Article

Loneliness, Social Isolation, and Behavioral and Biological Health Indicators in Older Adults

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  • FLAME University
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Abstract

A number of mechanisms have been proposed through which social isolation and loneliness may affect health, including health-related behavioral and biological factors. However, it is unclear to what extent isolation and loneliness are independently associated with these pathways. The objective of the present analysis was to determine the impact of social isolation and loneliness, individually as well as simultaneously, on health-related behavioral and biological factors using data from the English Longitudinal Study of Ageing (ELSA). Data on health behaviors (smoking and physical activity) were analyzed from 8,688 participants and data on blood pressure, cholesterol, and inflammatory markers were analyzed from over 5,000 of these participants who were eligible for a nurse visit and blood sampling. Loneliness was measured using the short form of the Revised UCLA scale and an index of social isolation was computed incorporating marital status; frequency of contact with friends, family, and children; and participation in social activities. Fewer than 2% of participants reported being lonely all the time, while nearly 7% had the highest possible scores on social isolation. Both social isolation and loneliness were associated with a greater risk of being inactive, smoking, as well as reporting multiple health-risk behaviors. Social isolation was also positively associated with blood pressure, C-reactive protein, and fibrinogen levels. Loneliness and social isolation may affect health independently through their effects on health behaviors. In addition, social isolation may also affect health through biological processes associated with the development of cardiovascular disease.

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... Loneliness, the subjective feeling of being socially isolated, is the perceived discrepancy between one's social needs and what one receives from their social environment (Hawkley and Capitanio, 2015). It is not necessarily synonymous with being alone (Mushtaq et al., 2014) and has been described as the 'psychological counterpart' (Shankar et al., 2011) of the objective construct of social isolation. The association between loneliness and social isolation is weak to moderate (Shankar et al., 2011). ...
... It is not necessarily synonymous with being alone (Mushtaq et al., 2014) and has been described as the 'psychological counterpart' (Shankar et al., 2011) of the objective construct of social isolation. The association between loneliness and social isolation is weak to moderate (Shankar et al., 2011). ...
... The odds of death are 26% higher among those who report being lonely (Holt-Lunstad et al., 2015) and elevated morbidity associated with loneliness includes coronary heart disease, stroke, hypertension, chronic pain and obesity (Hawkley and Cacioppo, 2010;Wang et al., 2018). Loneliness is associated with a greater risk of detrimental health behaviours such as physical inactivity, smoking and alcohol abuse (Beutel et al., 2017;Hawkley and Cacioppo, 2010;Shankar et al., 2011). Loneliness is also related to adverse mental health outcomes, including depression, anxiety, suicidal ideation, parasuicide and suicide (Beutel et al., 2017;Hawkley and Cacioppo, 2010;Killgore et al., 2020;Mushtaq et al., 2014;Wang et al., 2018). ...
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Loneliness is a major public health issue with renewed prominence due to the COVID-19 pandemic and associated social restrictions. Healthcare workers (HCWs) may be at heightened risk, but research is lacking. We measured the prevalence of loneliness among HCWs during the pandemic in 2020 and examined pre-pandemic predictors and pandemic experiences associated with loneliness. HCWs at a designated COVID-19 hospital in Sydney, Australia completed an online survey examining health and well-being before and during the pandemic and changes to work, family and social experiences. Loneliness had negatively affected the well-being of 129 (39%) respondents (n = 330). Pre-pandemic factors predicting loneliness were younger age (<30years compared to ≥50years), having ever been told you had a mental health problem and living alone. These became non-significant when pandemic-related factors were added to the regression. Less contact with family and friends, increased conflict at home, and living alone or with family but not a partner, increased the odds of loneliness, while a sense of camaraderie with colleagues had the opposite effect. Psychological distress and poor mental health during the pandemic were also positively associated with loneliness. Efforts to promote congenial social contacts may be effective in averting loneliness among HCWs.
... Social isolation has been defined as the objective situation of individuals with small social networks and reduced frequency diseases [8] and cardiovascular disease [3,7], as well as increased risk of physical inactivity, tobacco consumption, and various other risk behaviors [3,9]. Furthermore, in old age, social isolation is associated with increased feelings of loneliness [3]. ...
... Social isolation has been defined as the objective situation of individuals with small social networks and reduced frequency diseases [8] and cardiovascular disease [3,7], as well as increased risk of physical inactivity, tobacco consumption, and various other risk behaviors [3,9]. Furthermore, in old age, social isolation is associated with increased feelings of loneliness [3]. ...
... Social isolation has been defined as the objective situation of individuals with small social networks and reduced frequency diseases [8] and cardiovascular disease [3,7], as well as increased risk of physical inactivity, tobacco consumption, and various other risk behaviors [3,9]. Furthermore, in old age, social isolation is associated with increased feelings of loneliness [3]. ...
Article
Background: Social isolation has a negative impact on the quality of life of older people; therefore, studies have focused on identifying its sociodemographic, economic, and health determinants. In view of the growing importance of the internet as a means of communication, it is essential to assess whether internet use interferes with social isolation.
... Another plausible pathway for how Type D personality predicts adverse diabetes outcomes is via social isolation, which is characterized as a lack of contact with others and social involvement [25]. An association has been reported between Type D personality and social isolation among both people with cardiovascular disease and those from a general population [26,27]. ...
... Social isolation was measured using the ve-item Social Isolation Index [25], which determines whether a respondent (i) is not married/not cohabiting with a partner; (ii) does not participate in any organization, religious group, or committee; and has less than monthly contact with (iii) friends, (iv) relatives, and (v) other family members they do not live with (including face-to-face, telephone, or written/e-mail contact). ...
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Background: This study aims to investigate the relationship of Type D personality to glycated hemoglobin (HbA1c) and health-related quality of life (HRQOL) directly, and also indirectly via diabetes distress and social isolation in people with type 2 diabetes. Methods: Secondary data analysis of a cross-sectional survey was used. Data on 524 people with type 2 diabetes from outpatient clinics were obtained from June 2020 to February 2021. The hypotheses of this study were tested using the PROCESS macro with 10,000 bootstrapping iterations to estimate 95% confidence intervals (CIs) for indirect (mediating) effects. Results: Type D personality was present in 31.3% of the participants, and exerted a significant direct effect on HRQOL but not on HbA1c. Type D personality exerted a significant indirect effects on HbA1c via diabetes distress and social isolation (95% CI = 0.014 to 0.163 and 0.007 to 0.121, respectively), and on HRQOL via diabetes distress and social isolation (95% CI = -0.335 to -0.178 and -0.056 to -0.008, respectively). The indirect effects of Type D personality on HRQOL via diabetes distress had a greater magnitude than that via social isolation. Conclusion: It is necessary for health professionals to monitor people with type 2 diabetes to determine whether Type D personality is present. Those with Type D personality should be provided with interventions to reduce diabetes distress and alleviate social isolation in order to improve their glycemic control and HRQOL.
... Previous research has identified associations between social isolation, loneliness, and smoking, but has largely focused on the idea that social isolation and loneliness lead to more smoking, due to various reasons including reduced exposure to social pressures and social contexts in which smoking is discouraged. [7][8][9][10] However, these relationships could be bidirectional: smoking could also lead to increased social isolation and loneliness. 11 Potential mechanisms include the development of smoking related diseases; the onset of limitations affecting physical mobility that consequently impact on one's ability to interact; changing social norms around smoking, with smoking becoming less socially acceptable due to increased awareness of health impacts; 5,6 and smoke-free legislation for public spaces, 12 which could all impair social participation for smokers. ...
... Comparison with other studies. Our cross-sectional results corroborate previous studies of middle aged and older adults suggesting smokers are more likely to be socially isolated, [7][8][9] and (albeit to a slightly lesser extent) lonely, 7,21 compared with non-smokers. Longitudinal research on this topic is more limited, although social network analysis has shown that smokers can become increasingly marginalised in society over time, in keeping with our findings. ...
Article
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Background Smoking is often colloquially considered “social”. However, the actual relationship of smoking with current and future social isolation and loneliness is unclear. We therefore examined these relationships over a 12-year follow-up. Methods In this cohort study, we used a nationally representative sample of community dwelling adults aged 50 years and over from the English Longitudinal Study of Ageing (N=8780) (45% male, mean(SD) age 67(10) years. We examined associations of self-reported smoking status at baseline assessment, with social isolation (low social contact, social disengagement, domestic isolation), and loneliness (3-item UCLA loneliness scale), measured at baseline, and follow-up at 4, 8 and 12 years, using ordinary least squares regression models. Findings At baseline, smokers were more likely to be lonely (coef.=0·111, 95% CI 0·025 – 0·196) and socially isolated than non-smokers, having less frequent social interactions with family and friends (coef.= 0·297, 95%CI 0·148 – 0·446), less frequent engagement with community and cultural activities (coef.= 0·534, 95%CI 0·421 – 0·654), and being more likely to live alone (Odds Ratio =1·400, 95%CI 1·209 – 1·618). Smoking at baseline was associated with larger reductions in social contact (coef.=0·205, 95%CI 0·053 – 0·356, to 0·297, 95%CI 0·140 – 0·455), increases in social disengagement (coef.=0·168, 95%CI 0·066 – 0·270, to coef.=0·197, 95%CI 0·087 – 0·307), and increases in loneliness (coef.=0·105, 95%CI 0·003 – 0·207), at 4-year follow-up) over time. No association was found between smoking and changes in cohabitation status. Findings were independent of all identified confounders, including age, sex, social class and the presence of physical and mental health diagnoses. Interpretation Smoking is associated with the development of increasing social isolation and loneliness in older adults, suggesting smoking is detrimental to aspects of psychosocial health. The idea that smoking might be prosocial appears a misconception. Funding UK Economic and Social Research Council & Imperial College London.
... Living alone may cause social isolation and feelings of loneliness and depression, especially when individuals perceive that their social needs are not met. The influence of social isolation on mortality and morbidity has been established among the traditional clinical risk factors (2,4,5). Meanwhile, loneliness and depression can negatively impact health and survival. ...
... The social networks of individuals living alone tend to shrink, and these individuals are also likely to be in poorer health. Meanwhile, patients living alone have an increasing trend toward poor health behaviors (5,9), and are also more likely to experience unmet care needs (10). In addition, several studies found that single living increased worse outcomes post heart attack or myocardial infarction (11,12). ...
Article
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Background There is a lack of studies evaluating the association between living status and subsequent outcomes in patients with type 2 diabetes (T2DM). Objectives This study aimed to assess the association between living alone and the risk of all-cause mortality in T2DM patients. Methods We performed a secondary analysis in patients with long-lasting T2DM from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. The primary outcome was all-cause mortality. Multivariable Cox proportional hazard models was used to analyze and compare the hazard ratios (HRs) in patients living alone and with one or more adults. Results This study included 10,249 patients with T2DM. Of these, 2,078 (20.28%) were living alone and 8,171 (79.72%) lived with one or more adults. Over a median total follow-up of 8.8 years, 1,958 patients developed the primary endpoint. The all-cause mortality rates in patients living alone or living with one or more adults were 23.24 and 18.05%, respectively. Cox proportional hazard analysis showed that T2DM patients living alone had significantly higher rate of all-cause mortality than those living with others (HR, 1.34; 95% confidence interval [CI], 1.20–1.48; p < 0.001). After multivariable adjustment, living alone was an independent risk factor for all-cause mortality in patients with T2DM (adjusted HR, 1.27; 95% CI, 1.14–1.41; p < 0.001). Furthermore, the risks of both congestive heart failure (CHF) and fatal coronary heart disease (CHD) among 4,050 propensity score-matched patients were higher for patients living alone (respectively HR, 1.37; 95% CI, 1.08–1.74; p = 0.010; and HR, 1.16; 95% CI, 1.00–1.34; p = 0.047). Conclusions The risk of all-cause mortality was significantly higher in T2DM patients living alone than in those living with one or more adults.
