OBJECTIVES:This research examined the associations between neighborhood physical disorder and social participation among community-dwelling older adults, and whether low social cohesion, as a social-relational pathway, and depressive symptoms, as a psychological pathway, partially explain the associations. METHODS:Using national data from Rounds 12-14 of National Aging and Trends Study, this research involved 3,350 Americans aged 65 or older. Social participation was measured by self-reported participation in five informal and formal social activities. Linear regressions examined associations between physical disorder and social participation, both cross-sectionally and longitudinally. A lagged dependent variable was included in the longitudinal models. Path analysis examined whether low socia l cohesion and depressive symptoms mediated the associations. RESULTS:Living in neighborhoods with physical disorder was associated with reduced social participation over time, yet the strength of the associations weakened over time. Low social cohesion mediated the association between physical disorder and social participation in Rounds 12 and 13, whereas depressive symptoms partially explained the association between physical disorder and social participation in Round 13 only. No longitudinal mediation was found. DISCUSSION:The findings highlight the important role of neighborhood physical disorder in social participation in later life, with associations that may be attributed to lower social cohesion and more depressive symptoms.
OBJECTIVE:To examine the concurrent association between loneliness and life satisfaction across survey waves and assess whether depressive symptoms statistically account for this association among very old Mexican American adults. METHODS:Data were drawn from three waves of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE). The analytic sample included 944 person-wave observations from adults aged 82 years and older, of which 892 from 596 individuals were included in multivariable analyses after excluding missing data. Analyses were restricted to self-respondents. Ordinal logistic generalized estimating equation (GEE) models with a cumulative logit link accounted for repeated measures and adjusted for demographic, cognitive, health, and financial factors. Indirect effects evaluated the role of depressive symptoms in the association between loneliness and life satisfaction. RESULTS:Most participants reported high life satisfaction. Greater loneliness was associated with lower odds of higher life satisfaction (AOR = 0.28, 95% CI [0.20-0.39], p < 0.001). This association remained significant but was attenuated after including depressive symptoms (AOR = 0.40, 95% CI [0.29-0.57], p < 0.001). The indirect effect through depressive symptoms was statistically significant (a × b = -0.48, 95% Monte Carlo CI [-0.70, -0.30]). Better self-rated health, absence of pain during standing or walking, lower financial strain, and higher cognitive function were also associated with higher life satisfaction. CONCLUSIONS:Loneliness is strongly associated with lower life satisfaction, with depressive symptoms partially and modestly accounting for this association. Interventions addressing both may improve well-being in very old adults.
OBJECTIVE:Alzheimer's disease (AD) care has been reshaped by the integration of fluid biomarkers. This review addressed the question "What are the ethical considerations of fluid biomarker use in eligibility assessments for treatment in AD and mild cognitive impairment?" METHODS:A rapid review following established guidelines was performed. Relevant data were identified and organised within the four pillars of biomedical ethics. Results were reported in line with the PRISMA checklist. RESULTS:Searches identified 10,611 records; 34 were included following screening. Narrative synthesis suggests there are a greater number of ethical risks over benefits within the current clinical context. However, interpretation is subjective and empirical data is lacking. CONCLUSIONS:Multiple ethical concerns surround the use of fluid biomarkers in AD treatment decisions, and there is limited empirical evidence to substantiate claims about benefits and harms. Uncertainty in biomarker performance, particularly in underrepresented groups, raises risks to non-maleficence, autonomy, and justice and complicates clinical decision making.
OBJECTIVES:To investigate whether loneliness or social isolation serves as the main pathway connecting social connectedness dimensions to mental health outcomes among midlife to older adults. METHODS:We examined longitudinal data from 4,963 adults aged 40-65 at baseline in the U.S. national MIDUS study (2004-2014). Social connectedness was assessed across six areas: neighborhood social cohesion, social integration, family support, friend support, social contribution, and community contribution. Loneliness and social isolation (contact frequency) were measured at baseline; psychological distress and depressive symptoms were evaluated at follow-up. Structural equation modeling with inverse probability weighting was used to explore both direct and indirect pathways. RESULTS:Most social connectedness dimensions showed significant direct protective associations with psychological distress. Loneliness consistently functioned as a pathway linking social connectedness to both outcomes, with the strongest indirect effects for family support (psychological distress: β = -0.032, p < 0.001; depression: β = -0.015, p < 0.001). The loneliness pathway was more pronounced among women, particularly for depression (women: β = -0.023 to -0.020, all p < 0.001). DISCUSSION:Loneliness, rather than structural isolation, acts as the main pathway from social connectedness to mental health. While social connectedness helps reduce isolation, it does not necessarily lead to improvements in mental health. Interventions should prioritize relationship quality to enhance mental health.
