Abstract
Background
The prospective associations between social isolation, loneliness, and health behaviors are uncertain, despite the potential importance of these relationships over time for ...outcomes including mortality.
Purpose
To examine the associations between baseline social isolation, baseline loneliness, and engagement in health behaviors over 10 years among older adults.
Methods
Data were from 3,392 men and women aged ≥52 years in the English Longitudinal Study of Ageing from 2004/2005 to 2014/2015. Modified Poisson regression was specified to estimate relative risks (RRs) and 95% confidence intervals for the associations between baseline social isolation, baseline loneliness, and consistent weekly moderate-to-vigorous physical activity, consistent five daily fruit and vegetable servings, daily alcohol drinking at any time point, smoking at any time point, and a consistently overweight/obese body mass index over the follow-up (all yes vs. no). Models were population weighted and adjusted for sociodemographic factors, health indicators, and depressive symptoms, with mutual adjustment for social isolation and loneliness.
Results
Socially isolated participants were less likely than non-isolated participants to consistently report weekly moderate-to-vigorous physical activity (RR = 0.86; 0.77–0.97) or five daily fruit and vegetable servings (RR = 0.81; 0.63–1.04). They were less likely to be consistently overweight or obese (RR = 0.86; 0.77–0.97) and more likely to smoke at any time point (RR = 1.46; 1.17–1.82). Loneliness was not associated with health behaviors or body mass index in adjusted models. Among smokers, loneliness was negatively associated with successful smoking cessation over the follow-up (RR = 0.31; 0.11–0.90).
Conclusions
Social isolation was associated with a range of health-related behaviors, and loneliness was associated with smoking cessation over a 10 year follow-up in older English adults.
Social isolation is associated with a range of health-related behaviors and loneliness is associated with smoking cessation over a ten-year follow-up in older English adults.
In order to reduce the spread of SARS-CoV-2, much of the US was placed under social distancing guidelines during March 2020. We characterized risk perceptions and adherence to social distancing ...recommendations in March 2020 among US adults aged 18+ in an online survey with age and gender quotas to match the general US population (N = 713). We used multivariable logistic and linear regression to estimate associations between age (by generational cohort) and these outcomes. The median perceived risk of infection with COVID-19 within the next month was 32%, and 65% of individuals were practicing more social distancing than before the outbreak. Baby Boomers had lower perceived risk than Millennials (-10.6%, 95% CI: -16.2%, -5.0%), yet were more frequently social distancing (OR = 1.64; 95% CI: 1.05, 2.56). Public health outreach should focus on raising compliance with social distancing recommendations, especially among high risk groups. Efforts to address risk perceptions alone may be inadequate.
Social isolation and loneliness are increasingly prevalent among older adults in the United States, with implications for morbidity and mortality risk. Little research to date has examined the ...complex person-place transactions that contribute to social well-being in later life. This study aimed to characterize personal and neighborhood contextual influences on social isolation and loneliness among older adults. Interviews were conducted with independent-dwelling men and women (n = 124; mean age 71 years) in the Minneapolis metropolitan area (USA) from June to October, 2015. A convergent mixed-methods design was applied, whereby quantitative and qualitative approaches were used in parallel to gain simultaneous insights into statistical associations and in-depth individual perspectives. Logistic regression models predicted self-reported social isolation and loneliness, adjusted for age, gender, past occupation, race/ethnicity, living alone, street type, residential location, and residential density. Qualitative thematic analyses of interview transcripts probed individual experiences with social isolation and loneliness. The quantitative results suggested that African American adults, those with a higher socioeconomic status, those who did not live alone, and those who lived closer to the city center were less likely to report feeling socially isolated or lonely. The qualitative results identified and explained variation in outcomes within each of these factors. They provided insight on those who lived alone but did not report feeling lonely, finding that solitude was sought after and enjoyed by a portion of participants. Poor physical and mental health often resulted in reporting social isolation, particularly when coupled with poor weather or low-density neighborhoods. At the same time, poor health sometimes provided opportunities for valued social engagement with caregivers, family, and friends. The combination of group-level risk factors and in-depth personal insights provided by this mixed-methodology may be useful to develop strategies that address social isolation and loneliness in older communities.