... H umans are incredibly social, and difficulties with social connection have been linked to myriad negative consequences, including increased likelihood of morbidity and mortality [1][2][3][4] . Having many social ties is one factor that can protect against the detrimental consequences of social isolation and disconnection [5][6][7][8][9] . ...
... Additional research is necessary to disentangle various possible causes. We hope that such research will help discern whether (1) processing external stimuli in similar ways to their peers causes certain individuals to become highly central in their social networks, (2) being highly central in a social network causes certain individuals to process external stimuli in ways that are more similar to those of their peers, or (3) some combination of these two possibilities is at play. Moreover, if being highly central causes people to process stimuli similarly to their peers, future research can also help uncover whether (1) highly-central individuals (as a result of their central positions in a network) exert influence on others in their social network, so that many individuals in the network become more similar to the highly-central individuals, (2) highly-central individuals change the way that they process external stimuli to fit the norms of a social network, or (3) some combination of these two possibilities is at play. ...
Article
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Convergent processing of the world may be a factor that contributes to social connectedness. We use neuroimaging and network analysis to investigate the association between the social-network position (as measured by in-degree centrality) of first-year university students and their neural similarity while watching naturalistic audio-visual stimuli (specifically, videos). There were 119 students in the social-network study; 63 of them participated in the neuroimaging study. We show that more central individuals had similar neural responses to their peers and to each other in brain regions that are associated with high-level interpretations and social cognition (e.g., in the default mode network), whereas less-central individuals exhibited more variable responses. Self-reported enjoyment of and interest in stimuli followed a similar pattern, but accounting for these data did not change our main results. These findings show that neural processing of external stimuli is similar in highly-central individuals but is idiosyncratic in less-central individuals.
... According to the Cacioppo Evolutionary Theory of Loneliness, in all age groups, the experience of feeling lonely elicits a host of behavioral and biological processes that contributes to premature death (National Institute on Aging, 2019). Those that are isolated or less socially integrated are physically and psychologically less healthy and thus at greater risk of mortality (Shankar et al., 2011). While this public health concern is being addressed at multiple levels (e.g., government and local community programs), another avenue of exploration is whether sharing economy (SE) initiatives can foster human connections and thereby reduce social isolation and loneliness. ...
... For example, (Beller and Wagner, 2018, p. 810), in exploring the predictive effect of loneliness and social isolation on mortality, found that "the higher the social isolation, the larger the effect of loneliness on mortality, and the higher the loneliness, the larger the effect of social isolation." As people age, and become less ambulant and self-sufficient, their vulnerability to social isolation and loneliness increases the potential for cognitive decline, depression, weakened immunity, anxiety, obesity, and heart disease (Shankar et al., 2011;National Institute on Aging, 2019). Besides the elderly, loneliness also impacts young adults and mothers with small children (McDonald, 2021). ...
... The answers given indicate that feeling alone, unsafe, or well at home is equivalent to perceiving less well-being and being at greater risk of psychological stress. That agrees with the previous literature 18,19 . ...
Article
Objective: The year 2020 was characterized by the outbreak of a new pandemic caused by a novel coronavirus named SARS-CoV-2. To face the pandemic, many countries worldwide imposed general lockdowns, closing all non-essential businesses. As primary care services, pharmacies had to remain open, thus putting pharmacy staff at significant risk of viral infection and overwork. This study aimed to assess the mental health of Italian Pharmacists, considering demographic and occupational characteristics, lifestyle, and habits, during the SARS-CoV-2 outbreak and the subsequent lockdown period (March-May 2020). Materials and methods: A web-based survey was created using Google® Forms to collect data from March 30, 2020, to June 1, 2020. The questionnaire consisted of three sections investigating: (1) demographic and occupational variables, (2) lifestyle and habits variables, (3) psychological distress and perceived well-being. Results: A total of 401 participants completed the questionnaire. Older workers and those with more work experience reported more psychological stress. Older and female workers, who felt lonely at home and reported psychological stress, perceived poor well-being. Conclusions: Our findings demonstrate that the Sars-CoV-2 outbreak and subsequent lockdown rules affected pharmacists' mental health and that it is important to put in place preventive measures against the occurrence of mental disorders among them.
... There is ample evidence showing how social isolation is linked to an increased risk of early mortality and worsening health Cacioppo, 2003, 2010;Holt-Lunstad et al., 2015;Shankar et al., 2011). In particular, social isolation is also linked to higher mortality in older men and women (Cornwell and Waite, 2009;Steptoe et al., 2013). ...
Article
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The magnitude of the COVID-19 crisis is unprecedented; it has impacted millions of students around the world. Among these impacted students are participants in adult education. Adult education centres have engaged in a series of online activities that have enabled adults who had never used ICT resources before, to interact with other participants. In response to this challenge, this research provides scientific insight regarding the impact of the actions by one adult education centre in Spain, the participants' association Ágora, whose scope of responsibility is to service the entire neighbourhood of La Verneda (Barcelona). Its objective is to enable adults to acquire abilities and to develop initiative through participation in a broad and high-quality educational programme. Ágora offers the entire neighbourhood a range of cultural and educational activities. This article provides knowledge about how to help people minimize the negative consequences of confinement, and uses a communicative methodology to provide a dialogical recreation of knowledge which enables researchers to contribute to dismantling myths and false assumptions in identifying the benefits adult education can provide to participants. The field work was carried out online through semi-structured interviews with a number of adult participants between the ages of 30 and 90 who were engaged in adult education activities. The research revealed that participation improved the individuals' situation by enabling them to overcome loneliness or isolation.
... Hawkley & Cacioppo (2007) argue that unhealthy lifestyles contribute to poor health and early death in the first pathway health behaviours. Lonely people tend to be involved in more risky health behaviours (Shankar, 2017) and have been found to exercise less, smoke (Shankar et al., 2011), take in more fats and calories, and are more likely to have a higher body mass index (BMI) (Shiovitz-Ezra & Parag, 2019). It has been found that lonely people manage moods by eating, drinking and acting out sexually (Hawkley & Cacioppo, 2007), and they attend general practitioners surgeries and accident and emergency departments more frequently than those who are not lonely (Cleary, 2011). ...
Article
Background : Loneliness has been associated with hypervigilance and sad passivity. The physiological and psychological reactions of people with an intellectual disability to loneliness have never been investigated. This research aims to explore the outcomes of loneliness for an ageing intellectual disability population. Methods : In Ireland, data from a nationally representative data set of people aged over 40 years with an intellectual disability (N=317) was applied to a social environment model that describes the effects of loneliness in five pre-disease pathways health behaviours, exposure to stressful life events, coping, health and recuperation. The data was tested through chi-squared, ANCOVA and binary logistic regression. Results : Being lonely predicted raised systolic blood pressure (A.O.R=2.051, p=0.039), sleeping difficulties (AOR=2.526, p=0.002) and confiding in staff (AOR=0.464 p=0.008). Additionally, participants who did moderate activity had significantly higher loneliness scores (F=4.171, p<0.05). Conclusions : The analysis supports the concept of hypervigilance in older people with an intellectual disability and limited support for the use of coping mechanisms that differ from those found in the wider population. Future research needs to investigate the longitudinal relationships between loneliness and health.
... There is much evidence in the psychological literature pointing to other destructive functions of loneliness on psychological well-being and health. For example, it is also a predictor of unhealthy behaviors (Newall et al., 2012) such as smoking (Theeke, 2010), increased cardiovascular resistance and increased systolic blood pressure (Hawkley et al., 2010), impaired mental health and cognitive functions (Cacioppo & Hawkley, 2009), hospitalization (Löfvenmark, et al. 2009), and mortality (Shankar et al., 2011). Loneliness has been identified as a risk factor for depressive symptoms in both cross-sectional studies (Nolen-Hoeksema & Ahrens, 2002) and longitudinal studies (Heiniken & Kauppinen, 2004). ...
... Social relationships help us cope with stress, thereby buffering the health effects of stress (23,71), or conversely may be sources of interpersonal stress, thereby exacerbating biological stress responses and potentially downstream health effects (6,93). Several reviews have documented the influence of aspects of social connection on behavioral factors such as sleep quality and quantity, obsessive behavior, physical activity, and smoking (10,50,84). Social 29.6 Holt-Lunstad , . ...
Article
There is growing interest in and renewed support for prioritizing social factors in public health both in the USA and globally. While there are multiple widely recognized social determinants of health, indicators of social connectedness (e.g., social capital, social support, social isolation, loneliness) are often noticeably absent from the discourse. This article provides an organizing framework for conceptualizing social connection and summarizes the cumulative evidence supporting its relevance for health, including epidemiological associations, pathways, and biological mechanisms. This evidence points to several implications for prioritizing social connection within solutions across sectors, where public health work, initiatives, and research play a key role in addressing gaps. Therefore, this review proposes a systemic framework for cross-sector action to identify missed opportunities and guide future investigation, intervention, practice, and policy on promoting social connection and health for all. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
... Community-based group exercise programs are one approach that aim to encourage, enable, and engage older adults to participate in regular, appropriate, and healthpromoting exercise. Importantly, these programs have the added potential to stimulate social engagement amongst members of the community; a factor known to improve health outcomes in older age, in and of itself [17][18][19]. This is achieved through maximising accessibility (sessions are held at community halls and local gyms); and financial affordability (sessions are free or low-cost). ...
Article
Full-text available
Community-based exercise programs for older adults play a potentially important role in mitigating the decline in functional outcomes, body composition, psychosocial outcomes, and cardiovascular health outcomes that commonly occurs with advancing age. There is a limited understanding of the characteristics and effectiveness of community-based exercise programs, particularly when those programs are offered outside metropolitan areas. Rural/regional settings face unique challenges, such as limited access to equipment/resources, transportation, and services, as well as significant costs to run programs. The objective of this scoping review was to characterise studies in the field that have aimed to implement community-based programs in settings identified as rural / regional. A secondary aim was to establish guidance for future exercise programs in this setting and highlight future research directions. A total of 12 studies were conducted in settings identified as rural/regional areas in various countries across the world were included. Of the included studies, five were randomised controlled trials. The majority of included studies reported on functional outcomes (83%) and psychosocial outcomes (75%), yet only 42% reported body composition, 17% reported cardiovascular health and 17% reported dietary outcomes. Low male representation was observed, with women outnumbering men in 7 of 12 studies. There was also minimal investigation of qualitative outcomes in existing community-based exercise programs in rural/regional settings, presenting a key gap for future research to address. Study Protocol: https://osf.io/txpm3/ . Date of registration: 20 July 2020.
... [25][26][27][28][29][30][31] Similarly, it is known that social isolation, as a natural consequence of restrictions, has a negative effect on pain and physical activity level too. [32][33][34][35] In a study conducted in our country at the same time as our study, in which healthcare workers, mostly nurses, were evaluated, it was found that approximately one-third of the participants experienced severe extremely severe depression and anxiety, and a quarter of them were under severe extremely severe stress. [36] In a study conducted in Spain, in which individuals with chronic pain (52.2% musculoskeletal pain) were included, most of the participants stated that their pain increased, [37] as in our study. ...
Article
Objectives: Self-isolation seems to be the best way to slow down the coronavirus disease 2019 (COVID-19) outbreak, but it may also have negative impact on physical and mental health. The aim of this study was to investigate the changes in physical activity habits during the outbreak and also the impact of the pandemic on musculoskeletal pain and mood in correlation with physical activity in healthcare workers. Methods: This study is conducted through Google Forms web survey platform. A total of 310 hospital staffs completed the Google Forms questionnaire in 2 weeks during lockdown and curfew period in Istanbul. The questionnaire included 60 questions including demographic, occupational, COVID-19 exposure data, physical activity habits, musculoskeletal pain, and mood. Results: There was a significant difference between physical activity habits before and after the pandemic (p<0.001). Individuals engaged in regular physical activity (regardless of duration) had significantly higher happiness ratings (p=0.002). No statistically significant difference was found between the duration of physical activity and the musculoskeletal pain during the pandemic. Conclusion: Pandemic caused a decrease in physical activity, an unhappy and anxious mood, and an increase in musculoskeletal pain of healthcare workers. Participants who were doing regular physical activity were less unhappy, but no relationship between exercise and musculoskeletal pain was found which might be related to psychosocial state of the participants who worked under great stress with high effort during the pandemic.
