratum in JAD20(2), p. 681.
To determine cross-sectional and prospective associations between loneliness and physical activity, and to evaluate the roles of social control and emotion regulation as mediators of these associations.
A population-based sample of 229 White, Black, and Hispanic men and women, age 50 to 68 years at study onset, were tested annually for each of 3 years.
Physical activity probability, and changes in physical activity probability over a 3-year period.
Replicating and extending prior cross-sectional research, loneliness was associated with a significantly reduced odds of physical activity (OR = 0.65 per SD of loneliness) net of sociodemographic variables (age, gender, ethnicity, education, income), psychosocial variables (depressive symptoms, perceived stress, hostility, social support), and self-rated health. This association was mediated by hedonic emotion regulation, but not by social control as indexed by measures of social network size, marital status, contact with close ties, group membership, or religious group affiliation. Longitudinal analyses revealed that loneliness predicted diminished odds of physical activity in the next two years (OR = 0.61), and greater likelihood of transitioning from physical activity to inactivity (OR = 1.58).
Loneliness among middle and older age adults is an independent risk factor for physical inactivity and increases the likelihood that physical activity will be discontinued over time.
Recent findings suggest that a rich social network may decrease the risk of developing dementia. The authors hypothesized that such a protective effect may be due to social interaction and intellectual stimulation. To test this hypothesis, data from the 1987-1996 Kungsholmen Project, a longitudinal population-based study carried out in a central area of Stockholm, Sweden, were used to examine whether engagement in different activities 6.4 years before dementia diagnosis was related to a decreased incidence of dementia. Dementia cases were diagnosed by specialists according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, criteria. After adjustment for age, sex, education, cognitive functioning, comorbidity, depressive symptoms, and physical functioning at the first examination, frequent (daily-weekly) engagement in mental, social, or productive activities was inversely related to dementia incidence. Adjusted relative risks for mental, social, and productive activities were 0.54 (95% confidence interval (CI): 0.34, 0.87), 0.58 (95% CI: 0.37, 0.91), and 0.58 (95% CI: 0.38, 0.91), respectively. Similar results were found when these three factors were analyzed together in the same model. Results suggest that stimulating activity, either mentally or socially oriented, may protect against dementia, indicating that both social interaction and intellectual stimulation may be relevant to preserving mental functioning in the elderly.
We describe the design and methods of the Aging, Demographics, and Memory Study (ADAMS), a new national study that will provide data on the antecedents, prevalence, outcomes, and costs of dementia and "cognitive impairment, not demented" (CIND) using a unique study design based on the nationally representative Health and Retirement Study (HRS). We also illustrate potential uses of the ADAMS data and provide information to interested researchers on obtaining ADAMS and HRS data.
The ADAMS is the first population-based study of dementia in the United States to include subjects from all regions of the country, while at the same time using a single standardized diagnostic protocol in a community-based sample. A sample of 856 individuals age 70 or older who were participants in the ongoing HRS received an extensive in-home clinical and neuropsychological assessment to determine a diagnosis of normal, CIND, or dementia. Within the CIND and dementia categories, subcategories (e.g. Alzheimer's disease, vascular dementia) were assigned to denote the etiology of cognitive impairment.
Linking the ADAMS dementia clinical assessment data to the wealth of available longitudinal HRS data on health, health care utilization, informal care, and economic resources and behavior, will provide a unique opportunity to study the onset of CIND and dementia in a nationally representative population-based sample, as well as the risk factors, prevalence, outcomes, and costs of CIND and dementia.
Social isolation in old age has been associated with risk of developing dementia, but the risk associated with perceived isolation, or loneliness, is not well understood.
To test the hypothesis that loneliness is associated with increased risk of Alzheimer disease (AD).
Longitudinal clinicopathologic cohort study with up to 4 years of annual in-home follow-up.
A total of 823 older persons free of dementia at enrollment were recruited from senior citizen facilities in and around Chicago, Ill. Loneliness was assessed with a 5-item scale at baseline (mean +/- SD, 2.3 +/- 0.6) and annually thereafter. At death, a uniform postmortem examination of the brain was conducted to quantify AD pathology in multiple brain regions and the presence of cerebral infarctions.
