Differential indicators of loneliness among elderly. The importance of type of partner relationship, partner history, health, socioeconomic status and social relations

Using data from the 1992 NESTOR-survey 'Living arrangements and social networks of older adults' (N = 4494), the aim of the present study is to identify specific categories of older adults who are most vulnerable to loneliness. By looking at different types of partner relationships (first, second, and third marriages; consensual unions; partners who are not household members) and at partner histories (never married, ever divorced, ever widowed, remarried), this study elaborates on previous research which has tended to look only at the presence versus the absence of partner relationships. Findings indicate that different types of partner relationships provide differential protection against loneliness. There appears to be a 'shadow of the past' of a previous divorce or widowhood in second and third partnerships, which accounts for generally higher levels of loneliness. Single men tend to be more lonely than single women. Moreover, there are no differences in loneliness between men who have always been single and those previously married. Among single women, differences in partner history are relevant: never married single women tend to be least vulnerable to loneliness. The differences in loneliness between older adults with different types of partner relationships and partner histories are only partially attributable to network and social participation differences. The latter independently contribute to the explanation of loneliness. The role of non-social determinants (health and socioeconomic position) is also examined. The results underscore the socially isolating effects of sensory impairments. Older adults with functional limitations, and those with visual or auditory problems tend to be more lonely, findings which are only partially attributable to differences in the number and quality of social relationships. Socioeconomic circumstances primarily have an indirect influence on loneliness. Those with higher levels of educational attainment and higher incomes tend to have more extensive social networks and are therefore less prone to loneliness.     

Relationships between Geriatric Oral Health Assessment Index scores and general physical status in community-dwelling older adults

doi: 10.1111/j.1741‐2358.2011.00597.x Relationships between Geriatric Oral Health Assessment Index scores and general physical status in community‐dwelling older adults Objective: The aim of this study was to investigate the relationships between Geriatric Oral Health Assessment Index (GOHAI) and general physical status among community‐dwelling older adults. Background: Geriatric Oral Health Assessment Index is a patient‐centred assessment of oral health for older adults. We hypothesised that GOHAI is a significant indicator of general physical status of older adults. Methods: This study included 354 adults (age, ≥65 years) living independently. Body mass index, handgrip strength and one‐leg standing time with eyes open were used to evaluate the general physical status. Spearman’s rank correlation coefficients were calculated to examine the relationships between the GOHAI scores, its three subdivided categories (physical function, psychological function and pain and discomfort) and each physical status measurement. A stepwise linear regression model was applied with each physical status measurement as the dependent variable and the GOHAI scores and its subdivisions as the principal independent variable. Results: Positive correlations were found between the GOHAI scores, its three subdivided categories and handgrip strength. The physical function category positively correlated with one‐leg standing time. The GOHAI and the pain and discomfort category scores were retained in the final models of stepwise regression for handgrip strength, and significant relationships persisted after adjustments for demographic, psychosocial, medical and dental status. Conclusion: The GOHAI scores and its pain and discomfort category score may be significant indicators of body muscle strength.     

Pets,Networks and Well-Being

ABSTRACT

This study explores two explanations for well-being among older adults: social network analysis and human–animal relations. The data are based on a stratified probability sample of community living adults, aged 60 years and over, located in several rural communities in north-eastern Oregon. The dependent variables include three distinct measures of psychological well-being: life satisfaction, locus of control, and self-esteem. The independent variables include pet ownership and various measures of the personal network of respondents, including network structural variables (range, density, and frequency of contact) and network content variables (both instrumental and expressive). Control variables include socio-demographic characteristics and a measure of physical health. Multiple regression analysis is used to estimate the effects of the independent and control variables. Pet ownership was related to two of the well-being measures – self-esteem and locus of control – but only for men. Some methodological and theoretical implications are discussed.     

Personal Networks and Mortality Risk in Older Adults: A Twenty-Year Longitudinal Study

Background

Research on aging has consistently demonstrated an increased chance of survival for older adults who are integrated into rich networks of social relationships. Theoretical explanations state that personal networks offer indirect psychosocial and direct physiological pathways. We investigate whether effects on and pathways to mortality risk differ between functional and structural characteristics of the personal network. The objective is to inquire which personal network characteristics are the best predictors of mortality risk after adjustment for mental, cognitive and physical health.