... Indeed, loneliness has been linked with smoking in a systematic review; however, just three included studies focused on older adults. 16 Of these, two were conducted in England 17,18 and one was a convenience sample of HIV-positive adults age 50 and older. 19 Another study from the U.S. suggests loneliness predicts smoking cessation among older adults, which is counterintuitive and the authors called for more research in this area. ...
Article
Purpose To use the loneliness model in examining the influence of loneliness on the number cigarettes smoked per day and the different intensity levels of physical activity among community-dwelling older Americans in the United States. Design, setting, sample This study analyzed a nationally representative sample of older adults aged 65+ in two waves (2010 and 2012) of data from the Health and Retirement Study. Response rates for the two waves were 81% and 89.1%. The sample size for smoking model was 199, and for physical activity models was 3018. Measures Outcomes included number of cigarettes smoked per day and physical activity at three intensity levels: light, moderate, and vigorous. Independent variable was the UCLA loneliness scale. Analysis A lagged dependent approach for modeling longitudinal data was adopted. Models controlled for outcomes at the first timepoint (Wave 1), health/physical functioning, and demographic variables. Results Loneliness was associated with an increased number of cigarettes smoked per day (β = 2.93, P < .05) and decreased engagement in moderate and vigorous physical activity for older adults (β = .12, P < .05; β = .12, P <. 05), after controlling for these behaviors at baseline and other covariates. Conclusion The findings call for smoking reduction and physical activity enhancement interventions targeting older adults who have high levels of loneliness. Efforts to enhance social support will be crucial to eradicating the harmful health impact of loneliness. Critical limitations include self-reported measures and unobserved confounders.
... [16] In line with this, studies have indicated that enriched social interactions tend to enhanced neurogenesis and programming in the brain, particularly at the centers essential for social perceptions, communication, and memory consolidation. [17] Various functional neurological cellular changes observed with social isolation include: 1. Dysregulated development of the hippocampus due to modifications in microtubular instability and decreased microtubule-associated protein-2 expression leading to dysregulated remodeling of axons and dendrites [18] 2. Diminished expression of synaptophysin and dendritic cell length and density of pyramidal cells [19] 3. Increased in Tac2 gene (Tachykinin gene) expression and the production of NkB throughout the brain associated with impaired cognition, increased response to fearful stimuli, and difficulty in memory consolidation [16] 4. Diminished synthesis of newer neurons formation, brain-derived neurotropic factor, and nerve growth factor in hippocampal region [20] 5. Abnor mal expression of cAMP response element-binding protein in the regions such as the ventral striatum and the amygdala, which has been associated with depression, anxiety, and psychosis-like behaviors. [20] Several whole-brain exploratory studies in socially isolated individuals have highlighted various changes in brain: 1. ...
Article
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Coronavirus disease 2019 pandemic spreads through inhalation of aerosols or droplets. Therefore, the use of face masks, alcohol-based sanitizers, and most importantly practicing quarantine/ isolation and social distancing are the main modalities for its prevention and control. Although isolation is essential, various psychological effects have been implicated with its practice in most of the age groups. Longstanding isolation and negligible interpersonal interactions can have changes in psychological processes and neurological and morphological changes in the brain. Morphological changes as seen through the neuroimaging studies include reduced volume of the structures involved in the synthesis of various nerve growth factors leading to impaired neurogenesis and subsequently psychological changes which can manifest as mood alterations such as anxiety, depression, feeling demoralized, obsessive thinking, and altered sleep–wake cycles besides others especially, in the vulnerable age groups such as children and the elderly. Although quarantine remains the cornerstone to contain the spread of the pandemic, its psychological impact run simultaneously, which should be, understood, and addressed to ameliorate its long-term impact.
... Social connectedness has been widely implicated in preserving older adults' cognitive, physical, and mental wellbeing (Shankar et al., 2011;Boss et al., 2015;Kuiper et al., 2015). Socialcognitive function-the process by which people understand, store, and apply information about others (Fiske and Taylor, 1991)-is essential for maintaining social connectedness (see Krendl and Heatherton, 2009), and relates to social relationships in later life (Krendl et al., 2022). ...
Article
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Social cognition is critical for successfully navigating social relationships. Current evidence suggests that older adults exhibit poorer performance in several core social-cognitive domains compared to younger adults. Neurocognitive decline is commonly discussed as one of the key arbiters of age-related decline in social-cognitive abilities. While evidence supports this notion, age effects are likely attributable to multiple factors. This paper aims to recontextualize past evidence by focusing issues of motivation, task design, and representative samples. In light of these issues, we identify directions for future research to aide our understanding of social-cognitive aging.
... For example, individuals can feel lonely without feeling socially isolated (and vice versa). Moreover, they differ in their antecedents [10] and consequences [11]. ...
Article
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Purpose Our aim was to identify the prevalence and correlates of loneliness, perceived and objective social isolation in the German population during the COVID-19 pandemic. Methods Data were taken from a representative survey with n = 3075 individuals (18–70 years; August/September 2021). Valid measures were used to quantify the outcomes (loneliness: De Jong Gierveld scale; perceived social isolation: Bude/Lantermann tool; objective social isolation: Lubben Social Network Scale). Multiple logistic regressions were used to identify the correlates of these three outcomes. Results The prevalence of loneliness was 83.4%, the prevalence of perceived social isolation was 59.1% and the prevalence of objective social isolation was 28.9%. The prevalence rate significantly differed between the subgroups (e.g., the prevalence of perceived social isolation was 73.9% among individuals aged 18–29 years, whereas it was 48.8% among individuals aged 60–70 years). In regression analysis, several correlates of these outcomes were identified (e.g., marital status, age group (with changing signs), migration background, sports activities, or self-rated health). Conclusion Our study particularly identified very to extraordinarily high prevalence rates for social isolation and loneliness, respectively. Knowledge about the correlates (e.g., age group) may help to address these individuals during the ongoing pandemic.
... This is shown by the increase in the proportion of singleperson households from 7.7% in 1940 to 25.8% in 2000 in the United States (3). Living alone may lead to social isolation and a lack of social support, which may be detrimental to health (4). This phenomenon was verified in patients with cardiovascular disease (CVD) (5,6). ...
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Objective Living alone is often associated with reduced social support. However, there are limited data on the relationship between living alone and cardiovascular events or hypoglycemia in patients with type 2 diabetes mellitus (T2DM). This study reports a post-hoc analysis of the “Action to Control Cardiovascular Risk in Diabetes (ACCORD)” study. Research Design and Methods The Cox proportional hazard models were used to compare the hazard ratios (HRs) for the adverse health events selected as primary endpoints in the study participants; these were compared between those living alone and those living with others. The primary outcomes were hypoglycemia requiring any assistance (HAA), hypoglycemia requiring medical assistance (HMA), and major cardiovascular events (MACEs, including cardiac death, non-fatal myocardial infarction (MI), and non-fatal stroke). Our study included 10,249 participants (2,078 living alone) with a follow-up period of 4.91 ± 1.22 years. Results After a multivariable adjustment, the risk of HAA, HMA, and MACEs did not differ significantly between participants living alone and those living with others (HAA, HR: 0.88, 95% CI: 0.75–1.04, P = 0.13; HMA, HR: 1.11, 95% CI: 0.92–1.34, P = 0.26; MACEs, HR: 0.98, 95% CI: 0.80–1.19, P = 0.82). Participants living alone had higher levels of glycated hemoglobin in the middle follow-up period than those living with others. Conclusions In patients with T2DM, living alone did not increase the risk of cardiovascular events (cardiac death, non-fatal MI, or non-fatal stroke) and hypoglycemia. Patients living alone had higher Hb1AC levels than those living with others. Clinicians should consider an effective blood glucose control regardless of their living arrangement.
... The experiments show that people who live alone are than 30% more likely to report symptoms of mental distress than those living with family or friends [Shankar, A. et al. 2011]. Nearly half of people who live alone have experienced depression. ...
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One of the most important issues in recent years has been the issue of population aging and its effects on the economy. It is clear that aging leads to increased healthcare costs, decreased productivity, saving, investment, risk taking and etc. finally, the economic growth will slow. On the other hand, it is necessary to address the issues of sustainable development, namely inequality, life expectancy, green life and etc. The main goal of this article is survey the impacts of aging on sustainable development and G20 economies and their plans for reducing and controlling the negative consequences. The main contribution of this article is that we have integrated the issue of sustainable development and aging problem in G20 countries in terms of economic and finance. The results show that the rate of fertility is decreasing and the rate of aging is increasing. So, G20 programs need to be considered and acted upon. We can conclude that by investing and effective measures and identifying potential threats, the effects of reduced economic growth and productivity can be reduced.
... Social disconnectedness indirectly gave rise to mental health problems by increasing perceived isolation. While prior literature widely documented that the co-occurrence of social disconnectedness and perceived isolation has an impact on mental health [33][34][35], our study suggested that both social disconnectedness and perceived isolation led to mental health problems, with the former playing a more distal role and the latter a more proximate role in predicting the problems. ...
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Objectives: This study aimed to examine the mediating effect of perceived isolation and the moderating effect of COVID-19 related concerns in the relationship between social disconnectedness and mental health problems during the COVID-19 pandemic in China. Methods: A cross-sectional online survey of 11,682 Chinese residents were conducted during the COVID-19 outbreak. Conditional process analysis was performed to test the mediating effect of perceived isolation and the moderating effect of COVID-19 related concerns. Results: Social disconnectedness was positively related to mental health problems, and perceived isolation significantly mediated their relationship. COVID-19 related concerns exacerbated the direct link between social disconnectedness and mental health problems as well as the indirect link via perceived isolation. Conclusion: Social disconnectedness was a key predictor of mental health problems during the COVID-19 outbreak. The direct and indirect effects of social disconnectedness on mental health problems were stronger for respondents who had more COVID-19 related concerns. Understanding the underlying mechanisms by which social disconnectedness is related to mental health problems has important practical implications for the prevention of mental health problems during the COVID-19 pandemic.
... Importantly, evidence suggests that the correlation between measures of loneliness and social isolation are moderate (Kung et al. 2021;Newall and Menec 2017). However, social isolation has also shown significant associations with mortality and poor health outcomes, even after accounting for loneliness (Ge et al. 2017;Hakulinen et al. 2018;Newall and Menec 2017;Shankar et al. 2011;Steptoe et al. 2013). Social isolation does not tap into the function aspects, or quality, of these interactions; these are better captured by social support measures, where individuals appraise their interactions with regard to the availability of emotional support and/or access to resources (finances, goods, services or information) (Fiorillo and Sabatini 2015;Valtorta et al. 2016;Wang et al. 2017). ...
Article
Despite the substantial literature on how loneliness is associated with poor health and premature mortality, there is little detailed research on the extent of its economic gradients. We provide this evidence using a sample of around 400,000 respondents aged 40–70 years from the UK Biobank, who were assessed between 2006 and 2010. We focus on differences in loneliness, as well as social isolation and a lack of social support, across educational attainment, household income, local area deprivation, and recent experience of financial stress. We employ two statistical approaches, the first exploiting the large sample size and detailed geographical information about where respondents live, so we compare individuals who differ in their economic status but reside within the same postcode district. The second approach exploits the fact that for around 36,000 respondents we observe their social health and economic circumstances at two points in time (second wave of assessment conducted between 2014 and 2020), so we conduct a panel analysis that accounts for intercorrelations between the social health measures, and controls for incomplete follow-up of panel members. Across both approaches, we find a substantially higher probability of reporting loneliness, social isolation and a lack of social support, for men and women with lower economic status. Together with the existing health-loneliness literature, these findings establish a ‘loneliness pathway’ contributing to health inequalities, and consequently a need for effective interventions that might address loneliness and social isolation as part of a broad policy initiative on health inequalities.