Clinical diagnosis of AD and change in previously established composite measures of global cognition and specific cognitive functions.
During follow-up, 76 subjects developed clinical AD. Risk of AD was more than doubled in lonely persons (score 3.2, 90th percentile) compared with persons who were not lonely (score 1.4, 10th percentile), and controlling for indicators of social isolation did not affect the finding. Loneliness was associated with lower level of cognition at baseline and with more rapid cognitive decline during follow-up. There was no significant change in loneliness, and mean degree of loneliness during the study was robustly associated with cognitive decline and development of AD. In 90 participants who died and in whom autopsy of the brain was performed, loneliness was unrelated to summary measures of AD pathology or to cerebral infarction.
Loneliness is associated with an increased risk of late-life dementia but not with its leading causes.
Most studies of social relationships in later life focus on the amount of social contact, not on individuals' perceptions of social isolation. However, loneliness is likely to be an important aspect of aging. A major limiting factor in studying loneliness has been the lack of a measure suitable for large-scale social surveys. This article describes a short loneliness scale developed specifically for use on a telephone survey. The scale has three items and a simplified set of response categories but appears to measure overall loneliness quite well. The authors also document the relationship between loneliness and several commonly used measures of objective social isolation. As expected, they find that objective and subjective isolation are related. However, the relationship is relatively modest, indicating that the quantitative and qualitative aspects of social relationships are distinct. This result suggests the importance of studying both dimensions of social relationships in the aging process.
Objective:
Well-being is a psychological resource that buffers against age-related disease. We test whether this protective effect extends to dementia and whether it is independent of distress.
Methods:
Participants (N = 10,099) were from the Health and Retirement Study. Five aspects of positive psychological functioning (life satisfaction, optimism, mastery, purpose in life, and positive affect) were tested as predictors of incident dementia over 6 to 8 years.
Results:
Purpose in life was associated with a 30% decreased risk of dementia, independent of psychological distress, other clinical and behavioral risk factors, income/wealth, and genetic risk. After controlling for distress and other risk factors, the other aspects of well-being were not associated with dementia risk.
Conclusions:
After considering psychological distress, we found that measures of well-being were generally not protective against risk of dementia. An exception is purpose in life, which suggests that a meaningful and goal-driven life reduces risk of dementia.
Physiological reactivity to acute stress has been proposed as a potential biological mechanism by which loneliness may lead to negative health outcomes such as cardiovascular disease. This review was conducted to investigate the association between loneliness and physiological responses to acute stress. A series of electronic databases were systematically searched (PsycARTICLES, PsycINFO, Medline, CINAHL Plus, EBSCOhost, PubMed, SCOPUS, Web of Science, Science Direct) for relevant studies, published up to October 2016. Eleven studies were included in the review. Overall, the majority of studies reported positive associations between loneliness and acute stress responses, such that higher levels of loneliness were predictive of exaggerated physiological reactions. However, in a few studies, loneliness was also linked with decreased stress responses for particular physiological outcomes, indicating the possible existence of blunted relationships. There was no clear pattern suggesting any sex- or stressor-based differences in these associations. The available evidence supports a link between loneliness and atypical physiological reactivity to acute stress. A key finding of this review was that greater levels of loneliness are associated with exaggerated blood pressure and inflammatory reactivity to acute stress. However, there was some indication that loneliness may also be related to blunted cardiac, cortisol, and immune responses. Overall, this suggests that stress reactivity could be one of the biological mechanisms through which loneliness impacts upon health.
BACKGROUND
Positive affect (PA) and negative affect (NA) reflect subjective emotional experiences. Although related to depression and anxiety, these dimensions are distinct constructs representing affective states and patterns. Prior studies suggest that elevated depressive symptoms are associated with risk of mild cognitive impairment (MCI) and probable dementia, but whether affective states are associated with cognitive impairment is still unknown. The present study examined relationships between baseline affective states and cognitive impairment (MCI, probable dementia) in non-depressed women.
METHOD
Baseline PA and NA were assessed in postmenopausal women (N = 2137; mean age = 73.8 years) from the Women’s Health Initiative Study of Cognitive Aging (WHISCA) using the Positive and Negative Affect Schedule (PANAS). Women were followed annually for an average of 11.3 years; those with elevated depressive symptoms at baseline were excluded.