Methods and Findings

Empirical tests were carried out by combining official register information on mortality with data from the Longitudinal Aging Study Amsterdam (LASA). The sample included 2,911 Dutch respondents aged 54 to 85 at baseline in 1992 and six follow-ups covering a time span of twenty years. Four functional characteristics (emotional and social loneliness, emotional and instrumental support) and four structural characteristics (living arrangement, contact frequency, number of contacts, number of social roles) of the personal network as well as mental, cognitive and physical health were assessed at all LASA follow-ups. Statistical analyses comprised of Cox proportional hazard regression models. Findings suggest differential effects of personal network characteristics on survival, with only small gender differences. Mortality risk was initially reduced by functional characteristics, but disappeared after full adjustment for the various health variables. Mortality risk was lowest for older adults embedded in large (HR = 0.986, 95% CI 0.979—0.994) and diverse networks (HR = 0.948, 95% CI 0.917—0.981), and this effect continued to show in the fully adjusted models.

Conclusions

Functional characteristics (i.e. emotional and social loneliness) are indirectly associated with a reduction in mortality risk, while structural characteristics (i.e. number of contacts and number of social roles) have direct protective effects. More research is needed to understand the causal mechanisms underlying these relations.     

Age gradations in vocalization and body weight in Japanese monkeys (Macaca fuscata)

449 syllables in 174 food calls of Japanese monkeys of various ages were analyzed spectrographically. The fundamental frequency bands were divided into 55 frequency modulation patterns. The percentage of harsh syllables changed with age class among adults. Although the duration of syllables did not change with age, the maximum fundamental frequency and the minimum fundamental frequency showed age-related changes. Both were distinctly decreased by 6-8 years of age and thereafter the decline was far more gradual. Body weight also increased up to 6 years of age for females and 8 years for males, thereafter stabilizing for both sexes. The matching in age-related changes between fundamental frequency and body weight indicates that it is increase in size of the vocal folds with physical growth that lowers the fundamental frequency.     

Longitudinal changes in aerobic power in older men and women.

The purpose of this study was to describe the longitudinal (10 yr) decline in aerobic power [maximal O(2) uptake (Vo(2 max))] and anaerobic threshold [ventilatory threshold (T(Ve))] of older adults living independently in the community. Ten years after initial testing, 62 subjects (34 men, mean age 73.5 +/- 6.4 yr; 28 women, 72.1 +/- 5.3 yr) achieved Vo(2 max) criteria during treadmill walking tests to the limit of tolerance, with T(Ve) determined in a subset of 45. Vo(2 max) in men showed a rate of decline of -0.43 ml.kg(-1).min(-1).yr(-1), and the decline in Vo(2 max) was consequent to a lowered maximal heart rate with no change in the maximum O(2) pulse. The women showed a slower rate of decline of Vo(2 max) of -0.19.ml.kg(-1).min(-1).yr(-1) (P < 0.05), again with a lowered HR(max) and unchanged O(2) pulse. In this sample, lean body mass was not changed over the 10-yr period. Changes in Vo(2 max) were not significantly related to physical activity scores. T(Ve) showed a nonsignificant decline in both men and women. Groupings of young-old (65-72 yr at follow-up) vs. old-old (73-90 yr at follow-up) were examined. In men, there were no differences in the rate of Vo(2 max) decline. The young-old women showed a significant decline in Vo(2 max), whereas old-old women, initially at a Vo(2 max) of 19.4 +/- 3.1 ml.kg(-1).min(-1), showed no loss in Vo(2 max). The longitudinal data, vs. cross-sectional analysis, showed a greater decline for men but similar estimates of the rates of change in women. Thus the 10-yr longitudinal study of the cohort of community-dwelling older adults who remained healthy, ambulatory, and independent showed a 14% decline in Vo(2 max) in men, and a smaller decline of 7% in women, with the oldest women showing little change over the 10-yr period.     

Validation and User Evaluation of a Sensor-Based Method for Detecting Mobility-Related Activities in Older Adults

Regular physical activity is essential for older adults to stay healthy and independent. However, daily physical activity is generally low among older adults and mainly consists of activities such as standing and shuffling around indoors. Accurate measurement of this low-energy expenditure daily physical activity is crucial for stimulation of activity. The objective of this study was to assess the validity of a necklace-worn sensor-based method for detecting time-on-legs and daily life mobility related postures in older adults. In addition user opinion about the practical use of the sensor was evaluated. Twenty frail and non-frail older adults performed a standardized and free movement protocol in their own home. Results of the sensor-based method were compared to video observation. Sensitivity, specificity and overall agreement of sensor outcomes compared to video observation were calculated. Mobility was assessed based on time-on-legs. Further assessment included the categories standing, sitting, walking and lying. Time-on-legs based sensitivity, specificity and percentage agreement were good to excellent and comparable to laboratory outcomes in other studies. Category-based sensitivity, specificity and overall agreement were moderate to excellent. The necklace-worn sensor is considered an acceptable valid instrument for assessing home-based physical activity based upon time-on-legs in frail and non-frail older adults, but category-based assessment of gait and postures could be further developed.     