... First, peer isolation may induce a critical state for children by biological changes. Previous studies have found that social isolation is associated with a high cholesterol response to stress (24), elevated blood pressure, fibrinogen, and C-reactive protein (44,45), which increases the risk of diseases such as cardiovascular disease (46). Although these studies included participants who were in adulthood and old age, biological changes related to overweight and obesity due to peer isolation may also appear in children. ...
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Background Adverse childhood experience (ACE) is a major risk factor for obesity in both adults and adolescents. Although, arguably, peer isolation and low household income could be conceived as of ACEs, few studies have included these experiences as ACEs.Objectives This study aims to examine whether ACEs, including peer isolation and low household income, are associated with obesity in adolescents.Methods We used pooled data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study in 2016 and 2018, which is a school-based cross-sectional study in Adachi City, Tokyo, Japan, N = 6,946, 4th (9–10 years old), 6th (11–12 years old), and 8th (13–14 years old) grades. Among the eight items of ACEs, adolescents assessed one item, including peer isolation, and their caregivers assessed seven other items using questionnaires. The adolescents' body mass index (BMI) was measured in school health checkups and calculated to fit the World Health Organization (WHO) standards. Multinomial logistic regression was applied to investigate the association of the cumulative ACEs and each type of ACE with BMI, in which the study was conducted in 2020.ResultsThe number of ACEs was not associated with overweight or obesity among adolescents after adjusting for covariates. As for each type of ACE, single parenthood and low household income showed a significant independent association with obesity.Conclusions The number of ACEs was not associated with overweight or obesity in Japanese adolescents, while single parenthood and low household income showed a significant positive association with obesity. Further longitudinal studies are needed to replicate this association among adolescents.
... However, J o u r n a l P r e -p r o o f conducting this study online allowed us to recruit a large sample and rapidly collect relevant data during a period when in-person contact was restricted due to COVID-19 risk (52). Although we applied general population weights developed using American Community Survey data to our models, our results may be subject to residual bias if there are unmeasured drivers of study participation that are correlated with the mental health exposures and cognitive outcomes, but uncorrelated with the sociodemographic variables included in weighting (53). This sample had a higher proportion of non-Hispanic Whites and adults with higher educational attainment than the general US population aged ≥55 years. ...
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Background The acute impacts of COVID-19-related mental health concerns on cognitive function among middle-aged and older adults are unknown. We investigated whether between-person (BP) differences and within-person (WP) changes in loneliness, anxiety, and worry about COVID-19 were related to cognitive function and abilities in a longitudinal cohort of middle-aged and older United States (US) adults over a nine-month period during the COVID-19 pandemic. Methods Data were from bimonthly questionnaires in the nationwide COVID-19 Coping Study from August/September 2020 through April/May 2021 (N = 2262 adults aged ≥55). Loneliness was assessed with the 3-item UCLA Loneliness Scale, anxiety with the 5-item Beck Anxiety Inventory, and COVID-19 worry on a 5-point Likert-type scale. Cognitive outcomes were assessed with the 6-item Patient Reported Outcomes Measurement Information System (PROMIS®) Cognitive Function and Abilities scales. Marginal structural models incorporating inverse probability of treatment and attrition weights as well as sampling weights estimated the BP and WP relationships between the mental health predictors and PROMIS® cognitive scores over time. Results In any given month, experiencing a loneliness, anxiety symptom, or COVID-19 worry score higher than the sample mean (BP difference) or higher than one's personal mean across the nine-month period (WP change) was negatively associated with cognitive function and abilities in that month. The observed magnitudes of associations were stronger for BP differences than for WP changes and were the strongest for anxiety symptom scale scores. Conclusions Elevated loneliness, anxiety symptoms, and worry about COVID-19, both relative to other adults and to one's usual levels, were acutely associated with worse perceived cognitive function and abilities over a nine-month period during the COVID-19 pandemic in the United States. The long-term impacts of mental health symptoms experienced during the pandemic for population cognitive health should be explored.
... With the rapid increase in population ageing, social isolation and loneliness of older people were found to be the major issues (Clayton, 2018). Shankar et al. (2011) andWinningham &Pike (2007) mentioned older people in care homes (OPLICH) as a greater risk population of experiencing social isolation and loneliness. Other researchers mentioned that loneliness and social isolation resulted in poor health outcomes such as QoL (Cornwell & Waite, 2009;La Grow et al., 2012;Nummela et al., 2011;Sutin et al., 2020) and increased the risk of dementia (Tilvis et al., 2012). ...
Chapter
1. YAŞLILIK Yaşlılık, her canlıda görülen, tüm işlevlerde giderek azalmaya neden olan, ne zaman sonlanacağı belli olmayan ve evrensel bir süreç olarak tanımlanabil-mektedir (Aslan ve Ertem, 2012). İlk insanın 3,5 milyon yıl önce Afrika'da yaşadığını gösteren fosiller var olma-sına rağmen insanlara yaşlanmanın kapıları 19. yüzyıla kadar kapalı kalmış-tır. Hayat kısa ve yaşlılık çok az kişiye nasip olan çok özel ve tanınmayan bir durum olarak görülmüş, insanoğlu yaşlılık özlemi çekmemiş ve onu hiç kıs-kanmamıştır. Çünkü yaşlılar hasta, zayıf, alay edilecek birer zavallı olarak gö-rülmüşlerdir. Yaşlılar; insanlık tarihinde bazı dönemler hariç hep dışlanan, mecburen taşınması geren yük olarak görülmüştür. Ancak 19. yüzyıl her şe-yin değişmeye başladığı çağ olmuştur (Tufan, 2014). Sanayi devrimi sonrası Avrupa'da yaşanan gelişmeler yaşam süresinin uza-masına ve ölüm oranlarının düşmesine sebep olmuştur. Avrupa'dan başlaya-rak dünyaya yayılan bu gelişmeler insanlık tarihinin en büyük nüfus değişim-lerine de yol açmıştır. Ömür uzunluğunun artması, ölüm oranının azalması, aynı zamanda doğum oranının da azalması yaşlı nüfus oranlarının artmasına neden olmuştur (Korkmaz ve Yazıcı, 2014). Günümüzde, sağlık alanındaki ge-lişmelerle birlikte tedavisi mümkün olmayan hastalıkların tedavi edilmesi, kronik hastalıkların ve komplikasyonlarının kontrol altına alınması, kaliteli beslenilmesi, sağlığın yükseltilmesi ile yaşam kalitesinin olumlu yönde geliş-mesi dünyada ve özellikle gelişmiş olan ülkelerde yaşlı nüfus artışını berabe-rinde getirmektedir (Işıl ve Onan, 2016). Eski Roma döneminde ortalama ya-şam 22 yıl, 19. yy'da 41 iken Dünya Sağlık Örgütü (DSÖ) verilerine göre 2015 yılında yaşam süresi kadınlarda 73,8 yıl, erkeklerde ise 69,1 yıla ulaşmıştır. Özellikle gelişmiş ülkelerde yaşlı nüfus hızla artmakta, genel popülasyonun içinde önemli bir kısmı oluşturmakta; sağlık alanında yaşanan gelişmelere paralel olarak, her geçen gün payları daha da artmaktadır. 2018 verilerine göre Dünya nüfusunun %9,1 'ini 65 yaş ve üzeri bireyler oluşturmaktadır. Nüfus projeksiyonlarına göre 2023 yılında %10,2, 2040 yılında %16,3, 2080 1 Burdur İl Sağlık Müdürlüğü
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Importance: Social isolation and loneliness are increasing public health concerns and have been associated with increased risk of cardiovascular disease (CVD) among older adults. Objective: To examine the associations of social isolation and loneliness with incident CVD in a large cohort of postmenopausal women and whether social support moderated these associations. Design, setting, and participants: This prospective cohort study, conducted from March 2011 through March 2019, included community-living US women aged 65 to 99 years from the Women's Health Initiative Extension Study II who had no history of myocardial infarction, stroke, or coronary heart disease. Exposures: Social isolation and loneliness were ascertained using validated questionnaires. Main outcomes and measures: The main outcome was major CVD, which was physician adjudicated using medical records and included coronary heart disease, stroke, and death from CVD. Continuous scores of social isolation and loneliness were analyzed. Hazard ratios (HRs) and 95% CIs for CVD were calculated for women with high social isolation and loneliness scores (midpoint of the upper half of the distribution) vs those with low scores (midpoint of the lower half of the distribution) using multivariable Cox proportional hazards regression models adjusting for age, race and ethnicity, educational level, and depression and then adding relevant health behavior and health status variables. Questionnaire-assessed social support was tested as a potential effect modifier. Results: Among 57 825 women (mean [SD] age, 79.0 [6.1] years; 89.1% White), 1599 major CVD events occurred over 186 762 person-years. The HR for the association of high vs low social isolation scores with CVD was 1.18 (95% CI, 1.13-1.23), and the HR for the association of high vs low loneliness scores with CVD was 1.14 (95% CI, 1.10-1.18). The HRs after additional adjustment for health behaviors and health status were 1.08 (95% CI, 1.03-1.12; 8.0% higher risk) for social isolation and 1.05 (95% CI, 1.01-1.09; 5.0% higher risk) for loneliness. Women with both high social isolation and high loneliness scores had a 13.0% to 27.0% higher risk of incident CVD than did women with low social isolation and low loneliness scores. Social support was not a significant effect modifier of the associations (social isolation × social support: r, -0.18; P = .86; loneliness × social support: r, 0.78; P = .48). Conclusions and relevance: In this cohort study, social isolation and loneliness were independently associated with modestly higher risk of CVD among postmenopausal women in the US, and women with both social isolation and loneliness had greater CVD risk than did those with either exposure alone. The findings suggest that these prevalent psychosocial processes merit increased attention for prevention of CVD in older women, particularly in the era of COVID-19.
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Background: Loneliness is a growing public health concern, yet little is known about loneliness in young people. The current study aimed to identify social ecological factors related to loneliness and examine the extent to which geographic region may account for differences in loneliness. Methods: The data come from a cross-sectional sample of 6503 young people living in the UK. Loneliness was measured using the UCLA 3-item scale. Bivariate analyses were used to test associations between each predictor and loneliness. Multilevel models were used to identify key social ecological factors related to loneliness, and the extent to which loneliness may vary across geographic regions (local authority districts). Results: Sociodemographic, social, health and well-being, and community factors were found to be associated with loneliness. Geographic region was associated with 5-8% of the variation in loneliness. The effect of gender, sexual orientation and minority ethnic background on loneliness differed across regions. Conclusions: This is the first study to highlight modifiable social and community factors related to youth loneliness, and individual vulnerabilities, such as poor mental well-being. Results related to geographic differences suggest that local-level initiatives may be most appropriate in tackling loneliness, rather than wider, less contextualized national efforts.
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Social robots such as chatbots are regarded as a practical approach to alleviate loneliness. Few studies in the tourism field have focused on loneliness and its impact on the acceptance of chatbots used by the tourism industry. This paper explores the factors influencing tourists’ willingness to use chatbots from the perspective of loneliness by combining theories related to anthropomorphism and the uncanny valley effect. This paper adopts a qualitative research method by taking a semi-structured interview with 15 tourists who have used travel chatbots before. The results show that in addition to perceived ease of use and perceived usefulness, there are three factors (tourist loneliness, perceived anthropomorphism, and user anxiety) that directly influence tourists’ acceptance of travel chatbots. Moreover, tourist loneliness positively influences user anxiety through perceived anthropomorphism. User anxiety has a negative effect on perceived ease of use and perceived usefulness. This research then proposed an extended TAM model from the perspective of tourist loneliness. This paper enriches the research on loneliness as well as chatbots in the tourism field. The results provide suggestions for the practical application of travel chatbots.