RESULTS
Higher NA was associated with a higher risk of MCI and probable dementia, even after adjusting for important covariates including age, education, sociodemographic, lifestyle, and cardiovascular risk factors, global cognition, and hormone therapy assignment at baseline. PA was not significantly associated with either outcome.
CONCLUSIONS
We present the first evidence to date that greater NA, even in the absence of elevated depressive symptoms, is associated with higher risk of MCI and dementia. This suggests that NA may be an important, measureable and potentially modifiable risk factor for age-related cognitive decline.
The aging of the US population is expected to lead to a large increase in the number of adults with dementia, but some recent studies in the US and other high-income countries suggest that the age-specific risk of dementia may have declined over the last 25 years. Clarifying current and future population trends in dementia prevalence and risk has important societal implications.
We used data from the Health and Retirement Study (HRS), a nationally representative population-based longitudinal survey of US adults to compare the prevalence of dementia in the US in 2000 and 2012. Our sample included individuals aged 65 or older from the 2000 (N = 10,675) and 2012 (N = 10,627) waves of the HRS. Dementia was identified in each year using HRS cognitive measures and validated diagnostic classifications.
Dementia prevalence decreased from 11.7% in 2000 to 9.0% (P < .001). More years of education was associated with a lower risk for dementia, and average years of education increased significantly (from 11.7 to 12.7 years; P < .001) between 2000 and 2012. The decline in dementia prevalence occurred even though there was a significant age- and sex-adjusted increase between years in the cardiovascular risk profile among older US adults.
The prevalence of dementia in the US declined significantly between 2000 and 2012. An increase in educational attainment among older adults was associated with some of the decline in dementia prevalence, but the full set of social, behavioral, and medical factors contributing to the decline is still uncertain.
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality rates, costs of care, and the overall impact on caregivers and society. The Special Report examines how the use of biomarkers may influence the AD diagnostic process and estimates of prevalence and incidence of the disease. An estimated 5.5 million Americans have Alzheimer's dementia. By mid-century, the number of people living with Alzheimer's dementia in the United States is projected to grow to 13.8 million, fueled in large part by the aging baby boom generation. Today, someone in the country develops Alzheimer's dementia every 66 seconds. By 2050, one new case of Alzheimer's dementia is expected to develop every 33 seconds, resulting in nearly 1 million new cases per year. In 2014, official death certificates recorded 93,541 deaths from AD, making AD the sixth leading cause of death in the United States and the fifth leading cause of death in Americans age ≥65 years. Between 2000 and 2014, deaths resulting from stroke, heart disease, and prostate cancer decreased 21%, 14%, and 9%, respectively, whereas deaths from AD increased 89%. The actual number of deaths to which AD contributes is likely much larger than the number of deaths from AD recorded on death certificates. In 2017, an estimated 700,000 Americans age ≥65 years will have AD when they die, and many of them will die because of the complications caused by AD. In 2016, more than 15 million family members and other unpaid caregivers provided an estimated 18.2 billion hours of care to people with Alzheimer's or other dementias. This care is valued at more than 259 billion. In recent years, efforts to develop and validate AD biomarkers, including those detectable with brain imaging and in the blood and cerebrospinal fluid, have intensified. Such efforts could transform the practice of diagnosing AD from one that focuses on cognitive and functional symptoms to one that incorporates biomarkers. This new approach could promote diagnosis at an earlier stage of disease and lead to a more accurate understanding of AD prevalence and incidence.
Purpose of the Study
This study examined whether the social environment moderates the relationship between the APOE e4 allele and cognitive functioning.
Design and Methods
The Aging, Demographics, and Memory Study (ADAMS) data and multinomial logistic regression models were used to investigate these relationships for a nationally representative sample of U.S. adults aged 70 and older (n = 779).
Results
Living alone (relative risk ratio [RRR] = 5.814; p = .000) and self-reported loneliness (RRR = 1.928, p = .049) were associated with a greater risk of cognitive difficulty. Living arrangements, perceived social support, and loneliness were found to moderate the relationship between the APOE e4 allele and cognitive function.