Barriers to Social Participation among Lonely Older Adults: The Influence of Social Fears and Identity

IntroductionLoneliness among older adults is a major public health problem that may be associated with processes of social participation and identity. This study therefore sought to examine the relationship between social participation and identity in a sample of lonely older adults living independently in London, England.MethodAn inductive qualitative approach, based on semi-structured interviews and thematic analysis, was employed.ResultsParticipants commonly spoke of barriers to social participation that have been reported elsewhere, including illness/disability, loss of contact with friends/relatives, lack of a supportive community, and lack of acceptable social opportunities. However, novel findings were also derived. In particular, participants commonly minimised the difficulties they faced alone, and described attempts to avoid social opportunities. These behaviours were linked to fears about engaging in social participation opportunities, including fears of social rejection and/or exploitation, and fears of losing valued aspects of identity.DiscussionIt is concluded that social participation amongst lonely older people will not improve through the removal of previously reported barriers alone; instead, older peoples’ beliefs, fears and identities must be addressed. Suggestions for implementing these findings within community organisations are provided.     

Effects of depression on physical health and mortality in the elderly. Longitudinal results of the LASA research

This longitudinal study examines the physical health consequences of depression among 3107 older persons (55-85 years). Major depression was defined according to DSM-III criteria in a psychiatric interview. Minor depression was defined by a Center for Epidemiologic Studies Depression score > or = 16. Health consequences were assessed by 3-year change in self-reported functional status, 3-year change in performance on objective tests, and risk of death over 4.5 years. At baseline, 12.8% of the older persons had minor depression and 2.0% major depression. Minor depression was associated with a significantly greater decline in functional status and performance and, only in men but not in women, with an increased risk of death. Major depression also increases decline in functional status and the risk of death (irrespective of sex), but was not associated with decline in physical performance. These results show that late-life depression has strong unfavorable physical health consequences. The consequences of minor depression are comparable with those of major depression.     

Are There Age-Related Differences in the Ability to Learn Configural Responses?

Age is often associated with a decline in cognitive abilities that are important for maintaining functional independence, such as learning new skills. Many forms of motor learning appear to be relatively well preserved with age, while learning tasks that involve associative binding tend to be negatively affected. The current study aimed to determine whether age differences exist on a configural response learning task, which includes aspects of motor learning and associative binding. Young (M = 24 years) and older adults (M = 66.5 years) completed a modified version of a configural learning task. Given the requirement of associative binding in the configural relationships between responses, we predicted older adults would show significantly less learning than young adults. Older adults demonstrated lower performance (slower reaction time and lower accuracy). However, contrary to our prediction, older adults showed similar rates of learning as indexed by a configural learning score compared to young adults. These results suggest that the ability to acquire knowledge incidentally about configural response relationships is largely unaffected by cognitive aging. The configural response learning task provides insight into the task demands that constrain learning abilities in older adults.     

High-speed power training: a novel approach to resistance training in older men and women. A brief review and pilot study

Over the past century, increases in both longevity and the number of older adults in the U.S.A. have given rise to greater numbers of functionally limited and disabled older adults. This has resulted in a decline in the quality of life of our elderly population, as well as an increased burden on our health care system. Resistance training (RT) with a strengthening component has traditionally been recommended to improve health and physical functioning in older adults. Muscle power (force x velocity), or the ability to produce force rapidly, has recently emerged as an important predictor of functioning in older men and women and has been the current focus of many RT studies. In this review, the physiological changes that contribute to the declines in muscle strength and power with aging will first be examined, followed by a discussion of the prevailing theories behind the use of traditional RT in older men and women. The rationale for high-velocity RT will then be explored, and the recent literature on novel training interventions designed to improve muscle power in older adults will be discussed. Finally, some preliminary evidence demonstrating the benefits of high-velocity power training in older men and women will be presented.     