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Fatigue is lethargy and seen as unpleasant experience that occurs from physical labour or mental exertion. Fatigue can be either physical or mental. This paper examines the role of physical fatigue and mental fatigue in the relationship between physical isolation variables (social isolation and loneliness) and safety behaviour (safety compliance and safety participation). A cross-sectional study with data were collected by means of a questionnaire among oil and gas workers (foreign employees working at a remote oil and gas field site located in Kuwait), during a 3-month period (from October 2018 to December 2018). Regression analyses (bivariate and hierarchical), carried out on 387 responses, were employed to test the hypothesized model relating physical isolation variables, fatigue levels, and safety behaviour. The results provide support for the role of mental fatigue in mediating the relationship between loneliness and both types of safety behaviour (compliance and participation). Results indicate that mental fatigue is associated with feeling lonely and has negative effect on safety behaviour, which indicated a greater risk of injury incident rates. The study findings should facilitate the improvement of employee safe behaviour through monitoring workers’ fatigue levels. Moreover, they may enable prompt intervention and help to contribute to the development of recommendations that broaden our understanding of the effects of isolation and remote work in the context of workplace safety. The implications of these results for physical isolation, fatigue and/or safety behaviour interventions in the industry are discussed.
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Gauging the social relationships of the elderly is a significant sociometric research subject and a deep biomedical concern—particularly after the COVID-19 pandemic. It is imperative for facultatives in primary care, for geriatric clinics, and for social care services. In this respect, this article explores the validity of an abbreviated version of the Sociotype Questionnaire (SOCQ), a tool previously developed by the authors for assessing the social relationships of the general population, now specifically addressed to the elderly population. The aim is to construct a 4-item dichotomous scale (SOCG-4) out of the 12 items of the original scale of the SOCQ, so that it can serve to discriminate among the patients in primary care and the geriatric clinic, helping the facultative to find those in need of social care or of psychosocial intervention. The population data have been obtained from a series of previous studies on social relationships in different segments of the elderly population (Ntotal = 915). The resulting abbreviated version of SOCG-4 was extracted by means of confirmatory factor analysis, with the congruence, validity, and relationship with the determinants as close to optimal. The significant correlations with SOCQ (0.82), UCLA (−0.55), Barthel (0.40), and other relevant tests are obtained. The test was also put to trial in a pilot study, being applied to 150 subjects via phone surveys, home visiting, and geriatric clinic—it becomes particularly useful for assessing the social relationships in geriatric clinic use. The 4-item Geriatric Sociotype scale (SOCG-4) appears as a valid measurement instrument for use in the clinic and in other social care instances.
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Objectives: We provide new evidence on the profiles of social isolation, social support, and loneliness before and after spousal death for older widows. We also examine the moderating effects of gender and financial resources on changes in social health before and after widowhood. Methods: We use 19 waves of data from the Household, Income and Labour Dynamics in Australia Survey, including 749 widowed individuals and a comparison group of around 8,000 married individuals. We apply coarsened exact matching weights and control for age and time trends. Local polynomial smoothed plots show the profiles of social health from 3 years pre- to 3 years postspousal death. All analyses were stratified by gender. Results: Spousal death was strongly associated with increased loneliness for women and men, but also an increase in interactions with friends and family not living with the bereaved. For men, financial resources (both income and asset wealth) provided some protection against loneliness. Spousal death was not associated with changes in social support or participation in community activities. Discussion: We demonstrate that loneliness is a greater challenge of widowhood than social isolation or a lack of social support. Our findings suggest that interventions focusing only on increasing social interactions are unlikely to alleviate loneliness following spousal death. Moreover, policies that reduce the cost of formal social participation may have limited effectiveness in tackling loneliness, particularly for women. Alternative strategies, such as helping the bereaved form a new sense of identity and screening for loneliness around widowhood by health care workers, could be beneficial.
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Background: Recent advances in mobile and wearable technologies have led to new forms of interventions, called “Just-in-Time Adaptive Interventions” (JITAI). JITAIs interact with the individual at the most appropriate time and provide the most appropriate support depending on the continuously acquired Intensive Longitudinal Data (ILD) on participant physiology, behavior, and contexts. These advances raise an important question: How do we model these data to better understand and intervene on health behaviors? The HeartSteps II study, described here, is a Micro-Randomized Trial (MRT) intended to advance both intervention development and theory-building enabled by the new generation of mobile and wearable technology. Methods: The study involves a year-long deployment of HeartSteps, a JITAI for physical activity and sedentary behavior, with 96 sedentary, overweight, but otherwise healthy adults. The central purpose is twofold: (1) to support the development of modeling approaches for operationalizing dynamic, mathematically rigorous theories of health behavior; and (2) to serve as a testbed for the development of learning algorithms that JITAIs can use to individualize intervention provision in real time at multiple timescales. Discussion and Conclusions: We outline an innovative modeling paradigm to model and use ILD in real- or near-time to individually tailor JITIAs.
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Social determinants of health (SDOH) are defined as the set of modifiable social and physical risk factors that affect health. It is known that SDOH directly influence the population's overall health, but their effects on patients with cancer are considerably less elucidated. Here, we review the literature describing the effects of SDOH outlined by the Healthy People 2020 framework on patients diagnosed with cancer. We have found that while some SDOH are well-defined in cancer patients, evidence surrounding several variables is scarce. In addition, we have found that many SDOH are associated with disparities at the screening stage, indicating that upstream interventions are necessary before addressing the clinical outcomes themselves. Further investigation is warranted to understand how SDOH affect screenings and outcomes in multiple disciplines of oncology and types of cancers as well as explore how SDOH affect the treatments sought by these vulnerable patients.
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Objective: We aimed to identify patient-level demographic and behavioral characteristics associated with higher social isolation among patients with cancer throughout the coronavirus disease 2019 (COVID-19) pandemic. Method: Moffitt Cancer Center patients seen on or after January 1, 2015, had a last known alive vital status, a valid e-mail address, and were 18-89 years old, were emailed a survey regarding social isolation. We collected information on age, sex, race, ethnicity, marital status, smoking, self-reported cancer diagnosis, cancer treatment, and perceived life changes due to the COVID-19 pandemic. We calculated a COVID-19 risk mitigation score by summing the frequency of risk mitigation behaviors (e.g., mask wearing). Social isolation was assessed with the self-reported Patient-Reported Outcomes Measurement Information System (PROMIS) Social Isolation Short Form. Logistic regression models compared characteristics of participants reporting higher versus lower social isolation (T-scores >60 vs. ≤60). Results: Most participants (N = 9,579) were female (59.2%), White (93.0%), and non-Hispanic (92.5%). Participants at greater odds of higher social isolation were younger (per 10 years decrease odds ratio [OR] = 1.36, 95% confidence interval, CI [1.30, 1.43]), female (vs. male OR = 1.54, 95% CI [1.36, 1.74]), unmarried (vs. married OR = 1.83, 95% CI [1.62, 2.08]), current smokers (vs. never OR = 2.38, 95% CI [1.88, 3.00]), reporting more risk mitigation behaviors (per 1 SD; OR = 1.33, 95% CI [1.24, 1.42]), and more perceived life changes (vs. little/no change; OR = 2.64, 95% CI [2.08, 3.35]). Conclusions: We identified younger age, females, unmarried, current smokers, more risk mitigation behaviors, and more perceived life changes increased odds of social isolation for patients with cancer during the COVID-19 pandemic. This can inform identification of patients with cancer at higher risk of social isolation for targeted mitigation strategies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Article
Background: The COVID-19 pandemic has had the greatest impact in LTCFs by disproportionately harming older adults and heightening social isolation and loneliness (SIL). Living in close quarters with others and in need of around-the-clock assistance, interactions with older adults, which used be in-person, have been replaced by virtual chating using Information and Communication Technologies (ICTs). ICTs applications such as FaceTime, Zoom and Microsoft Teams video chating have been overwhelmingly used by families to maintain residents' social capital and subsequently reduce their SIL. Objective: Because of the lack of substantive knowledge on this ever-increasing form of social communication, this systematic review intends to synthesize the effects of ICT interventions to address SIL of residents in long-term care facilities during the COVID-19 period. Methods: We will include studies published in Chinese, English and French from December 2019 onwards. Beyond the traditional search strategy approach, four of the 12 electronic data bases to be queried will be in Chinese. We will include quantitative and intervention studies as well as qualitative and mixed methods designs. Using a two-person approach, the principal investigator and one author will blindly screen eligible articles, extract data, and assess risk of bias. In order to improve the first round of screening, a pilot-tested algorithm will be used. Disagreements will be resolved through discussion with a third author. Results will be presented as structured summaries of the included studies. We plan to conducted a meta-analysis if sufficient data are available. Results: A total of 1,803 articles have been retrieved to date. Queries of the Chinese databases are ongoing. The systematic review and subsequent manuscript will be completed by the fall of 2022. Conclusions: ICT applications have become a promising avenue to reduce SIL by providing a way to maintain communication between LTCFs residents and their families and will certainly remains in post-COVID-19 pandemic. This review will investigate and describe context-pertinent and high-quality programs and initiatives to inform, at the macro-level, policy makers as well as researchers, frontline managers, and families. These methods will remain relevant in the post-Covid-19 era.
Article
Purpose Although very much needed from an infection control perspective, there is deep concern about the impact of social distancing during COVID-19, particularly on older adults. Design/methodology/approach A phenomenological design was used to gain insight into older adults’ experiences of living with social distancing during the first wave of COVID-19. Semi-structured interviews were conducted with eight older adults. Findings Six themes were identified: a smaller life, feelings of unease, resilience, connection to the community centre, technology: a boon, but one with limitations, and the way through social distancing. Originality/value This study captures older adults’ experiences early in COVID-19. Findings indicate that there is much we can learn from these older adults regarding social isolation that could apply to other older adults and potentially other age groups during the time of pandemic and beyond.
Article
Objectives Using data from a large random sample of U.S. older adults ( N = 7982), the effect of loneliness and social isolation on all-cause mortality was examined considering their separate and combined effects. Methods The UCLA-3 Loneliness Scale and the Social Network Index (SNI) were used to define loneliness and social isolation. Cox proportional hazards regression models were performed. Results Among study participants, there were 548 deaths. In separate, adjusted models, loneliness (severe and moderate) and social isolation (limited and moderate social network) were both associated with all-cause mortality. When modeled together, social isolation (limited and moderate social network) along with severe loneliness remained significantly associated with mortality. Discussion Results demonstrate that both loneliness and social isolation contribute to greater risk of mortality within our population of older adults. As the COVID-19 pandemic continues, loneliness and social isolation should be targeted safely in efforts to reduce mortality risk among older adults.
Article
Several measures that assess loneliness have been developed for adults. Across three studies, we investigated psychometric features of scores of different versions of the Rasch-Type Loneliness Scale, the University of California Los Angeles Loneliness Scale, and three single-item measures. In Study 1 ( N = 697 self-ratings, N = 282 informant-ratings of 160 targets) and Study 2 ( N = 1,216 individuals from 608 couples), we investigated convergent validity, self-informant agreement, and nomological nets of the item scores using correlates related to demographic aspects, personality, satisfaction, and network characteristics. In Study 3 ( N = 411), we estimated a reliability of [Formula: see text] for scores of three single-item measures of loneliness. Overall, scores of all measures and their nomological nets were highly correlated within and across studies, indicating that the scores of the included measures are all reliable and valid. Recommendations for choosing a loneliness measure are discussed.