Implications
The results support the need to consider the social context when examining cognitive well-being in later life. These findings also indicate a need for the development of policies and services that promote a rich social environment.
Objective: The objective of this study was to examine whether loneliness was associated with the risk of developing dementia in Chinese older adults and whether the association was moderated by gender.
Method: A 3-year cohort study was conducted using data from the 2008/2009 and 2011/2012 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Multiple logistic regression was used to analyze the relationship between loneliness and dementia. The interaction between loneliness and gender was also evaluated.
Results: At 3-year follow-up, 393 of the 7867 participants had dementia. Loneliness was associated with dementia (odds ratio (OR) = 1.31, 95% confidence interval (CI) = 1.11–1.56) after adjustment for sociodemographic characteristics, lifestyle, and baseline health status. A significant interaction between loneliness and gender was also found (OR = 0.81, 95% CI = 0.65–0.99).
Conclusion: Loneliness increased the risk of developing dementia among people aged 65 years and older in China. Moreover, the effect of loneliness on dementia risk varied by gender. Specifically, men who felt lonely were more likely to suffer from dementia than women.
Objective:
To examine whether long-term measures of cortisol predict Alzheimer disease (AD) risk.
Method:
We used a prospective longitudinal design to examine whether cortisol dysregulation was related to AD risk. Participants were from the Baltimore Longitudinal Study of Aging (BLSA) and submitted multiple 24-hour urine samples over an average interval of 10.56 years. Urinary free cortisol (UFC) and creatinine (Cr) were measured, and a UFC/Cr ratio was calculated to standardize UFC. To measure cortisol regulation, we used within-person UFC/Cr level (i.e., within-person mean), change in UFC/Cr over time (i.e., within-person slope), and UFC/Cr variability (i.e., within-person coefficient of variation). Cox regression was used to assess whether UFC/Cr measures predicted AD risk.
Results:
UFC/Cr level and UFC/Cr variability, but not UFC/Cr slope, were significant predictors of AD risk an average of 2.9 years before AD onset. Elevated UFC/Cr level and elevated UFC/Cr variability were related to a 1.31- and 1.38-times increase in AD risk, respectively. In a sensitivity analysis, increased UFC/Cr level and increased UFC/Cr variability predicted increased AD risk an average of 6 years before AD onset.
Conclusions:
Cortisol dysregulation as manifested by high UFC/Cr level and high UFC/Cr variability may modulate the downstream clinical expression of AD pathology or be a preclinical marker of AD.
Importance:
The aging of the US population is expected to lead to a large increase in the number of adults with dementia, but some recent studies in the United States and other high-income countries suggest that the age-specific risk of dementia may have declined over the past 25 years. Clarifying current and future population trends in dementia prevalence and risk has important implications for patients, families, and government programs.
Objective:
To compare the prevalence of dementia in the United States in 2000 and 2012.
Design, setting, and participants:
We used data from the Health and Retirement Study (HRS), a nationally representative, population-based longitudinal survey of individuals in the United States 65 years or older from the 2000 (n = 10 546) and 2012 (n = 10 511) waves of the HRS.
Main outcomes and measures:
Dementia was identified in each year using HRS cognitive measures and validated methods for classifying self-respondents, as well as those represented by a proxy. Logistic regression was used to identify socioeconomic and health variables associated with change in dementia prevalence between 2000 and 2012.
Results:
The study cohorts had an average age of 75.0 years (95% CI, 74.8-75.2 years) in 2000 and 74.8 years (95% CI, 74.5-75.1 years) in 2012 (P = .24); 58.4% (95% CI, 57.3%-59.4%) of the 2000 cohort was female compared with 56.3% (95% CI, 55.5%-57.0%) of the 2012 cohort (P < .001). Dementia prevalence among those 65 years or older decreased from 11.6% (95% CI, 10.7%-12.7%) in 2000 to 8.8% (95% CI, 8.2%-9.4%) (8.6% with age- and sex-standardization) in 2012 (P < .001). More years of education was associated with a lower risk for dementia, and average years of education increased significantly (from 11.8 years [95% CI, 11.6-11.9 years] to 12.7 years [95% CI, 12.6-12.9 years]; P < .001) between 2000 and 2012. The decline in dementia prevalence occurred even though there was a significant age- and sex-adjusted increase between years in the cardiovascular risk profile (eg, prevalence of hypertension, diabetes, and obesity) among older US adults.