Relationships between higher‐level functional capacity and dental health behaviors in community‐dwelling older adults

doi: 10.1111/j.1741‐2358.2012.00654.x Relationships between higher‐level functional capacity and dental health behaviors in community‐dwelling older adults Objective: The aim of the present study was to elucidate relationships between higher‐level functional capacity and dental health behaviours in community‐dwelling older adults. Background: In ageing society, it is necessary to promote oral health in the elderly, because good oral health is a significant contributing factor to good general health. Higher‐level functional capacity has been considered a crucial factor for successful independent living in the elderly. We hypothesised that functional capacity is a significant indicator of dental health behaviours. Methods: Three hundred and thirty‐eight adults aged 65 years or older were enrolled in this study. Higher‐level functional capacity was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG‐index). Univariate and multivariate models were constructed with dental health behaviours, such as regular visits to a dentist, brushing frequency and use of extra cleaning devices, as the dependent variable, and the total TMIG‐index score and its subcategory scores as the principal independent variable. Results: Univariate logistic regression analysis demonstrated a significant correlation between low TMIG‐index and ‘intellectual activity’ subcategory scores to lack of regular visits to a dentist and not using extra cleaning devices. Using a multivariate model, significant relationships remained after adjusting for a number of variables including demographics, medical status, lifestyle and number of remaining teeth. Conclusion: Intellectual activity of higher‐level functional capacity may be an accurate indicator of dental health behaviours in community‐dwelling older adults. Intellectual activity should be taken into consideration to effectively promote oral health behaviours and oral hygiene in elderly persons living independently.     

Under-recruitment and nonselective recruitment: dissociable neural mechanisms associated with aging

Frontal contributions to cognitive decline in aging were explored using functional MRI. Frontal regions active in younger adults during self-initiated (intentional) memory encoding were under-recruited in older adults. Older adults showed less activity in anterior-ventral regions associated with controlled use of semantic information. Under-recruitment was reversed by requiring semantic elaboration suggesting it stemmed from difficulty in spontaneous recruitment of available frontal resources. In addition, older adults recruited multiple frontal regions in a nonselective manner for both verbal and nonverbal materials. Lack of selectivity was not reversed during semantically directed encoding even when under-recruitment was diminished. These findings suggest two separate forms of age-associated change in frontal cortex: under-recruitment and nonselective recruitment. The former is reversible and potentially amenable to cognitive training; the latter may reflect a less malleable change associated with cognitive decline in advanced aging.     

Social relationships of piglets in a semi-natural environment

The social relationships of domestic piglets (Sus scrofa) kept with adult and juvenile pigs in a large outsid enclosure were examined. Focal and scan sampling techniques were used to collect data on five measures of social behaviour: resting, social facilitation, nearest neighbours, butting and sniffing. Cluster analysis indicated that, between birth and 13 weeks of age, piglets had stronger social relationships with littermates than with non-littermates, their dam, other adults or juveniles but social preferences were not found between particular pairs of littermates. Litters were born in separate farrowing nests but nonlittermates came into contact within 15 days of birth. Fostering occurred when two piglets switched dams spontaneously, and these piglets subsequently exhibited stronger relationships with their foster than with their natural littermates. Results are discussed with reference to intensive housing systems and evolutionary pressures.     

Huddling relationships in night sleeping groups among wild Japanese macaques in Kinkazan Island during winter

Huddling groups at sleeping sites, and allogrooming and proximity in the daytime during winter, were examined in a wild Japanese macaque (Macaca fuscata) troop on Kinkazan Island in the non-snowy district of northern Japan. All sleeping groups, defined as a cluster in which individuals huddle at sleeping sites, were formed on the ground. Their sizes tended to increase when the temperature was lower. The number of adults with mutual physical contact in sleeping groups increased when the size of sleeping groups increased. These results suggest that the physiological function of huddling is protection from low temperatures, and that macaques select the ground as sleeping sites to form large sized groups. Huddling was performed most frequently among kin dyads. Non-related dyads which appeared to be affiliative in the daytime also huddled frequently at sleeping sites. Even non-related dyads which showed affiliative behavior less frequently in the daytime exhibited huddling, at night, however, they did so less often than those of kin dyads and affiliated dyads. It appears that huddling at night by pairs that did not normally affiliate in the daytime was made possible by the increased tolerance of individuals responding to colder temperatures at night in winter. Furthermore, huddling, grooming, and proximity were exhibited at greater frequency between kin dyads, and between high-ranking males and specific females of kin groups, although the dyads of individuals older than 15 years often were involved only in huddling. These results suggest that two types of social bonds exist at sleeping sites in winter. One is the social bond common to both the daytime and nighttime, the other is peculiar to nighttime. Consequently, the social function of huddling is that, troop integration might increase at sleeping sites in winter as close social relationships among adults are extended more widely than those in daytime.     

Social Relationships and Depression: Ten-Year Follow-Up from a Nationally Representative Study

Background

Social network characteristics have long been associated with mental health, but their longitudinal impact on depression is less known. We determined whether quality of social relationships and social isolation predicts the development of depression.