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Loneliness is a rapidly growing problem globally and has attracted a great deal of attention in light of the COVID‐19 pandemic. Young adults, and in particular, those residing in deprived areas are currently the loneliest group in the United Kingdom. Utilizing a novel‐free association technique, young adults’ experiences of loneliness were explored both prior to (n = 48) and during (n = 35) the COVID‐19 pandemic. Drawing on social representations theory, a thematic analysis revealed that many young adults associated the experience of loneliness with their homes. Therefore, this comparative study aims to investigate how the home features in young adults’ representations of loneliness, prior to and during the COVID‐19 pandemic using a systematic qualitative methodology. Three salient themes emerged from the data in both periods: ‘The Lonely Home,’ ‘The Socially Connected Home’ and ‘The Safe, Peaceful, Authentic Home’. ‘The Lonely Home’ and ‘The Socially Connected Home’ emerged as a dialogical antimony. Representations of home were similar across the two periods; however, there were some notable differences. In particular, the themes ‘The Socially Connected Home’ and ‘The Safe, Peaceful, Authentic Home’ were less frequently mentioned by the during‐COVID‐19 sample where the ‘The Lonely Home’ was more frequently mentioned by the during‐COVID‐19 sample. Overall, discussion of the home was more negatively valenced in the during‐COVID‐19 sample compared to the pre‐COVID‐19 sample. This comparative, exploratory study alerts us to the nature of the role that home plays in exacerbating or ameliorating loneliness both prior to and during the COVID‐19 pandemic.
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Compounded by the COVID-19 pandemic, both loneliness and isolation are a growing concern for the older adult population. An intergenerational holistic exchange, Cardinals CARE (Cardinals, Adopt, Residents for Engagement), was developed as a way to connect older adults in long-term care facilities (LTCFs) with nursing students while demonstrating the meeting of student service learning outcomes. Students shared correspondence with residents in LTCFs for a 10-week period, sending mail weekly in the form of letters, artwork, crafts, an appropriate joke, or anything to encourage engagement. Jean Watson's Theory of Transpersonal Caring was used as a framework for the project. Students (n = 109) participating in the program provided interaction with 734 residents in 11 LTCFs in 3 counties. Students utilized reflective journaling to demonstrate the meeting of service learning outcomes and described the power of connection and the opportunity to provide holistic care. A result of the project was the intergenerational connectedness showcasing the reciprocal nature of the CARE project. Further research is needed to build an evidence base for the use of such interaction to promote connection and combat loneliness.
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This study aims to analyze the relationship between social isolation and loneliness with smoking in older adults. This is a cross-sectional, population-based study performed with 986 individuals aged 60 years or older. Data were collected from the Health Survey of the Municipality of Campinas (ISACamp 2014/2015), state of São Paulo, Brazil. We estimated the prevalence of smoking and smoking cessation according to independent variables and tested the associations using the chi-square test, considering a 5% significance level. Adjusted prevalence ratios were calculated using simple and multiple Poisson regression. Smoking and smoking cessation were not associated with most variables that indicate objective social isolation. “Often or always” loneliness was related to a higher prevalence of smoking (PR = 2.25; 95%CI: 1.38-3.66) whereas loneliness accompanied of self-reported emotional problems or common mental disorders was strongly associated with smoking and with lower smoking cessation (PR = 6.24; 95%CI: 1.37-28.47 and PR = 0.46; 95%CI: 0.28-0.77, respectively). These findings indicate that loneliness is a psychosocial aspect related to tobacco use which hinders smoking cessation in older adults, emphasizing the importance of emotional problems in this association.
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Background: Over recent decades, chronic stress at an early age has become a worrying health problem in children. We seek to evaluate an intervention involving mindfulness-based practices and prosocial activities in 7-8-year-old children. Methods: Stress levels were determined using hair cortisol concentration (HCC), and social integration was measured by means of a sociogram. The program had previously proven to be effective in decreasing salivary cortisol levels and in favouring social integration in children. A total of thirty-five children participated in the study: 18 constituted the intervention group and 17 the wait-list group. In both groups, HCC and social integration were evaluated before and after the intervention conducted throughout an entire school year. Results: The experimental group showed a significant reduction in HCC, as well as significant enhancement of social integration levels, whereas no changes were observed in the wait-list group. Conclusions: This is the first research to show that HCC, a reliable neuroendocrine indicator, decreased as a result of a mindfulness-based program. This successful outcome adds new evidence to previous findings regarding the reduction of chronic stress in children following participation in this program.
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“At Home” is a program, in which students reside in the homes of older adults. Three studies were designed to evaluate the program. One study was a comparative quantitative investigation that used a cross-sectional survey design aimed at assessing ageism and knowledge of ageing among students. The other two studies were qualitative studies based on Interpretative Phenomenological Analysis, aimed at obtaining the perspective of the students and the older people. The main findings indicated satisfaction with the program among students and older adults as well, and the relationships often described by both sides as good and warm. The most common activities shared by the student and the older adult were watching television, eating dinner, having conversations, and going for walks. The contribution of the program for the older adults reflected in the relief of their loneliness. Among the students, the contribution reflected in familiarity with the world of older adults, the strengthening of intergenerational relationships, and the financial aid for their studies.
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Loneliness is a risk factor for older adults, one exacerbated by the COVID-19 pandemic. Although time spent alone is associated with both loneliness and greater well-being, the experience of solitude may depend on the type of activity pursued. We examined formal prosocial activity as one facilitator of positive solitary experiences. Older adults ( N = 165, M age = 71.13, SD = 5.70) highly committed to prosocial-program work (e.g., tutoring) filled out surveys at six random times every day for a week. Using multilevel modeling, we investigated whether participating in prosocial-program activity alone was associated with greater well-being compared to other solitary activity. While prosocial-program activity did not buffer against negative affect in solitude, it promoted positive affect and relatedness when alone. To the extent that prosocial-program work can facilitate positive solitary experiences by enhancing feelings of connection, it may protect against threats to well-being posed by loneliness in later life.
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Earlier studies on gender differences in loneliness appear to have produced contradictory results. However, when 39 existing data sets were classified according to whether they used the UCLA scale (N = 28) or a self-labeling measure (N = II) of loneliness, the results revealed a clear pattern. Statistically significant sex differences are not usually found with the UCLA scale, but, when they are found, males typically have higher loneliness scores. In terms of self-labeling, women more frequently than men admit being lonely. Sex role factors may help explain these seemingly contradictory results. Of the various possible explanations of the gender differences in self-labeled loneliness, most assume that social influence processes play a crucial role. To test this viewpoint, an experiment was conducted. Subjects (N = 117) were presented with a case history of a lonely person, which varied only the target person's sex. The subjects were more rejecting of a lonely male than of a lonely female. These results support the view that women are more apt to acknowledge their loneliness than men because the negative consequences of admitting loneliness are less for women.
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A widely held stereotype associates old age with social isolation and loneliness. However, only 5% to 15% percent of older adults report frequent loneliness. In this study, we report a meta-analysis of the correlates of loneliness in late adulthood. A U-shaped association between age and loneliness is identified. Quality of social network is correlated more strongly with loneliness, compared to quantity; contacts with friends and neighbors show stronger associations with loneliness, compared to contacts with family members. Being a woman, having low socioeconomic status and low competence, and living in nursing homes were also associated with higher loneliness. Age differences in the association of social contacts and competence with loneliness are investigated as well.
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Associations of C-reactive protein (CRP) concentration with risk of major diseases can best be assessed by long-term prospective follow-up of large numbers of people. We assessed the associations of CRP concentration with risk of vascular and non-vascular outcomes under different circumstances. We meta-analysed individual records of 160 309 people without a history of vascular disease (ie, 1.31 million person-years at risk, 27 769 fatal or non-fatal disease outcomes) from 54 long-term prospective studies. Within-study regression analyses were adjusted for within-person variation in risk factor levels. Log(e) CRP concentration was linearly associated with several conventional risk factors and inflammatory markers, and nearly log-linearly with the risk of ischaemic vascular disease and non-vascular mortality. Risk ratios (RRs) for coronary heart disease per 1-SD higher log(e) CRP concentration (three-fold higher) were 1.63 (95% CI 1.51-1.76) when initially adjusted for age and sex only, and 1.37 (1.27-1.48) when adjusted further for conventional risk factors; 1.44 (1.32-1.57) and 1.27 (1.15-1.40) for ischaemic stroke; 1.71 (1.53-1.91) and 1.55 (1.37-1.76) for vascular mortality; and 1.55 (1.41-1.69) and 1.54 (1.40-1.68) for non-vascular mortality. RRs were largely unchanged after exclusion of smokers or initial follow-up. After further adjustment for fibrinogen, the corresponding RRs were 1.23 (1.07-1.42) for coronary heart disease; 1.32 (1.18-1.49) for ischaemic stroke; 1.34 (1.18-1.52) for vascular mortality; and 1.34 (1.20-1.50) for non-vascular mortality. CRP concentration has continuous associations with the risk of coronary heart disease, ischaemic stroke, vascular mortality, and death from several cancers and lung disease that are each of broadly similar size. The relevance of CRP to such a range of disorders is unclear. Associations with ischaemic vascular disease depend considerably on conventional risk factors and other markers of inflammation. British Heart Foundation, UK Medical Research Council, BUPA Foundation, and GlaxoSmithKline.
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To examine the association of social ties and income with self reported health, in order to investigate if social ties have a greater impact on the health of people on low incomes compared to those financially better off. A nationally representative cross-sectional study of 5205 French adults using data from questionnaires which asked about health, income and relationships with family and friends etc. Less than good self-rated health (SRH) is twice as frequently reported by people in the lowest income group than those in the highest income group. People with low incomes are also more likely to have felt alone on the previous day, received no phone call during the last week, have no friends, not be a member of a club, and to live alone. Socially isolated people report lower SRH. Likelihood ratio tests for interaction vs. main effect models were statistically significant for 2 of the measures of social ties, borderline for 2 others and non-significant for one. For 4 of the 5 indicators of social ties, larger odd ratios show that social isolation is more strongly associated with less than good SRH among people on low incomes compared to those with a higher income. Social isolation is associated with 'less than good' self-rated health. This effect appears to be more important for people on a low income.
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Social isolation is associated with poorer health, and is seen by the World Health Organisation (WHO) as one of the major issues facing the industrialised world. To explore the significance of social isolation in the older population for GPs and for service commissioners. Secondary analysis of baseline data from a randomised controlled trial of health risk appraisal. A total of 2641 community-dwelling, non-disabled people aged 65 years and over in suburban London. Demographic details, social network and risk for social isolation based on the 6-item Lubben Social Network Scale, measures of depressed mood, memory problems, numbers of chronic conditions, medication use, functional ability, self-reported use of medical services. More than 15% of the older age group were at risk of social isolation, and this risk increased with advancing age. In bivariate analyses risk of social isolation was associated with older age, education up to 16 years only, depressed mood and impaired memory, perceived fair or poor health, perceived difficulty with both basic and instrumental activities of daily living, diminishing functional ability, and fear of falling. Despite poorer health status, those at risk of social isolation did not appear to make greater use of medical services, nor were they at greater risk of hospital admission. Half of those who scored as at risk of social isolation lived with others. Multivariate analysis showed significant independent associations between risk of social isolation and depressed mood and living alone, and weak associations with male sex, impaired memory and perceived poor health. The risk of social isolation is elevated in older men, older persons who live alone, persons with mood or cognitive problems, but is not associated with greater use of services. These findings would not support population screening for individuals at risk of social isolation with a view to averting service use by timely intervention. Awareness of social isolation should trigger further assessment, and consideration of interventions to alleviate social isolation, treat depression or ameliorate cognitive impairment.