•Social isolation and loneliness are influenced by personal and neighborhood factors.•Qualitative findings explain variations in trends identified in quantitative models.•Poor health can have both negative and positive effects on social isolation.•Some socially isolated older adults seek solitude and are content, not lonely.•Results are relevant for strategies to address social isolation and loneliness.
To investigate the relationship between late-life duration of poverty exposure and cognitive function and decline among older adults in China.
Data were from 3,209 participants ≥64 years of age in ...the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Duration of poverty, defined according to urban and rural regional standards from the China Statistical Yearbook, was assessed according to annual household income from 2005 to 2011 (never in poverty; one-third of the period in poverty; two-thirds or more of the period in poverty). Cognitive function was measured by the Chinese Mini-Mental State Examination (CMMSE) from 2011 to 2018. We used attrition-weighted, multivariable mixed-effects Tobit regression to examine the association of duration of poverty with cognitive function and rate of decline.
A total of 1,162 individuals (36.21%) were never in poverty over the period from 2005 to 2011; 1,172 (36.52%) were in poverty one-third of the period; and 875 (27.27%) were in poverty two-thirds or more of the period. A longer poverty duration was associated with lower subsequent CMMSE scores with a dose-response relationship (one-third vs never in poverty: β = -0.98; 95% confidence interval -1.61 to -0.35; two-thirds or more vs never in poverty: β = -1.55; 95% confidence interval -2.29 to -0.81). However, a longer duration of poverty was associated with a slower rate of CMMSE score decline over time from 2011 to 2018.
These findings provide valuable evidence for the role of cumulative late-life poverty in relation to cognitive health among older adults in a rapidly urbanizing and aging middle-income country. Our findings may support a compensation hypothesis for cognitive reserve in this setting.
The role of parks and nature to support well-being during the COVID-19 pandemic is uncertain. To examine this topic, we used mixed-methods data collected in April–May 2020 from US adults aged ≥55 in ...the COVID-19 Coping Study. We quantitatively evaluated the associations between number of neighborhood parks and depression, anxiety, and loneliness; and conducted qualitative thematic analysis of participants’ outdoor experiences. Among urban residents, depression and anxiety were inversely associated with the number of neighborhood parks. Thematic analysis identified diverse engagement in greenspaces that boosted physical, mental, and social well-being. The therapeutic potential of outdoor and greenspaces should be considered for interventions during future epidemics.
•Responses to COVID-19 highlight therapeutic landscapes experiences as dynamic & relational.•Participants purposefully engaged with diverse natural and outdoor spaces during COVID-19.•Outdoor engagement supported perceived social, mental, and physical well-being.•Living around more parks was linked to less depression and anxiety among urban residents.•The pandemic highlights natural and built environmental disparities.
The effects of late-life subjective poverty on brain health are understudied. We aimed to investigate the association between duration of subjective poverty after age 64 and subsequent cognitive ...function and decline in China.
Data were from 4118 adults aged ≥64 at baseline in the population-based China Longitudinal Healthy Longevity Survey (CLHLS), 2005–2018. The duration of subjective poverty was measured from self-rated economic status relative to neighbors in 2005, 2008, and 2011 (never; one time point; two or three time points). Cognitive function was assessed by the Chinese Mini-Mental State Exam (CMMSE; range: 0–30) in 2011, 2014, and 2018. We fitted attrition-weighted, multivariable mixed-effects Tobit regression models to examine the relationship between duration of subjective poverty from 2005 to 2011 and subsequent cognitive function and decline from 2011 to 2018.
A total of 2675 (64.96%) participants never reported subjective poverty over the period 2005–2011, 930 (22.58%) participants reported subjective poverty at one time point, and 513 (12.46%) reported subjective poverty at two or three time points. Compared to those who never reported subjective poverty, participants experiencing subjective poverty at one time point (β = −0.95, 95% CI: −1.48 to −0.41) and two or three time points (β = −2.01; 95% CI: −2.73 to −1.29) had lower CMMSE scores in 2011, indicating a dose-response relationship. Individuals with a longer duration of subjective poverty had a slower rate of decline in CMMSE scores than those never in subjective poverty (β = 1.44; 95% CI: 0.20 to 2.68 for 2018 X Two or three time points).
Subjective poverty in late life may have unique and cumulative contributions to cognitive aging among older adults in China. The lower level of initial cognitive function but slower rate of cognitive decline observed for those with greater subjective poverty is consistent with theories of cognitive reserve and empirical evidence from Western settings on other socioeconomic markers.