Conclusions and relevance:
The prevalence of dementia in the United States declined significantly between 2000 and 2012. An increase in educational attainment was associated with some of the decline in dementia prevalence, but the full set of social, behavioral, and medical factors contributing to the decline is still uncertain. Continued monitoring of trends in dementia incidence and prevalence will be important for better gauging the full future societal impact of dementia as the number of older adults increases in the decades ahead.
This report discusses the public health impact of Alzheimer’s disease (AD), including incidence and prevalence, mortality rates, costs of care and the overall effect on caregivers and society. It also examines the challenges encountered by health care providers when disclosing an AD diagnosis to patients and caregivers. An estimated 5.3 million Americans have AD; 5.1 million are age 65 years, and approximately 200,000 are age <65 years and have younger onset AD. By mid-century, the number of people living with AD in the United States is projected to grow by nearly 10 million, fueled in large part by the aging baby boom generation. Today, someone in the country develops AD every 67 seconds. By 2050, one new case of AD is expected to develop every 33 seconds, resulting in nearly 1 million new cases per year, and the estimated prevalence is expected to range from 11 million to 16 million. In 2013, official death certificates recorded 84,767 deaths from AD, making AD the sixth leading cause of death in the United States and the fifth leading cause of death in Americans age 65 years. Between 2000 and 2013, deaths resulting from heart disease, stroke and prostate cancer decreased 14%, 23% and 11%, respectively, whereas deaths from AD increased 71%. The actual number of deaths to which AD contributes (or deaths with AD) is likely much larger than the number of deaths from AD recorded on death certificates. In 2015, an estimated 700,000 Americans age 65 years will die with AD, and many of them will die from complications caused by AD. In 2014, more than 15 million family members and other unpaid caregivers provided an estimated 17.9 billion hours of care to people with AD and other dementias, a contribution valued at more than 226 billion. Among people with a diagnosis of AD or another dementia, fewer than half report having been told of the diagnosis by their health care provider. Though the benefits of a prompt, clear and accurate disclosure of an AD diagnosis are recognized by the medical profession, improvements to the disclosure process are needed. These improvements may require stronger support systems for health care providers and their patients.
Introduction:
Prior research has established an association between loneliness and a variety of negative health conditions among older people. However, little is known about the mechanisms underlying this association.
Objective:
Building on the Loneliness Model, Hawkley and Cacioppo (2010) identified possible pathways through which loneliness may affect the development of adverse health conditions. The present study was designed to test the pathways proposed by Hawkley and Cacioppo.
Methods:
The sample consisted of 8593 elderly ranging from 65 to 102 years of age participating in the 2013 Public Health Survey "How are you?".
Results:
Findings show that loneliness was significantly associated with cardiovascular disease, diabetes, and migraine. In addition high perceived stress, physical inactivity, daily smoking, and poor sleep mediated the association between loneliness and adverse health conditions. Moreover, findings demonstrate several gender differences in the association between loneliness and various adverse condition and the indirect mechanisms affecting these associations.
Conclusion:
The findings largely support the pathways proposed by Hawkley and Cacioppo.
The recent availability of longitudinal data on the possible association of different lifestyles with dementia and Alzheimer's disease (AD) allow some preliminary conclusions on this topic. This review systematically analyses the published longitudinal studies exploring the effect of social network, physical leisure, and non-physical activity on cognition and dementia and then summarises the current evidence taking into account the limitations of the studies and the biological plausibility. For all three lifestyle components (social, mental, and physical), a beneficial effect on cognition and a protective effect against dementia are suggested. The three components seem to have common pathways, rather than specific mechanisms, which might converge within three major aetiological hypotheses for dementia and AD: the cognitive reserve hypothesis, the vascular hypothesis, and the stress hypothesis. Taking into account the accumulated evidence and the biological plausibility of these hypotheses, we conclude that an active and socially integrated lifestyle in late life protects against dementia and AD. Further research is necessary to better define the mechanisms of these associations and better delineate preventive and therapeutic strategies.
