Social vulnerability, frailty and mortality in elderly people

Background

Social vulnerability is related to the health of elderly people, but its measurement and relationship to frailty are controversial. The aims of the present study were to operationalize social vulnerability according to a deficit accumulation approach, to compare social vulnerability and frailty, and to study social vulnerability in relation to mortality.

Methods and Findings

This is a secondary analysis of community-dwelling elderly people in two cohort studies, the Canadian Study of Health and Aging (CSHA, 1996/7–2001/2; N = 3707) and the National Population Health Survey (NPHS, 1994–2002; N = 2648). Social vulnerability index measures that used self-reported items (23 in NPHS, 40 in CSHA) were constructed. Each measure ranges from 0 (no vulnerability) to 1 (maximum vulnerability). The primary outcome measure was mortality over five (CHSA) or eight (NPHS) years. Associations with age, sex, and frailty (as measured by an analogously constructed frailty index) were also studied. All individuals had some degree of social vulnerability. Women had higher social vulnerability than men, and vulnerability increased with age. Frailty and social vulnerability were moderately correlated. Adjusting for age, sex, and frailty, each additional social ‘deficit’ was associated with an increased odds of mortality (5 years in CSHA, odds ratio = 1.05, 95% confidence interval: 1.02–1.07; 8 years in the NPHS, odds ratio = 1.08, 95% confidence interval: 1.03–1.14). We identified a meaningful survival gradient across quartiles of social vulnerability, and although women had better survival than men, survival for women with high social vulnerability was equivalent to that of men with low vulnerability.

Conclusions

Social vulnerability is reproducibly related to individual frailty/fitness, but distinct from it. Greater social vulnerability is associated with mortality in older adults. Further study on the measurement and operationalization of social vulnerability, and of its relationships to other important health outcomes, is warranted.     

The influence of immigrant parent legal status on U.S.-born children's academic abilities: The moderating effects of social service use

The present study investigated the relationship between immigrant parent legal status and academic performance among U.S.-born children, ages 7–10. Building on previous research and a social ecological framework, the study further explored how social service use moderates the relationship between parent legal status and academic performance. Participants included 178 low-income, urban parent/child dyads; all parents were immigrants from Mexico, Central America, or the Dominican Republic and all children were U.S.-born citizens. Using a standardized academic assessment as the outcome, parent legal vulnerability was a significant negative predictor of children's academic performance on reading, spelling, and math subtests. Additionally, parent use of social services significantly and positively moderated the relationship between parent legal vulnerability and children's word reading and spelling skills, indicating that social service use can serve as a protective buffer against the negative associations between parental unauthorized status and child achievement.     

The Politics of Adaptation: Subsistence Livelihoods and Vulnerability to Climate Change in the Koyukon Athabascan Village of Ruby,Alaska

The concepts of vulnerability and adaptation have contributed to understanding human responses to climate change. However, analysis of the implications of the broader political context on adaptation has largely been absent. Through a case study of the subsistence livelihoods of Koyukon Athabascan people of Ruby Village, this paper examines the implications of adaptation to the social changes precipitated by colonization for the articulation of current responses to climate change. Semi-structured interviews, seasonal rounds, and land-use mapping conducted with 20 community experts indicate that subsistence livelihoods are of continued importance to the people of Ruby in spite of the dramatic social change. While adaptive responses demonstrate resilience, adaptation to one form of change can increase vulnerability to other kinds of perturbations. Research findings illustrate that a historical approach to adaptation can clarify the influence of the present political context on indigenous peoples’ responses to impacts of climate changes.     

社会生态系统及脆弱性驱动机制分析

生态系统与社会经济要素的相互渗透和相互作用形成了社会生态系统复合结构。"社会生态系统"(SES)理念是当今世界生态系统分析的新思路,它立足于社会生态经济综合指标,突出社会生态经济系统的整体性,以人地和谐、综合的思想,分析和解决生态和社会经济问题。社会生态系统脆弱性驱动机制分析和综合研究已成为脆弱性研究的趋势。综述了"社会生态系统"概念、结构、特征和属性,分析了社会生态系统脆弱性内涵,结合"压力-状态-响应"模型(PSR)和"暴露度-敏感性-恢复力"模型,从社会-经济-生态复合系统角度,从风险(压力)、敏感性、应对能力三方面对社会生态系统脆弱性驱动机制进行分析,最后文章对相关问题进行了讨论,并指出了脆弱性驱动机制分析的局限性,提出未来研究的展望。     