•One of the first longitudinal studies of subjective poverty and cognitive aging.•This study focuses on the middle-old and oldest-old adults in China.•A longer subjective poverty duration was associated with worse cognitive function.•However, a longer subjective poverty duration may lead to slower cognitive decline.
To review the evidence on the association between age and limited health literacy, overall and by health literacy test, and to investigate the mediating role of cognitive function.
The Embase, ...MEDLINE, and PsycINFO databases were searched. Eligible studies were conducted in any country or language, included participants aged ≥50 years, presented a measure of association between age and health literacy, and were published through September 2013.
Seventy analyses in 60 studies were included in the systematic review; 29 of these were included in the meta-analysis. Older age was strongly associated with limited health literacy in analyses that measured health literacy as reading comprehension, reasoning, and numeracy skills (random-effects odds ratio OR = 4.20; 95% confidence interval CI: 3.13-5.64). By contrast, older age was weakly associated with limited health literacy in studies that measured health literacy as medical vocabulary (random-effects OR = 1.19; 95% CI: 1.03-1.37). Evidence on the mediating role of cognitive function was limited.
Health literacy tests that utilize a range of fluid cognitive abilities and mirror everyday health tasks frequently observe skill limitations among older adults. Vocabulary-based health literacy skills appear more stable with age. Researchers should select measurement tests wisely when assessing health literacy of older adults.
Poor mental health associated with the COVID-19 pandemic may prompt the utilization of various coping behaviors, including alcohol use. We aimed to investigate the relationships between mental health ...symptomatology and self-reported changes in alcohol consumption at the onset of the pandemic. Data were from the nationwide COVID-19 Coping Study of US adults aged ≥55 in April and May 2020 (n = 6548). We used population-weighted multivariable-adjusted multi-nomial logistic regression models to estimate odds ratios (ORs) for the associations between mental health (of depression, anxiety, and loneliness, each) and self-reported increased alcohol consumption (vs. no change in consumption). One in ten adults (717/6548; 11%) reported an increase in their alcohol consumption in the past week compared to their usual pre-COVID-19 drinking. Mental health symptomatology was associated with increased drinking since the pandemic onset (depression: OR = 2.66, 95% CI: 1.99-3.56; anxiety: OR = 1.80, 95% CI: 1.34-2.42; loneliness: OR = 2.45, 95% CI: 1.83-3.28). Participants who screened positive for all three mental health outcomes were substantially more likely to report increased alcohol consumption since the onset of the pandemic (OR = 3.87, 95% CI: 2.52-5.96, vs. no mental health outcomes). This study demonstrates potentially harmful changes in alcohol intake among middle-to-older aged adults experiencing mental health symptomatology during the early months of the COVID-19 pandemic.
BackgroundAlthough being employed during midlife is positively associated with cognitive function in later life, little is known with respect to cumulative trajectories or durations of time spent in ...different kinds of work.MethodsWe investigated the relationships between employment trajectory from ages 31 years to 50 years and cognitive skills at ages 50–78 years among 2521 adults in the US Panel Study of Income Dynamics from 1968 to 2016. Sequence analysis was used to identify prototypical employment trajectories, capturing employment status and high versus lower job skill level at each year of age from 31 years to 50 years. Adjusted and weighted logistic regression was used to estimate relationships between employment trajectory and performance on each of four cognitive tests representing numerical reasoning, verbal reasoning, health literacy and financial literacy. Dose–response relationships between the duration of high-skill employment and cognitive skills were examined.ResultsSeven prototypical employment trajectories were identified, the most common being consistently lower skill employment (44%; 1105/2521). Consistently high-skill and fluctuating skill trajectories were associated with high numerical reasoning scores (OR=1.54, 95% CI 0.99 to 2.40; OR=2.52, 95% CI 1.39 to 4.58, respectively), compared with consistently lower skill employment. There was a dose–response relationship between duration of high-skill employment and numerical reasoning (OR=1.17; 95% CI 1.06 to 1.28), plateauing after approximately 4 years of high-skill employment.ConclusionsSequence analysis of exposure trajectories is a novel method for life course epidemiology that accounts for exposure timing, duration and ordering. Our results using this method indicate that the duration may be more important than the timing of high-skill midlife employment for later-life numerical reasoning skills.
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