Methods

The sample consisted of a cohort of 4,642 American adults age 25–75 who completed surveys at baseline in 1995–1996 and at ten-year follow-up. Quality of relationships was assessed with non-overlapping scales of social support and social strain and a summary measure of relationship quality. Social isolation was measured by presence of a partner and reported frequency of social contact. The primary outcome was past year major depressive episode at ten-year follow-up. Multivariable logistic regression was conducted, adjusting for the presence of potential confounders.

Results

Risk of depression was significantly greater among those with baseline social strain (OR, 1.99; 95% CI, 1.47–2.70), lack of social support (OR, 1.79; 95% CI, 1.37–2.35), and poor overall relationship quality (OR 2.60; 95% CI, 1.84–3.69). Those with the lowest overall quality of social relationships had more than double the risk of depression (14.0%; 95% CI, 12.0–16.0; p<.001) than those with the highest quality (6.7%; 95% CI, 5.3–8.1; p<.001). Poor quality of relationship with spouse/partner and family each independently increased risk of depression. Social isolation did not predict future depression, nor did it moderate the effect of relationship quality.

Conclusions

Quality of social relationships is a major risk factor for major depression. Depression interventions should consider targeting individuals with low quality of social relationships.     

Health-related fitness of sedentary elderly in the Netherlands

The assessment of fitness is a component of a national project aimed at the enhancement of physical avtivity among sedentary older adults, aged 55-65 year in the Netherlands. Deterioration in physical functioning may be improved through an exercise programme. Research showed that enhancement of physical activity results in improved fitness, increased functional ability and health-related quality of life. Scientific results of the association between exercise and physical fitness in older adults is not sufficiently evidence-based in the Netherlands. In order to support health policy interventions 5.584 fitness tests of sedentary older adults were analyzed. The fitness was assessed by the Groninger Fitnesstest for Elderly (GFE). The analysis of physical fitness in sedentary older adults showed a lower fitness status among the age group 55-65 of age and women. Health risk factors such as overweight and having a chronic disease explained 88% of the variance between a low fitness and a high fitness profile.     

Zorgzame vrienden en buren als mantelzorgers van oudere volwassenen: een vergelijking met kinderen

This study compared informal care to older, non-coresiding adults provided by friends and neighbours and informal care by children or their partners. Using data from a Dutch representative survey among informal caregivers conducted by CBS and SCP, caregivers of friends (n=133), neighbours (n=108) and parents (n=1,008) were compared with one another to investigate care that friends and neighbours provide to the elderly non-coresiding adults (age 55 and over). Nine percent of those providing care to someone outside the household were friends and nine percent were neighbours. Friends, like children, usually provide long-lasting care, up to four or five years. Friends are similar to neighbours in the number of hours that they provide care. Friends and neighbours experience a lower caregiver burden than children. However, when fulfilling multiple caring tasks, both friends and children, have a greater chance of experiencing higher levels of burden. When there were other caregivers to help, friends experienced a small reduction in burden. Friends and neighbours deserve to be recognized as informal caregivers by policy makers and they deserve attention and support along with family caregivers.     

Obesity Stigma in Sexual Relationships

Objective: Obese children are stigmatized in same‐sex relationships. This study examines whether, in adulthood, obesity stigma exists in adults when they are asked to rank order preferences for a sexual partner. Research Methods and Procedures: Following the methods of Richardson et al. (Richardson SA, Goodman N, Hastorf AH, Dornbusch SM. Cultural uniformity in reaction to physical disabilities. Am Sociol Rev. 1961;26:241–247) and Latner and Stunkard (Latner J, Stunkard AJ, Wilson GT. Age, ethnic and gender differences in stigmatization of obesity. Orlando, FL: International Conference on Eating Disorders; 2004), 449 college students were asked to rank order six drawings of potential sexual partners. The drawings included an obese partner, partners with various other disabilities, and a healthy partner. Results: The least‐preferred partners were obese. Men, compared with women, provided significantly lower ranks for obese partners (U = 20, 180.00, z = ?2.84, p = 0.01). Discussion: Despite the fact that the majority of adults in the U.S. are overweight, discrimination on the basis of weight occurs in making a choice of a sexual partner. Males particularly make choices of partner based on their weight. Obesity stigma may specifically affect women in sexual relationships. Weight‐related stigma needs to be addressed in the treatment of binge eating disorder or weight management. Finding ways to change attitudes and behavior toward the overweight is a goal for future research in the area.