OBJECTIVES:The association between mental health literacy and personal and interpersonal mental health experiences with personal stigma is increasingly recognized. However, the underlying mechanisms remain unclear. This study investigated the hypothesized mediating role of social support networks between mental health literacy and personal and interpersonal mental health experiences, and personal depression stigma among Chinese older adults. METHODS:Using a cross-sectional design with 1,044 participants, we measured depression stigma with the Depression Stigma Scale, mental health literacy through vignettes, and social support with the Lubben Social Network Scale. Personal and interpersonal mental health experiences were assessed with yes/no questions. Structural equation modeling was used to examine their hypothesized relationships. RESULTS:Mental health literacy (b = -0.616, p < 0.001) and personal mental health experiences (b = -1.327, p < 0.001) were statistically associated with lower levels of personal depression stigma. Social support networks show statistical mediation in the relationships between mental health literacy, personal mental health experiences, and personal depression stigma (CFI = 0.977; TLI = 0.956; RMSEA = 0.035; SRMR = 0.027). CONCLUSION:Our cross-sectional study suggested that mental health literacy and personal mental health experiences were associated with lower levels of personal depression stigma in Chinese older adults, with their associations being statistically mediated by the presence of informal social support networks.
BACKGROUND:Older adults with HIV (OAWH) face elevated dementia risk, yet dementia remains under-addressed in HIV care. Given the multidisciplinary nature of HIV clinics, there is unique opportunity to expand dementia care capacity by training HIV clinic staff. METHODS:In this feasibility study we adapted Scotland's National Dementia Champions Programme for use in HIV clinics, creating the 'HIV Dementia Champion Program.' Implementation strategies focused on stakeholder engagement, local relevance, and sustainability. A community advisory board of OAWH guided program development. Training involved ten sessions with local dementia experts. Educational outcomes and implementation outcomes were measured via surveys. Assessments of program sustainability and cost were also conducted. RESULTS:Four trainees completed the program. Educational performance was high at baseline with minimal change following training. Implementation outcomes indicated high acceptability, appropriateness, and feasibility. Sustainability scores were favorable, noting funding challenges. Community advisory board feedback was positive and highlighted interest in cognitive health. CONCLUSIONS:The HIV Dementia Champion Program is a feasible intervention for expanding dementia care capacity. Educational outcomes were modest but the program enhanced resource awareness and trainee confidence. This initiative demonstrates the potential of adapting geriatric training models to meet the needs of OAWH.
OBJECTIVES:Invoking the perspective that unpleasant behaviors can be transmitted within a family through social learning, emotional mimicry, and emotional displacement, the primary study objective is to examine whether negative family exchanges induce potentially harmful behaviors (PHB) by caregivers. The secondary objective is to clarify the causal relationship between burden and (care-recipient) challenging behaviors on the one hand, and PHB on the other, in light of the lack of longitudinal evidence. METHODS:99 Alzheimer family caregivers participated in a 6-month 2-wave longitudinal survey. Ten items tapping psychological and physical domains were used to assess PHB. The quality of exchanges with each familial network member was measured using the social convoy questionnaire. RESULTS:Controlling for baseline PHB in multiple regression, BPSD did not predict PHB at follow-up, but burden did. However, the effect of burden was reduced to nonsignificance after including family exchange variables. In the final model, only negative family exchanges significantly predicted PHB (f2 = 0.05), and this effect was not mediated by burden. CONCLUSION:Negative family exchanges contribute to caregivers' PHB over and above burden, underscoring the need to address the broader family dynamics in which caregiving is embedded in dementia care.
OBJECTIVES:This study examines the association between financial strain and loneliness among adults aged 66 years and older. Guided by stress-buffering and gender socialization perspectives, it also assesses whether neighborhood cohesion moderates this association and whether this moderation varies by gender. METHODS:Using two waves of the United Kingdom Household Longitudinal Study that include measures of loneliness and neighborhood cohesion (n = 3,467 individuals; 6,934 person-wave observations), fixed-effects regression models examined whether within-individual changes in financial strain were associated with changes in loneliness over time. Interaction terms assessed moderation by neighborhood cohesion and whether this moderation varied by gender. RESULTS:Financial strain was associated with increased loneliness over time, whereas higher neighborhood cohesion was associated with lower loneliness. Neighborhood cohesion attenuated the adverse association between financial strain and loneliness. Gender-stratified analyses showed that this buffering effect was statistically significant among women but not among men; however, the three-way interaction among financial strain, neighborhood cohesion, and gender was not statistically significant. DISCUSSION:The findings highlight the need for community-based initiatives that foster neighborhood cohesion and for targeted financial support programs to reduce financial strain and its psychological consequences among older adults.