Increasing evidence suggests that perceived social isolation or loneliness is a major risk factor for physical and mental illness in later life. This review assesses the status of research on loneliness and health in older adults. Key concepts and definitions of loneliness are identified, and the prevalence, correlates, and health effects of loneliness in older individuals are reviewed. Theoretical mechanisms that underlie the association between loneliness and health are also described, and illustrative studies examining these mechanisms are summarized. Intervention approaches to reduce loneliness in old age are highlighted, and priority recommendations for future research are presented.
Recent findings suggest that a rich social network may decrease the risk of developing dementia. The authors hypothesized that such a protective effect may be due to social interaction and intellectual stimulation. To test this hypothesis, data from the 1987-1996 Kungsholmen Project, a longitudinal population-based study carried out in a central area of Stockholm, Sweden, were used to examine whether engagement in different activities 6.4 years before dementia diagnosis was related to a decreased incidence of dementia. Dementia cases were diagnosed by specialists according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, criteria. After adjustment for age, sex, education, cognitive functioning, comorbidity, depressive symptoms, and physical functioning at the first examination, frequent (daily-weekly) engagement in mental, social, or productive activities was inversely related to dementia incidence. Adjusted relative risks for mental, social, and productive activities were 0.54 (95% confidence interval (CI): 0.34, 0.87), 0.58 (95% CI: 0.37, 0.91), and 0.58 (95% CI: 0.38, 0.91), respectively. Similar results were found when these three factors were analyzed together in the same model. Results suggest that stimulating activity, either mentally or socially oriented, may protect against dementia, indicating that both social interaction and intellectual stimulation may be relevant to preserving mental functioning in the elderly.
Background
Recent estimates suggesting that over half of Alzheimer's disease burden worldwide might be attributed to potentially modifiable risk factors do not take into account risk-factor non-independence. We aimed to provide specific estimates of preventive potential by accounting for the association between risk factors.
Methods
Using relative risks from existing meta-analyses, we estimated the population-attributable risk (PAR) of Alzheimer's disease worldwide and in the USA, Europe, and the UK for seven potentially modifiable risk factors that have consistent evidence of an association with the disease (diabetes, midlife hypertension, midlife obesity, physical inactivity, depression, smoking, and low educational attainment). The combined PAR associated with the risk factors was calculated using data from the Health Survey for England 2006 to estimate and adjust for the association between risk factors. The potential of risk factor reduction was assessed by examining the combined effect of relative reductions of 10% and 20% per decade for each of the seven risk factors on projections for Alzheimer's disease cases to 2050.
Findings
Worldwide, the highest estimated PAR was for low educational attainment (19·1%, 95% CI 12·3–25·6). The highest estimated PAR was for physical inactivity in the USA (21·0%, 95% CI 5·8–36·6), Europe (20·3%, 5·6–35·6), and the UK (21·8%, 6·1–37·7). Assuming independence, the combined worldwide PAR for the seven risk factors was 49·4% (95% CI 25·7–68·4), which equates to 16·8 million attributable cases (95% CI 8·7–23·2 million) of 33·9 million cases. However, after adjustment for the association between the risk factors, the estimate reduced to 28·2% (95% CI 14·2–41·5), which equates to 9·6 million attributable cases (95% CI 4·8–14·1 million) of 33·9 million cases. Combined PAR estimates were about 30% for the USA, Europe, and the UK. Assuming a causal relation and intervention at the correct age for prevention, relative reductions of 10% per decade in the prevalence of each of the seven risk factors could reduce the prevalence of Alzheimer's disease in 2050 by 8·3% worldwide.
Interpretation
After accounting for non-independence between risk factors, around a third of Alzheimer's diseases cases worldwide might be attributable to potentially modifiable risk factors. Alzheimer's disease incidence might be reduced through improved access to education and use of effective methods targeted at reducing the prevalence of vascular risk factors (eg, physical inactivity, smoking, midlife hypertension, midlife obesity, and diabetes) and depression.
Funding
National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Cambridgeshire and Peterborough.