Economic and socio-behavioural issues related to highly active antiretroviral therapies for HIV infection: the contribution of social science research

This article presents a synthesis of the main topics covered by social science research (SSR) on HIV/AIDS, since the advent of highly active antiretroviral therapies (HAART) in 1996. SSR has shown that non-adherence cannot be reliably on the sole basis of a few a priori patient characteristics that clinicians could easily identify before initiation of HAART, and that a dynamic approach to adherence, continuously monitoring the impact of patients' subjective experience with HAART is needed. In relationship with the evolution of HIV infection toward a , SSR has dealt with the impact of HAART on all aspects of patients' daily lives (from employment and professional status to sexuality). It has also emphasised the potential contradictions between the hopes generated by these cost-effective therapeutic advances, on the one hand, and the high social vulnerability of a growing proportion of people living with HIV-AIDS, on the other hand. Finally, SSR suggests recommendations for AIDS public policies without losing the potential for innovations that the fight against this epidemic has introduced in health care and systems, as well as physician-patient's relationships.     

In the Time of Frost: El Niño and the Political Ecology of Vulnerability in Papua New Guinea

ABSTRACT

Climatic anomalies associated with El Niño bring prolonged droughts and night-time frosts that devastate subsistence gardens in the Papua New Guinea highlands. As a customary process of adaptation to the subsequent food insecurity caused by crop-destroying frosts, people migrate to lower altitude areas where kin and friends provide sustenance and social support. However, with increasing economic development and the demise of collective kin endeavours in the region, long-distance migration networks no longer appear to offer people respite from food insecurity. In this paper, I examine the changes in social responses to El Niño-caused food shortages at varying scales – from subsistence farmers to international aid agencies – over the past several El Niño events. The paper explores the production of vulnerability when customary social-ecological systems of adaptation intersect with regional and national politics, development efforts, and humanitarian aid agencies.     

Social vulnerability among cancer patients and changes in vulnerability during their trajectories – A longitudinal population-based study

BackgroundIdentification of socially vulnerable cancer patients in the health care system is difficult. Only little is known concerning changes in the patients’ social circumstances during the trajectory. Such knowledge is valuable regarding the identification of socially vulnerable patients in the health care system. The objective of this study was to use administrative data to identify population-based characteristics of socially vulnerable cancer patients and investigate how social vulnerability changed during the cancer trajectory.MethodologyA registry-based social vulnerability index (rSVI) was applied to each cancer patient prior to their diagnosis, and used to assess changes in social vulnerability after the diagnosis.ResultsA total of 32,497 cancer patients were included. Short-term survivors (n = 13,994) died from cancer from one to three years after the diagnosis, and long-term survivors (n = 18,555) survived at least three years after the diagnosis. 2452 (18 %) short-term survivors and 2563 (14 %) long-term survivors were categorized as socially vulnerable at diagnosis, of these 22 % and 33 % changed category to not socially vulnerable during the first two years after the diagnosis, respectively. For patients changing status of social vulnerability, several social and health-related indicators changed, which is in line with the complexity of the multifactorial social vulnerability. Less than 6 % of the patients categorized as not vulnerable at diagnosis, changed to become vulnerable during the following two years.ConclusionDuring the cancer trajectory, social vulnerability may change in both directions. Surprisingly, more patients, who were categorized as socially vulnerable when their cancer was diagnosed, changed status to not socially vulnerable during follow-up. Future research should attempt to increase knowledge on identifying cancer patients, who experience deterioration after the diagnosis.     

Responses to a Drought in the Interior Lowlands of Papua New Guinea: A Comparison of Bedamuni and Kubo-Konai

The ways that people experience, respond to and pattern recovery from major climatic aberrations must be understood within the context of existing socioeconomic arrangements and the ethos that informs these. This paper describes immediate and longer term impacts of a major drought on two populations—Bedamuni and Kubo-Konai—in the interior lowlands of Papua New Guinea. Though they occupy similar environments, are culturally related and reliant on similar technology and resources, these two populations differ in density, intensity of land use, and social complexity. The drought of 1997 affected one of the populations much more severely than the other. A comparison of effects on subsistence regimes, mobility and social life in the two areas suggests that these were mediated by understandings people held of relationships with both the environment and other people. Bedamuni pattern their lives around an expectation of favorable returns on effort, emphasising security of tenure to protect those returns. Kubo-Konai, in contrast, pattern their lives around an expectation that availability of resources will be often in flux, and emphasise means of ensuring security of supply. These understandings are reflected, respectively, in risk-prone and risk-averse strategies of subsistence and sociality which directly influence vulnerability and responses to disruptive events.     