BACKGROUND:Functional difficulties associated with subjective cognitive decline (SCD) represent a public health concern. While physical activity (PA) and body mass index (BMI) are associated with cognitive health, their combined association with functional difficulties is unclear. This study examined the combined associations of PA and BMI on the prevalence of functional difficulties in a nationally representative sample of U.S. adults living with SCD. METHODS:BRFSS data from 2011, 2015, 2017, and 2019 were pooled. Cross-sectional associations between independent and combined PA and BMI levels were estimated using Poisson log-linear regression and reported by Adjusted Prevalence Ratios (APRs).Results Data from 29,343 adults (≥18 years) were included. Compared to the reference group (Highly Active, Normal Weight), individuals with lower PA and increased BMI were more likely to report functional difficulties; APRs ranged from 1.10, 95% CI: 1.10-1.11 (Nonactive, Normal Weight) to 1.19, 95% CI: 1.18-1.19 (Nonactive, Obesity). Meeting PA guidelines reduced the prevalence of functional difficulties across all BMI categories, though benefits were smaller among individuals with obesity. CONCLUSION:Low PA and higher BMI were associated with greater prevalence of SCD functional difficulties. Guideline-level PA may reduce difficulties among BMI groups, but to a lesser extent among individuals living with obesity, supporting tailored PA strategies.
BACKGROUND:Late life depression is a prevalent and under-treated public health concern. Empathy may be relevant to depressive symptoms in older adults, but different empathy dimensions may have different implications. Apathy, characterized by reduced motivation and goal-directed engagement, may help explain how empathy is linked to later depressive symptoms. METHODS:Older adults aged 60-85 years from two communities in Beijing were recruited as participants. A three-wave longitudinal survey design was employed at intervals of 1.5 and 3 months following the baseline measurement. Perspective-taking, empathic concern, fantasy, personal distress, apathy, and depressive symptoms were assessed at each wave. Cross-lagged panel model was used to test direct and indirect effects over time. RESULTS:All four longitudinal mediation models showed acceptable overall fit (PCMIN/DF = 2.43-3.35; RMSEA = 0.076-0.096; SRMR = 0.062-0.075; TLI = 0.903-0.911; CFI = 0.909-0.935). Perspective-taking showed a significant indirect effect on T3 depression via reduced T2 apathy (indirect effect= -0.083, 95% CI [-0.172, -0.009]); indirect effects for empathic concern and fantasy were nonsignificant, and personal distress predicted T3 depression directly without mediation. CONCLUSION:Perspective-taking may be prospectively linked to later depression through apathy, although the effect was small and should be interpreted cautiously. These findings suggest that assessing both cognitive empathy and apathy may provide additional information for understanding depression risk in community-dwelling older adults.
OBJECTIVES:This study explored the network structure of depressive and anxiety symptoms among community-dwelling older adults, compared networks between those with more negative or positive self-perceptions of aging (SPA), and examined direct associations between SPA and depressive-anxiety. METHODS:A sample of 1,019 older adults from Xinxiang, China, was stratified by the Brief Aging Perceptions Questionnaire into more positive or negative group. Depression and anxiety symptoms were assessed via the PHQ-9 and GAD-7. Network centrality was measured using expected influence and bridge expected influence. RESULTS:In the more negative SPA network, "fatigue", "uncontrollable worry", and "feeling of worthlessness" showed the highest expected influence. In the more positive SPA network, central symptoms were "depressed or sad mood", "uncontrollable worry", and "worry too much". Flow network analysis identified strong positive correlations between SPA and symptoms including "afraid something will happen", "thoughts of death", and "feeling of worthlessness". CONCLUSION:This was the first study to compare depression-anxiety networks across older adults with more positive versus negative SPA and investigate their associations. Targeting central symptoms may effectively alleviate depression and anxiety. Moreover, intervening on symptoms strongly linked to SPA may offer a novel route for improving SPA.