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In the UK, population screening for unmet need has failed to improve the health of older people. Attention is turning to interventions targeted at 'at-risk' groups. Living alone in later life is seen as a potential health risk, and older people living alone are thought to be an at-risk group worthy of further intervention. To explore the clinical significance of living alone and the epidemiology of lone status as an at-risk category, by investigating associations between lone status and health behaviours, health status, and service use, in non-disabled older people. Design of study: Secondary analysis of baseline data from a randomised controlled trial of health risk appraisal in older people. Four group practices in suburban London. Sixty per cent of 2641 community-dwelling non-disabled people aged 65 years and over registered at a practice agreed to participate in the study; 84% of these returned completed questionnaires. A third of this group, (n = 860, 33.1%) lived alone and two-thirds (n = 1741, 66.9%) lived with someone else. Those living alone were more likely to report fair or poor health, poor vision, difficulties in instrumental and basic activities of daily living, worse memory and mood, lower physical activity, poorer diet, worsening function, risk of social isolation, hazardous alcohol use, having no emergency carer, and multiple falls in the previous 12 months. After adjustment for age, sex, income, and educational attainment, living alone remained associated with multiple falls, functional impairment, poor diet, smoking status, risk of social isolation, and three self-reported chronic conditions: arthritis and/or rheumatism, glaucoma, and cataracts. Clinicians working with independently-living older people living alone should anticipate higher levels of disease and disability in these patients, and higher health and social risks, much of which will be due to older age, lower educational status, and female sex. Living alone itself appears to be associated with higher risks of falling, and constellations of pathologies, including visual loss and joint disorders. Targeted population screening using lone status may be useful in identifying older individuals at high risk of falling.
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The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality. This meta-analytic review was conducted to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk. Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships. Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were found across the type of social measurement evaluated (p<0.001); the association was strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus with others) (OR = 1.19; 95% CI 0.99 to 1.44). The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality. Please see later in the article for the Editors' Summary.
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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.
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Loneliness is a prevalent social problem with serious physiological and health implications. However, much of the research to date is based on cross-sectional data, including our own earlier finding that loneliness was associated with elevated blood pressure (Hawkley, Masi, Berry & Cacioppo, 2006). In this study, we tested the hypothesis that the effect of loneliness accumulates to produce greater increases in systolic blood pressure (SBP) over a 4-year period than are observed in less lonely individuals. A population-based sample of 229 50- to 68-year-old White, Black, and Hispanic men and women in the Chicago Health, Aging, and Social Relations Study was tested annually for each of 5 consecutive years. Cross-lagged panel analyses revealed that loneliness at study onset predicted increases in SBP 2, 3, and 4 years later (B = 0.152, SE = 0.091, p < .05, one-tailed). These increases were cumulative such that higher initial levels of loneliness were associated with greater increases in SBP over a 4-year period. The effect of loneliness on SBP was independent of age, gender, race or ethnicity, cardiovascular risk factors, medications, health conditions, and the effects of depressive symptoms, social support, perceived stress, and hostility.
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There is limited information about the clustering of health behaviors in older people. This study aims to examine clustering of smoking, low levels of physical activity, and risky drinking in older adults and the relationship of these behaviors with measures of SES. Data on health behaviors were analyzed from 11,214 individuals aged > or =50 years (mean age=65.2 years) who participated in the 2002 wave of the English Longitudinal Study of Ageing. Clustering was examined by studying the ratio of observed to expected prevalence of each combination of health behavior. Logistic regressions tested the relationship between socioeconomic measures (education, wealth, and subjective social status) and health behaviors. Data were collected between March 2002 and March 2003, and analyses were conducted in 2008. Only a small proportion of participants reported all three health-risk behaviors, although this was higher than that expected on the basis of prevalence of individual behaviors. Combinations of two health-risk behaviors were common. Multiple health-risk behaviors were less common among individuals of a higher SES. Total accumulated wealth and subjective social status were more consistently related to health-risk behaviors than education in this population. This study provides evidence of clustering of health-risk behaviors in older adults and suggests that interventions aimed at multiple risk factors could usefully target less affluent groups.
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In this meta-analytic review of 31 laboratory studies, we examined if relatively older adults showed lower or higher cardiovascular reactivity compared with relatively younger adults. Results revealed that age was associated with lower heart rate reactivity but higher systolic blood pressure (SBP) reactivity during emotionally evocative tasks. Consistent with the predictions of dynamic integration theory, the result for SBP was moderated by the degree of task activation. These data are discussed in light of existing self-regulatory models and important future research directions.
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To understand why children exposed to adverse psychosocial experiences are at elevated risk for age-related disease, such as cardiovascular disease, by testing whether adverse childhood experiences predict enduring abnormalities in stress-sensitive biological systems, namely, the nervous, immune, and endocrine/metabolic systems. A 32-year prospective longitudinal study of a representative birth cohort. New Zealand. A total of 1037 members of the Dunedin Multidisciplinary Health and Development Study. Main Exposures During their first decade of life, study members were assessed for exposure to 3 adverse psychosocial experiences: socioeconomic disadvantage, maltreatment, and social isolation. At age 32 years, study members were assessed for the presence of 3 age-related-disease risks: major depression, high inflammation levels (high-sensitivity C-reactive protein level >3 mg/L), and the clustering of metabolic risk biomarkers (overweight, high blood pressure, high total cholesterol, low high-density lipoprotein cholesterol, high glycated hemoglobin, and low maximum oxygen consumption levels. Children exposed to adverse psychosocial experiences were at elevated risk of depression, high inflammation levels, and clustering of metabolic risk markers. Children who had experienced socioeconomic disadvantage (incidence rate ratio, 1.89; 95% confidence interval, 1.36-2.62), maltreatment (1.81; 1.38-2.38), or social isolation (1.87; 1.38-2.51) had elevated age-related-disease risks in adulthood. The effects of adverse childhood experiences on age-related-disease risks in adulthood were nonredundant, cumulative, and independent of the influence of established developmental and concurrent risk factors. Children exposed to adverse psychosocial experiences have enduring emotional, immune, and metabolic abnormalities that contribute to explaining their elevated risk for age-related disease. The promotion of healthy psychosocial experiences for children is a necessary and potentially cost-effective target for the prevention of age-related disease.
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This study examines the prevalence of loneliness amongst older people in Great Britain, and makes comparisons with the findings of studies undertaken during the last five decades. In addition, the risk factors for loneliness are examined using a conceptual model of vulnerability and protective factors derived from a model of depression. Loneliness was measured using a self-rating scale, and measures of socio-demographic status and health/social resources were included. Interviews were undertaken with 999 people aged 65 or more years living in their own homes, and the sample was broadly representative of the population in 2001. Among them the prevalence of ‘severe loneliness’ was seven per cent, indicating little change over five decades. Six independent vulnerability factors for loneliness were identified: marital status, increases in loneliness over the previous decade, increases in time alone over the previous decade; elevated mental morbidity; poor current health; and poorer health in old age than expected. Advanced age and possession of post-basic education were independently protective of loneliness. From this evidence we propose that there are three loneliness pathways in later life: continuation of a long-established attribute, late-onset loneliness, and decreasing loneliness. Confirmation of the different trajectories suggests that policies and interventions should reflect the variability of loneliness in later life, for undifferentiated responses may be neither appropriate nor effective.
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The purpose of this study was to examine sociodemographic and health-related risks for loneliness among older adults using Health and Retirement Study Data. Overall prevalence of loneliness was 19.3%. Marital status, self-report of health, number of chronic illnesses, gross motor impairment, fine motor impairment, and living alone were predictors of loneliness. Age, female gender, use of home care, and frequency of healthcare visits were not predictive. Loneliness is a prevalent problem for older adults in the United States with its own health-related risks. Future research of interventions targeting identified risks would enhance the evidence base for nursing and the problem of loneliness.
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The National Social Life, Health, and Aging Project (NSHAP) data contain multiple indicators of social connectedness, social participation, social support, and loneliness among older adults. We suggest that these indicators can be combined to measure two aspects of social isolation: social disconnectedness (i.e., physical separation from others) and perceived isolation (i.e., feelings of loneliness and a lack of social support). We use the NSHAP data to create scales measuring social disconnectedness and perceived isolation and examine their distribution among older adults. We assess the reliability of the scales using Cronbach's alpha and item-total correlations and perform confirmatory factor analysis to test the model against the data. Finally, we test differences in scale means across subgroups to assess the distribution of social disconnectedness and perceived isolation among older adults. We find that 17 indicators combine into two reliable scales. The social disconnectedness scale has a two-factor structure, including the restricted social network dimension and the social inactivity dimension. The perceived isolation scale also comprises two dimensions: lack of support and loneliness. We find that social disconnectedness does not vary across age groups, but the oldest old feel more isolated than the young old. Social disconnectedness and perceived isolation are greater among those who have worse health. Discussion The creation of scales measuring social disconnectedness and perceived isolation provides one way to utilize the wide variety of indicators of social isolation collected in the NSHAP study. Although individual indicators of social connectedness or isolation are useful in their own right, these scales provide parsimonious, continuous variables that account for a variety of aspects of social isolation, which may be especially useful for inclusion in multivariate analyses predicting health outcomes.
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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.
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Previous research has identified a wide range of indicators of social isolation that pose health risks, including living alone, having a small social network, infrequent participation in social activities, and feelings of loneliness. However multiple forms of isolation are rarely studied together making it difficult to determine which aspects of isolation are most deleterious for health. Using population-based data from the National Social Life, Health, and Aging Project, we combine multiple indicators of social isolation into scales assessing social disconnectedness (e.g., small social network, infrequent participation in social activities) and perceived isolation (e.g., loneliness, perceived lack of social support). We examine the extent to which social disconnectedness and perceived isolation have distinct associations with physical and mental health among older adults. Results indicate that social disconnectedness and perceived isolation are independently associated with lower levels of self-rated physical health. However, the association between disconnectedness and mental health may operate through the strong relationship between perceived isolation and mental health. We conclude that health researchers need to consider social disconnectedness and perceived isolation simultaneously.
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Social support is a strong and consistent predictor of health outcomes, and social isolation predicts increased morbidity and mortality. The mediating processes are not completely understood. The purpose of the study is to investigate associations between social isolation and cardiovascular and lipid responses to acute stress in the laboratory, and cortisol profiles over the day. Cardiovascular and lipid responses to acute stress tasks, and salivary cortisol monitoring, were carried out in 238 healthy middle-aged men and women from the Whitehall II cohort. Social isolation was measured using an adapted version of the Close Persons Questionnaire. Social isolation was associated with slower post-task recovery of systolic blood pressure in men and women, a higher cholesterol response to stress in men only, and also with larger cortisol awakening responses and greater cortisol output over the day in both men and women. The impact of social isolation on cardiovascular disease risk may be mediated through stress-related dysregulation of cardiovascular, metabolic, and neuroendocrine processes.
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In this article I evaluated the psychometric properties of the UCLA Loneliness Scale (Version 3). Using data from prior studies of college students, nurses, teachers, and the elderly, analyses of the reliability, validity, and factor structure of this new version of the UCLA Loneliness Scale were conducted. Results indicated that the measure was highly reliable, both in terms of internal consistency (coefficient alpha ranging from .89 to .94) and test-retest reliability over a 1-year period (r = .73). Convergent validity for the scale was indicated by significant correlations with other measures of loneliness. Construct validity was supported by significant relations with measures of the adequacy of the individual's interpersonal relationships, and by correlations between loneliness and measures of health and well-being. Confirmatory factor analyses indicated that a model incorporating a global bipolar loneliness factor along with two method factor reflecting direction of item wording provided a very good fit to the data across samples. Implications of these results for future measurement research on loneliness are discussed.