Research in social epidemiology suggests that the absence of positive social relationships is a significant risk factor for broad-based morbidity and mortality. The nature of these social relationships and the mechanisms underlying this association are of increasing interest as the population gets older and the health care costs associated with chronic disease escalate in industrialized countries. We review selected evidence on the nature of social relationships and focus on one particular facet of the connection continuum – the extent to which an individual feels isolated (i.e., feels lonely) in a social world. Evidence indicates that loneliness heightens sensitivity to social threats and motivates the renewal of social connections, but it can also impair executive functioning, sleep, and mental and physical well-being. Together, these effects contribute to higher rates of morbidity and mortality in lonely older adults.
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
Although evidence suggests that loneliness may increase risk for health problems, the mechanisms responsible are not well understood. Immune dysregulation is one potential pathway: Elevated proinflammatory cytokines such as interleukin-6 (IL-6) increase risk for health problems. In our first study (N = 134), lonelier healthy adults exposed to acute stress exhibited greater synthesis of tumor necrosis factor-alpha (TNF-α) and IL-6 by peripheral blood mononuclear cells (PBMCs) stimulated with lipopolysaccharide (LPS) than their less lonely counterparts. Similarly, in the second study (N = 144), lonelier posttreatment breast-cancer survivors exposed to acute stress exhibited greater synthesis of IL-6 and interleukin-1 beta (IL-1β) by LPS-stimulated PBMCs than their counterparts who felt more socially connected. However, loneliness was unrelated to TNF-α in Study 2, although the result was in the expected direction. Thus, two different populations demonstrated that lonelier participants had more stimulated cytokine production in response to stress than less lonely participants, which reflects a proinflammatory phenotype. These data provide a glimpse into the pathways through which loneliness may affect health.
Inflammatory responses are associated with cardiovascular disease and may be associated with dementing disease. We evaluated the long-term prospective association between dementia and high-sensitivity C-reactive protein, a nonspecific marker of inflammation. Data are from the cohort of Japanese American men who were seen in the second examination of the Honolulu Heart Program (1968-1970) and subsequently were reexamined 25 years later for dementia in the Honolulu-Asia Aging Study (1991-1996). In a random subsample of 1,050 Honolulu-Asia Aging Study cases and noncases, high-sensitivity C-reactive protein concentrations were measured from serum taken at the second examination; dementia was assessed in a clinical examination that included neuroimaging and neuropsychological testing and was evaluated using international criteria. Compared with men in the lowest quartile (<0.34mg/L) of high-sensitivity C-reactive protein, men in the upper three quartiles had a 3-fold significantly increased risk for all dementias combined, Alzheimer's disease, and vascular dementia. For vascular dementia, the risk increased with increasing quartile. These relations were independent of cardiovascular risk factors and disease. These data support the view that inflammatory markers may reflect not only peripheral disease, but also cerebral disease mechanisms related to dementia, and that these processes are measurable long before clinical symptoms appear.
We tested whether social integration protects against memory loss and other cognitive disorders in late life in a nationally representative US sample of elderly adults, whether effects were stronger among disadvantaged individuals, and whether earlier cognitive losses explained the association (reverse causation).
Using data from the Health and Retirement Study (N = 16,638), we examined whether social integration predicted memory change over 6 years. Memory was measured by immediate and delayed recall of a 10-word list. Social integration was assessed by marital status, volunteer activity, and frequency of contact with children, parents, and neighbors. We examined growth-curve models for the whole sample and within subgroups.
The mean memory score declined from 11.0 in 1998 to 10.0 in 2004. Higher baseline social integration predicted slower memory decline in fully adjusted models (P<.01). Memory among the least integrated declined at twice the rate as among the most integrated. This association was largest for respondents with fewer than 12 years of education. There was no evidence of reverse causation.
Our study provides evidence that social integration delays memory loss among elderly Americans. Future research should focus on identifying the specific aspects of social integration most important for preserving memory.
One hundred years of Alzheimer’s disease: The amyloid cascade hypothesis
- M. T Maloney
Maloney, M. T. (2015). One hundred years of Alzheimer's disease:
The amyloid cascade hypothesis. Nature Education, 8, 6.