OBJECTIVE:To assess whether neighborhood poverty, income, crime, and walkability are associated with psychosocial outcomes in older adults. METHODS:We analyzed 198 of 301 participants from the Collaborative Aging Research Using Technology study in Oregon and Washington. Geocoded addresses were linked to census block-group and ½-mile buffer indicators. Single-exposure regression models, adjusted for age, gender, education, and neighborhood healthcare infrastructure, examined loneliness (UCLA Loneliness Scale), weekly lonely mood, anxiety (GAD-7), depressive symptoms (Geriatric Depression Scale), and weekly blue mood. RESULTS:Lower median household income was associated with greater loneliness (p=.023). Higher crime risk was associated with increased weekly loneliness (p=.001), anxiety (OR=1.007; 95% CI: 1.001-1.013), and blue mood (p=.002). Greater walkability was also linked to blue mood (p=.035). No associations emerged for depressive symptoms. Indicators overlapped substantially (walkability-crime ρ≈0.78). CONCLUSIONS:Lower income was linked to chronic loneliness, while higher crime was consistently associated with weekly lonely mood, anxiety, and blue mood, suggesting safety-related exposures may be particularly salient for momentary emotional states. The absence of associations with depressive symptoms suggests trait-level depression may be less responsive to proximate environmental conditions than state-sensitive mood. These findings support community-level interventions targeting neighborhood safety among older adults aging in place.
BACKGROUND:Adverse childhood experiences (ACES) are associated with health issues that can persist into adulthood including mental disorders, behavioral problems, and suicide. Physical activity (PA) is a potential tool in response to these burdens as it is profoundly beneficial for mental health. AIMS:The purpose of this study is to examine the relationship between PA and mental health in adults with one or more ACEs. METHODS:Using the 2022 Behavioral Risk Factor Surveillance System, we evaluated the relationship between ACEs, days of poor mental health and PA in a sample of adults (N = 54,251), adjusted for age, sex, race, and education. RESULTS:ACE scores were positively related to poor mental health. Adults who reported non-work-related PA showed a significant reduction in the odds of poor mental health (AOR: 0.60; CI: 0.50-0.70). PA appeared to reduce the odds of poor mental health by 31%, even in those with the highest ACE scores. CONCLUSIONS:These data suggest that being physically active as an adult can significantly reduce the frequency of poor mental health, even in those with significant childhood adversity. Future research should continue to explore the role of PA in both the prevention and treatment of mental health disorders across the lifespan.
METHODS:We sought to examine whether the negative associations between the two facets of ageism (internalized ageism and ageist discrimination) and psychological wellbeing are moderated by individual differences in personality, emotion regulation strategy use, and difficulties with strategy use in two cross-sectional studies. RESULTS:Findings suggested that age-based discrimination and internalized ageism are associated with lower wellbeing. Extraversion, neuroticism, response modulation strategies, and difficulties with emotion regulation did not moderate ageism-wellbeing associations. However, use of engaged and disengaged cognitive change strategies did moderate the association between environmental mastery and internalized ageism, such that the effect of internalized ageism on environmental mastery was lessened. CONCLUSION:These findings are discussed with respect to the potential for applicable and implementable interventions for older adults.
OBJECTIVES:To examine associations of baseline marital status and partnership-status trajectories with alcohol use, gender differences, and potential mediation by depressive symptoms and loneliness. METHODS:Participants were 5071 adults (53.6% women; 65-85 years) in the 2016 and 2021 Gerontological Regional Database waves in Northern Sweden and Western Finland. Partnered status included marriage, cohabitation, or living-apart-together; unpartnered status included single, divorced, or widowed. Partnership-status trajectories distinguished those who remained or transitioned to unpartnered status from those who remained or transitioned to partnered status. AUDIT-C assessed 2021 abstinence, low-risk (scores 1-3), hazardous drinking (≥4), and binge drinking (≥6 drinks/occasion at least monthly). Elevated depressive symptoms were defined as GDS-4 ≥ 2. Inverse-probability-weighted multinomial, logistic, and mediation models were estimated. RESULTS:At baseline, unpartnered respondents were more likely to abstain than partnered respondents. Unpartnered trajectories were associated with abstinence (adjusted relative risk ratio = 1.40, 95% CI = 1.16-1.68), but not binge drinking (adjusted odds ratio = 0.97, 95% CI = 0.66-1.43). Among women, unpartnered trajectories were associated with lower hazardous drinking and binge drinking. No indirect effects via depressive symptoms or loneliness were observed. CONCLUSION:Unpartnered older adults were more likely to abstain. Among women, partnership was associated with hazardous and binge drinking. These patterns may reflect shared drinking environments and partnership-related social contexts rather than psychological distress following marital loss.