The straw that breaks the camel's back. Redirecting health-seeking behavior studies on malaria and vulnerability

In the wake of the Millennium Development Goals, the focus on vulnerability and access to care has increasingly gained ground in the malaria social science literature. However, little emphasis has been given to the cumulative processes of vulnerability. In this article, we draw on ethnographic data, in particular on case studies, gathered in southeastern Tanzania in the 1990s and reexamine them in the context of vulnerability. We analyze the underpinnings of the cumulative dimension of vulnerability at three levels: (1) structural, that is, elements that determine access to material and social resources; (2) agent driven, that is, the consequences of coping strategies that enhance vulnerability; and (3) conjunctural, that is, periods characterized by the confluence of adverse circumstances. We argue that the analysis of cumulative processes of vulnerability paints a more comprehensive picture of people's struggle for health. This opens up a more systemic and dynamic perspective on access to care for disadvantaged populations.     

Focus: The Aging Brain: Social capital,health, and elderly driver status

Driving a car enables many people to engage in meaningful activities that, in turn, help develop and maintain personal social capital. Social capital, a combination of community participation and social cohesion, is important in maintaining well-being. This paper argues that social capital can provide a framework for investigating the general role of transportation and driving a car specifically to access activities that contribute to connectedness and well-being among older people. This paper proposes theoretically plausible and empirically testable hypotheses about the relationship between driver status, social capital, and well-being. A longitudinal study may provide a new way of understanding, and thus of addressing, the well-being challenges that occur when older people experience restrictions to, or loss of, their driver’s license.     

Do socioeconomic health gradients persist over time and beyond income? A distributional analysis using UK biomarker data

This paper analyses the relationship between health and socioeconomic disadvantage by adopting a dynamic approach accounting for spatial and temporal changes across ten domains including social isolation, environment, financial hardship and security. As a first step we develop a measure of overall multidimensional deprivation and undertake a decomposition analysis to explore the role of breadth and duration of deprivation on shaping the deprivation gradient in health. Subsequently, we employ unconditional quantile regression to conduct a distributional analysis of the gradient to understand how the gradient evolves for people with vulnerability in health. In contrast to the majority of existing studies, we capture health status using a range of nurse measured biomarkers, rather than self reported health measures, taken from the UKHLS and BHPS databases. The first main finding is that the socioeconomic gradient in most of our health measures is not solely attributed to income as it accounts for only 3.8% of total deprivation and thus it is important to account for other domains through a multidimensional deprivation measure in health gradient analysis. Our second finding is the existence of a systematic deprivation gradient for BMI, waist circumference, heart rate, C-reactive protein and HbA1c where evolution over time is an important factor particularly for individuals with greater burden of illness lying at the right tail of the biomarker distribution. Thus cost effective health policy would need to adopt targeted interventions prioritising people experiencing persistent deprivation in dimensions such as housing conditions and social isolation.     

Two ethical concerns about the use of persuasive technology for vulnerable people

Persuasive technologies for health-related behaviour change give rise to ethical concerns. As of yet, no study has explicitly attended to ethical concerns arising with the design and use of these technologies for vulnerable people. This is striking because these technologies are designed to help people change their attitudes or behaviours, which is particularly valuable for vulnerable people. Vulnerability is a complex concept that is both an ontological condition of our humanity and highly context-specific. Using the Mackenzie, Rogers and Dodds’ taxonomy of vulnerability, this paper identifies (a) the wrongs or harms to which a person is vulnerable, (b) the source of this vulnerability, and (c) the safeguards needed in response. Two ethical concerns with the design of persuasive technology for vulnerable people are discussed: the concerns of taking into account users' interests and their autonomy.     

Impact of Childhood Adversity and Vasopressin receptor 1a Variation on Social Interaction in Adulthood: A Cross-Sectional Study

Background

Arginine vasopressin (AVP) plays a role in social behavior, through receptor AVPR1A. The promoter polymorphism AVPR1A RS3 has been associated with human social behaviors, and with acute response to stress. Here, the relationships between AVPR1A RS3, early-life stressors, and social interaction in adulthood were explored.

Methods

Adult individuals from a Swedish population-based cohort (n = 1871) were assessed for self-reported availability of social integration and social attachment and for experience of childhood adversities. Their DNA samples were genotyped for the microsatellite AVPR1A RS3.