Article
A widely held stereotype associates old age with social isolation and loneliness. However, only 5% to 15% percent of older adults report frequent loneliness. In this study, we report a meta-analysis of the correlates of loneliness in late adulthood. A U-shaped association between age and loneliness is identified. Quality of social network is correlated more strongly with loneliness, compared to quantity; contacts with friends and neighbors show stronger associations with loneliness, compared to contacts with family members. Being a woman, having low socioeconomic status and low competence, and living in nursing homes were also associated with higher loneliness. Age differences in the association of social contacts and competence with loneliness are investigated as well.
Article
The prevalence of obesity has increased substantially over the past 30 years. We performed a quantitative analysis of the nature and extent of the person-to-person spread of obesity as a possible factor contributing to the obesity epidemic. We evaluated a densely interconnected social network of 12,067 people assessed repeatedly from 1971 to 2003 as part of the Framingham Heart Study. The body-mass index was available for all subjects. We used longitudinal statistical models to examine whether weight gain in one person was associated with weight gain in his or her friends, siblings, spouse, and neighbors. Discernible clusters of obese persons (body-mass index [the weight in kilograms divided by the square of the height in meters], > or =30) were present in the network at all time points, and the clusters extended to three degrees of separation. These clusters did not appear to be solely attributable to the selective formation of social ties among obese persons. A person's chances of becoming obese increased by 57% (95% confidence interval [CI], 6 to 123) if he or she had a friend who became obese in a given interval. Among pairs of adult siblings, if one sibling became obese, the chance that the other would become obese increased by 40% (95% CI, 21 to 60). If one spouse became obese, the likelihood that the other spouse would become obese increased by 37% (95% CI, 7 to 73). These effects were not seen among neighbors in the immediate geographic location. Persons of the same sex had relatively greater influence on each other than those of the opposite sex. The spread of smoking cessation did not account for the spread of obesity in the network. Network phenomena appear to be relevant to the biologic and behavioral trait of obesity, and obesity appears to spread through social ties. These findings have implications for clinical and public health interventions.
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A competent immune response is central to good health. There is good evidence that both aging and psychological stress can dysregulate immune function, resulting in changes in various aspects of the immune response that are large enough to have consequences for health. Older adults appear to show even greater immunological impairments associated with stress or depression than younger adults. Thus, the data suggest that aging interacts with stress and depression to enhance risks for morbidity and mortality among older adults.
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"Predicting Health Behaviour" brings together current research and practical details of how models of social cognition can be applied in health research. [This book] provides the theoretical background and examples of how to apply the most common social cognition models to the explanation of health behaviours. . . . Each chapter provides a general review of relevant research, applying the model to a variety of health behaviours . . . and discussing the strengths and weaknesses of models. [This book] examines how to: assess the advantages and disadvantages of using each of these models; appropriately apply each model to their work [and] adequately analyse and report the results. It [is intended] for health professionals, and researchers and students of health and health psychology. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Preventing and alleviating social isolation and loneliness among older people is an important area for policy and practice, but the effectiveness of many interventions has been questioned because of the lack of evidence. A systematic review was conducted to determine the effectiveness of health promotion interventions that target social isolation and loneliness among older people. Quantitative outcome studies between 1970 and 2002 in any language were included. Articles were identified by searching electronic databases, journals and abstracts, and contact-ing key informants. Information was extracted and synthesised using a standard form. Thirty studies were identified and categorised as 'group ' (n=17) ; ' one-to-one ' (n=10) ; 'service provision' (n=3) ; and ' community development ' (n=1). Most were conducted in the USA and Canada, and their design, methods, quality and transferability varied considerably. Nine of the 10 effective interventions were group activities with an educational or support input. Six of the eight ineffective interventions provided one-to-one social support, advice and information, or health-needs assessment. The review suggests that educational and social activity group interventions that target specific groups can alleviate social isolation and loneliness among older people. The effectiveness of home visiting and befriending schemes remains unclear.
Article
Little is known about the effects of long-term marital history on mortality, and the relative importance of using marital history instead of baseline marital status in mortality analyses. No previous comparative studies on the associations of marital history and mortality exist. Longitudinal data from England & Wales and from Finland were used to assess the effects of marital history, constructed from census records from years 1971, 1981 and 1991, on all-cause mortality in 1991-2004 among men and women aged ≥ 50 years. Data from England & Wales include 57,492 deaths; data from Finland include 424,602 deaths. Poisson regression analysis was applied. Adding marital history into models including baseline marital status was statistically significant when explaining male mortality, while it was generally not important for female mortality. Adjusted for socio-demographic covariates, those consistently married with no record of marital break-up had the lowest mortality rates among both men and women aged 50-74 in both countries. Those never married, those divorced with a history of divorce and those widowed with a history of widowhood showed the highest mortality risks. Associations between marital history and mortality were weaker among those aged 75+. Consistent evidence in favour of both protective effects of long-lasting marriage and detrimental effects of marital dissolution were found. Studies would benefit from including marital history in the models instead of baseline marital status whenever possible, especially when studying male mortality.
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From introduction: Do people rage against the dying of the light or do they go gently into that good night? Translating Dylan Thomas: as people age, do they continue to participate actively in work and social life, retain health and function for substantial periods, or do they subside, go gently, into inactivity, decline and eventual death? There are two types of questions here: what policymakers, politicians and social commentators think people should do - subject of much current debate; and what people actually do. A key purpose of ELSA (the English Longitudinal Study of Ageing) is to discover what people aged 50 years and above do, and are able to do, in areas that are of great interest to all of us whether policymaker, researcher, commentator or simply interested citizen: work, spending, health and receipt of healthcare, social participation, cognitive ability. A second major purpose is to go beyond description of what people do to discover why - to seek explanations for which people have good trajectories in older age and which less good. Without such understanding, it is hard to see how policies could be designed to make things better. In our first report from ELSA (Marmot et al., 2003), following the first wave of fieldwork in 2002-03, we drew attention to the great diversity in health, physical, social and psychological functioning and economic fortunes in the population. We hoped that results from ELSA would do much to contradict the picture of older age as a time of inevitable decline. In this second report, following the second wave of fieldwork in 2004-05, we fill out the picture further. In particular, we examine an important aspect of diversity: how each of the areas covered by ELSA varies according to people's level of wealth.
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We investigated the prospective impact of self-reported loneliness on all-cause mortality, mortality from ischemic disease and mortality from other cardiovascular diseases. We tested these effects through GEE binomial regression models applied to longitudinal data from the Alameda County Study of persons aged 21 and over arranged into person-years. Controlling for age and gender, the chances of all-cause mortality were significantly higher among respondents reporting that they often feel lonely compared to those who report that they never feel lonely. Frequent loneliness was not significantly associated with mortality from ischemic heart disease but more than doubled the odds of mortality from other ailments of the circulatory system in models controlling for age and gender. Subsequent models showed that physical activity and depression may be important mediators of loneliness-mortality associations. Finally, we find support for the contention that chronic loneliness significantly increases risk of mortality but also find reason to believe that relatively recent changes in feelings of loneliness increase risk of mortality as well.
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Alcohol consumption has important health-related consequences and numerous biological and social determinants. To explore quantitatively whether alcohol consumption behavior spreads from person to person in a large social network of friends, coworkers, siblings, spouses, and neighbors, followed for 32 years. Longitudinal network cohort study. The Framingham Heart Study. 12 067 persons assessed at several time points between 1971 and 2003. Self-reported alcohol consumption (number of drinks per week on average over the past year and number of days drinking within the past week) and social network ties, measured at each time point. Clusters of drinkers and abstainers were present in the network at all time points, and the clusters extended to 3 degrees of separation. These clusters were not only due to selective formation of social ties among drinkers but also seem to reflect interpersonal influence. Changes in the alcohol consumption behavior of a person's social network had a statistically significant effect on that person's subsequent alcohol consumption behavior. The behaviors of immediate neighbors and coworkers were not significantly associated with a person's drinking behavior, but the behavior of relatives and friends was. A nonclinical measure of alcohol consumption was used. Also, it is unclear whether the effects on long-term health are positive or negative, because alcohol has been shown to be both harmful and protective. Finally, not all network ties were observed. Network phenomena seem to influence alcohol consumption behavior. This has implications for clinical and public health interventions and further supports group-level interventions to reduce problematic drinking.
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Data regarding the relationship between physical activity and cognitive impairment are limited and controversial. We examined whether physical activity is associated with incident cognitive impairment during follow-up. As part of a community-based prospective cohort study in southern Bavaria, Germany, 3903 participants older than 55 years were enrolled between 2001 and 2003 and followed up for 2 years. Physical activity (classified as no activity, moderate activity [<3 times/wk], and high activity [> or =3 times/wk]), cognitive function (assessed by the 6-Item Cognitive Impairment Test), and potential confounders were evaluated. The main outcome measure was incident cognitive impairment after 2 years of follow-up. At baseline, 418 participants (10.7%) had cognitive impairment. After a 2-year follow-up, 207 of 3485 initially unimpaired subjects (5.9%) developed incident cognitive impairment. Compared with participants without physical activity, fully adjusted multiple logistic regression analysis showed a significantly reduced risk of incident cognitive impairment after 2 years for participants with moderate or high physical activity at baseline (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.37-0.87 [P = .01]; and OR, 0.54; 95% CI, 0.35-0.83 [P = .005]; respectively). Further subanalysis including participants (n = 2029) without functional impairment and without prodromal phase of dementia resulted in an even higher reduction of risk of incident cognitive impairment for participants with moderate or high physical activity (OR, 0.44; 95% CI, 0.24-0.83 [P = .01]; and OR, 0.46; 95% CI, 0.25-0.85 [P = .01]; respectively) compared with no activity. Moderate or high physical activity is associated with a reduced incidence of cognitive impairment after 2 years in a large population-based cohort of elderly subjects.
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Both the size and diversity of an individual's social network are strongly and prospectively linked with cardiovascular morbidity and mortality. Social relationships may influence cardiovascular outcomes, at least in part, via their impact on physiologic pathways influenced by stress, such as daytime blood pressure (BP) levels. However, scant research has examined whether social relationships influence key nocturnal pathways, such as nocturnal BP dipping. The current study examined the degree to which social integration, as measured by participants' reported engagement in a range of different types of social relationships, and the frequency of daily social contacts influence the ratio of night/day mean arterial pressure (MAP) in a community sample of African-American and white men and women (N = 224). In addition, we examined the degree to which observed associations persisted after statistical adjustment for factors known to covary with nocturnal BP, including objective measures of sleep, catecholamines, health behaviors, and comorbidities. In fully adjusted models, there was a significant association between both social integration and frequency of social contacts and the ratio of night/day MAP, indicating that socially isolated individuals were more likely to have blunted nocturnal BP-dipping profiles. There was also a significant interaction between social contact frequency and ethnicity, suggesting that the benefits of social relationships were particularly evident in African-Americans. These findings contribute to our understanding of how social integration or conversely, social isolation, influences cardiovascular risk.
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Several international studies have substantiated the role of loneliness as a risk factor for mortality. Although both theoretical and empirical research has supported the classification of loneliness as either situational or chronic, research to date has not evaluated whether this classification has a differential impact upon mortality. To establish the definition of situational vs. chronic loneliness, we used three waves of the Health and Retirement Study (HRS), a nationally representative sample of Americans over the age of 50 years. Baseline data for the present study were collected in the years 1996, 1998, and 2000. The present study concerns the 7,638 individuals who completed all three waves; their loneliness was classified as either not lonely, situational loneliness or chronic loneliness. Mortality data were available through to the year 2004. Those identified as "situationally lonely" (HR = 1.56; 95% CI: 1.52-1.62) as well as those identified as "chronically lonely" (HR = 1.83; 95% CI: 1.71-1.87) had a greater risk for all cause mortality net of the effect of possible demographic and health confounders. Nonetheless, relative to those classified as "situationally lonely," individuals classified as "chronically lonely" had a slightly greater mortality risk. The current study emphasizes the important role loneliness plays in older adults' health. The study further supports current division into situational vs. chronic loneliness, yet suggests that both types serve as substantial mortality risks.