OBJECTIVES:Multimorbidity (MM) is a major public health challenge, particularly in ageing populations. Living alone and loneliness are distinct psychosocial conditions linked to adverse health outcomes. This study aimed to investigate the association of living alone and loneliness with MM among middle- and older-aged Portuguese adults. METHODS:Data were drawn from EPIPorto, a cohort study encompassing 2485 adults evaluated from 1999-2003 to 2022. Based on international consensus criteria, MM outcomes included: (1) a count of all chronic conditions; (2) a count of specific aggregated conditions (cardiovascular, metabolic-endocrine, mental-behavioural, and musculoskeletal); (3-6) counts specific by body system. Living alone was assessed through household size. Loneliness was measured using the Portuguese version of the UCLA Loneliness Scale, analysing the total score and its two dimensions (UCLA Social Isolation [UCLA-SI] and UCLA Affinities [UCLA-A]). Missing data were handled through multiple imputation by chained equations. Generalized linear models with a Poisson distribution were used to estimate adjusted relative risks (aRR) and 95% confidence intervals (95% CI). RESULTS:Larger households (living with two or more persons) were associated with an increased risk of metabolic-endocrine conditions (aRR = 1.50, 95% CI: 1.11-2.02). Loneliness increased the risk of MM for the specific aggregation of conditions (aRR = 1.13, 95% CI: 1.05-1.21), particularly mental-behavioural conditions (aRR = 1.25, 95% CI: 1.11-1.40). Higher UCLA-SI scores increased the risk for the specific aggregation of conditions (aRR = 1.20, 95% CI: 1.08-1.35), cardiovascular (aRR = 1.17, 95% CI: 1.05-1.32), metabolic-endocrine (aRR = 1.20, 95% CI: 1.05-1.37), and mental-behavioural conditions (aRR = 1.29, 95% CI: 1.07-1.56). CONCLUSION:Living alone and loneliness were differently associated with MM. Public health interventions should consider these distinctions to promote healthy ageing and reduce MM burden.
OBJECTIVES:To quantify the magnitude and trends the national and subnational burden of Alzheimer's disease and other dementias (ADOD) in Mexico from 1990 to 2023, analyzing patterns by sex and age and exploring their association with the Socio-Demographic Index (SDI) and the Healthcare Access and Quality Index (HAQI). METHOD:A secondary ecological study was conducted using updated estimates from the Global Burden of Disease and Risk Factors Study (GBD) 2023. Prevalence, incidence, mortality, and disability-adjusted life years (DALYs) were examined. Temporal trends were assessed using joinpoint regression. Pearson correlation and linear regression were used to evaluate associations between DALYs rates and SDI and HAQI. RESULTS:Between 1990 and 2023, ADOD prevalence and incidence increased, despite significant declines in age-standardized prevalence and incidence rates. Females consistently experienced higher mortality and disability, with age-standardized DALYs rates 1.28 times those of males. The ADOD burden increased sharply with age, peaking among those aged 85 years and older, with premature mortality accounting for 63.0% of total DALYs. A significant increase in DALYs rates occurred during 2020-2023 after previous periods of gradual decline. DALYs rates were negatively correlated with both SDI and HAQI. CONCLUSION:ADOD disproportionately affect women, while higher modeled burden was observed in several states with lower socioeconomic development and weaker health system performance. The post-2020 increase represents an epidemiological signal warranting further investigation into excess mortality among people with dementia, healthcare disruption, social isolation, and changes in long-term care during the COVID-19 period. Strengthening early diagnosis, long-term care, and management of modifiable risk factors is essential to reduce the future burden and persistent regional and sex-based inequalities in ageing populations.
OBJECTIVES:To examine whether emotion regulation dimensions explain age-related differences in loneliness, and whether these associations differ across adulthood. METHODS:In a cross-sectional survey, 609 adults aged 18-80 years (M = 48.32, SD = 15.69; 83% women; 98% White) completed measures of loneliness, cognitive reappraisal and expressive suppression, and six dimensions of emotion regulation difficulties. Parallel mediation and moderation analyses examined indirect associations between age and loneliness via eight emotion regulation variables, and whether emotion regulation-loneliness associations varied by age. RESULTS:Higher age was indirectly associated with lower loneliness via cognitive reappraisal, lower emotional awareness, and fewer perceived limitations accessing regulation strategies. Associations between loneliness and limited access to strategies and impulse control difficulties became stronger with increasing age, whereas lack of emotional clarity was associated with higher loneliness at younger ages but lower loneliness in older adulthood. CONCLUSION:Emotion regulation partially accounts for age differences in loneliness, with perceived limited access to regulation strategies the strongest pathway. Findings indicate regulatory capacity becomes more consequential for loneliness in later life, and age-sensitive consideration of emotion regulation is warranted in loneliness interventions.