Results

Among males, particularly those homozygous for the long alleles of AVPR1A RS3 were vulnerable to childhood adversity for their social attachment in adulthood. A similar vulnerability to childhood adversity among long allele carriers was found on adulthood social integration, but here both males and females were influenced.

Limitation

Data were self-reported and childhood adversity data were retrospective.

Conclusions

Early-life stress influenced the relationship between AVPR1A genetic variants and social interaction. For social attachment, AVPR1A was of importance in males only. The findings add to previous reports on higher acute vulnerability to stress in persons with long AVPR1A RS3 alleles and increased AVP levels.     

Social Cognition Deficits and Psychopathic Traits in Young People Seeking Mental Health Treatment

Antisocial behaviours and psychopathic traits place an individual at risk for criminality, mental illness, substance dependence, and psychosocial dysfunction. Social cognition deficits appear to be associated with psychopathic traits and are believed to contribute to interpersonal dysfunction. Most research investigating the relationship of these traits with social cognition has been conducted either in children or adult forensic settings. We investigated whether psychopathic traits were associated with social cognition in 91 young people presenting for mental healthcare (aged between 15 and 25 years). Participants completed symptom severity measures, neuropsychological tests, the Reading the Mind in the Eyes Test of social cognition (RMET), and the Antisocial Process Screening Device (APSD) to assess psychopathic personality traits. Correlation analyses showed poorer social cognition was associated with greater psychopathic traits (r = −.36, p = .01). Interestingly, social cognition performance predicted unique variance in concurrent psychopathic personality traits above gender, IQ sustained attention, and working memory performance. These findings suggest that social cognitive impairments are associated with psychopathic tendencies in young people presenting for community mental healthcare. Research is needed to establish the directionality of this relationship and to determine whether social cognition training is an effective treatment amongst young people with psychopathic tendencies.     

Social support and distress among Q'eqchi' refugee women in Maya Tecún, Mexico

This article addresses issues of vulnerability and distress through an analysis of the relationship between social support networks and traumatic stress in a Q'eqchi' refugee community in southern Mexico. The sociopolitical violence, forced displacement, and encampment of Guatemalan Mayan populations resulted in the breakdown and dispersal of kin and community groups, leaving many Q'eqchi' women with weakened social support networks. Research involving testimonial interviews and traumatic stress and social support questionnaires revealed that Q'eqchi' refugee women with weak natal kin social support networks reported greater feelings of distress and symptoms of traumatic stress than did women with strong networks. In particular, a condition identified as muchkej emerged as one of the most significant symptoms reported by women with weak natal kin support networks. I critically consider muchkej as an idiom of distress and argue that aid organizations should consider the relationship between social support and traumatic stress, as expressed through such idioms, when attempting to identify vulnerable members of a refugee population.     

The vulnerable and the susceptible

Human beings are essentially vulnerable in the view that their existence qua humans is not given but constructed. This vulnerability received basic protection from the State, expressed in the form of the universal rights all citizens are meant to enjoy. In addition, many individuals fall prey to destitution and deprivation, requiring social action aimed at recognising the specific harms they suffer and providing remedial assistance to palliate or remove their plights. Citizens receive protection against their biologic vulnerability by means of an in rem right to health [care], which is more an attitude of protection than a specific programme. When individuals become susceptible, that is, biologically weak or diseased, they also increase their predisposition to additional harm, and require social actions to treat their demeaned condition. Such assistance takes the form of positive healthcare rights. Research on human beings has been slow to observe that the subjects recruited are susceptible, especially so if research is done in less developed countries. By mislabelling them as vulnerable--a characteristic they share with all humans--sponsors avoid registering the deprivation these people suffer, and the ethical obligation to offer them remedial help. The distinction between vulnerability and susceptibility also marks the difference between being intact but fragile--vulnerable--and being injured and predisposed to compound additional harm--susceptible. Awareness of this difference should give additional force to the rejection of double standards in research ethics.     

Social Provisions of the Human—Animal Relationship amongst 30 People Living with HIV in Australia

ABSTRACT

Research on the relationship between humans and animals has identified some links between companion animals and physiological, psychological, and social benefits for the human. Adopting Robert Weiss's (1974) Theory of Social Provisions as a framework, this qualitative study explores the role of the human-animal relationship amongst 30 people living with the Human Immunodeficiency Virus (HIV) in Australia. Despite the transition of HIV from a terminal to chronic condition in many developed nations, there can still be personal and social challenges accompanying an HIV-diagnosis. Thematic analysis of the 30 interviews identified themes of Attachment, Opportunity for Nurturance, Reassurance of Worth, Reliable Alliance, Obtaining of Guidance/Emotional Support, and Social Integration. Extracts coded to these themes indicated that many participants believed their companion animal motivated them to remain socially and physically active; provided an outlet for love and attachment; remained non-judgmental irrespective of the human's physical or social status; and was capable of providing both day-to-day comfort through their reliable presence, and episode-specific supportive responses during periods of heightened stress. It was proposed that for people living with a chronic and/or stigmatized condition like HIV, these aspects of the human-animal relationship may play an important part in their overall wellbeing. In conclusion, this study contributes to a greater understanding of the lived experience of HIV and provides a conceptually sound mechanism for validating the love and support that some HIV-positive people perceive in their relationship with a companion animal. This knowledge draws attention to the need to normalize, validate, and support the human-animal relationship throughout the animal's life, and death.     

我国省域基础设施投入对社会-生态系统脆弱性的影响

基础设施投入对社会经济或生态系统的影响已被广泛讨论,但对社会-生态系统(SES)的作用如何仍不得而知。本研究梳理了基础设施投入对SES脆弱性的影响机理,并在核算省域人均基础设施资本存量及综合评估SES脆弱性的基础上,采用空间自相关与空间计量模型实证分析了我国省域基础设施投入对SES脆弱性的作用。结果表明: 2004—2017年,我国省域人均基础设施投入水平显著提高,且呈北高南低、东西高中间低的空间分布格局;省域SES脆弱性也在不断改善,却表现出由东向西逐步恶化的分布特点;我国省域人均基础设施投入与SES脆弱性具有空间正相关性,存在聚集性分布特征;两者呈倒U型曲线关系,即早期适量基础设施投入会降低SES脆弱性,而过度投入则会导致SES脆弱性逐步增加。本研究揭示了基础设施投入对SES脆弱性的影响机理与动态特点,可为宏观层面统筹协调基础设施建设与SES脆弱性治理提供理论与决策支持。     

干旱区内陆河流域农户生计对生态退化的脆弱性评价——以石羊河中下游为例

生态退化对干旱区内陆河流域农业人口的负面影响非常显著,当前急需评估农户生计对生态退化的脆弱性,识别脆弱群体及脆弱性成因,并依此寻求降低生计脆弱性的对策措施。以石羊河中下游为研究区,基于366户农户调查数据,分析了不同类型农户对生态退化的暴露度、敏感性及适应能力,评估了农户生计对生态退化的脆弱性,探明了影响农户生计对生态退化脆弱性的关键因素。结果表明:(1)高收入及高文化程度农户的适应能力强,暴露度与敏感性高,生计脆弱性较低;(2)从纯农户到非农户、从单一生计农户到多种生计农户,适应能力依次增强,暴露度与敏感性递减,生计脆弱性降低;(3)改善生态环境质量,提高农户的富裕水平、受教育程度及社会资本,促进生计转型能够显著降低农户生计对生态退化的脆弱性。最后,提出了减轻农户生计脆弱性的对策建议及未来需进一步关注的问题。     

What Actually Confers Adaptive Capacity? Insights from Agro-Climatic Vulnerability of Australian Wheat

Vulnerability assessments have often invoked sustainable livelihoods theory to support the quantification of adaptive capacity based on the availability of capital—social, human, physical, natural, and financial. However, the assumption that increased availability of these capitals confers greater adaptive capacity remains largely untested. We quantified the relationship between commonly used capital indicators and an empirical index of adaptive capacity (ACI) in the context of vulnerability of Australian wheat production to climate variability and change. We calculated ACI by comparing actual yields from farm survey data to climate-driven expected yields estimated by a crop model for 12 regions in Australia’s wheat-sheep zone from 1991–2010. We then compiled data for 24 typical indicators used in vulnerability analyses, spanning the five capitals. We analyzed the ACI and used regression techniques to identify related capital indicators. Between regions, mean ACI was not significantly different but variance over time was. ACI was higher in dry years and lower in wet years suggesting that farm adaptive strategies are geared towards mitigating losses rather than capitalizing on opportunity. Only six of the 24 capital indicators were significantly related to adaptive capacity in a way predicted by theory. Another four indicators were significantly related to adaptive capacity but of the opposite sign, countering our theory-driven expectation. We conclude that the deductive, theory-based use of capitals to define adaptive capacity and vulnerability should be more circumspect. Assessments need to be more evidence-based, first testing the relevance and influence of capital metrics on adaptive capacity for the specific system of interest. This will more effectively direct policy and targeting of investment to mitigate agro-climatic vulnerability.