Loneliness and social isolation are associated with numerous adverse physical and psychological health outcomes in older adulthood, including cognitive impairment and mortality risk. Yet, how the individual and joint effects of loneliness and social isolation contribute to these outcomes remains unclear, particularly given the interplay between individual differences (loneliness) and environmental factors (social isolation) in shaping these important health outcomes in older adulthood (i.e., person-environment interactions). We used Cox regression, logistic regression, and multistate survival models to systematically investigate the individual and adjusted associations among loneliness, social isolation, cognitive aging outcomes, and mortality risk. Further, extensive between-study variability in operational definitions, modeling approaches, and covariate adjustments may be contributing to mixed results in the existing literature. In this registered report, we applied a multistudy approach (i.e., coordinated data analysis) in which independent but identical models were fit across 11 longitudinal studies representing participants from 18 countries (Ntotal = 175,070). Random effects meta-analyses synthesized results across studies, showing that loneliness was consistently associated with an elevated risk of cognitive impairment and mortality across statistical approaches, even after adjusting for social isolation. Conversely, social isolation was not consistently associated with cognitive impairment and showed weaker associations with mortality risk. Together, our findings suggest that loneliness is a robust, proximal predictor of major aging outcomes and highlight avenues for theory development, strategies to strengthen cognitive resilience and independence in older adulthood, and more efficient resource allocation of public health resources. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

OBJECTIVES:A growing body of literature suggests that self- or patient- reported health may be associated with objective health outcomes. Self-reported health could thus be a non-invasive and low-cost way of identifying who is at risk of poor health in later life. However, no prior study has systematically examined this relationship using multiple large datasets. The goal of the current study was thus to examine the extent to which self-rated health was associated with cognitive function, a distinct outcome rather than an aspect of health itself. METHODS:Using a coordinated data analysis (CDA) methodological framework, we identified 15 longitudinal datasets comprising over 140,000 participants representing 38 countries that met our analytic inclusion criteria. Our preregistered analyses tested 1) whether self-rated health was associated with cognitive function both concurrently and at longitudinal follow-up, 2) the odds of developing cognitive impairment or dementia over the course of the study, and 3) whether these associations persisted net of demographic and health covariates. RESULTS:Across nearly all datasets, higher self-rated health was associated with better cognitive function (both concurrently and longitudinally) and lower odds of developing dementia, over and above the effects of chronic conditions. Age moderated some effects, such that these associations may be strongest among older adults. DISCUSSION:The implications of these findings are discussed in terms of the predictive utility of single-item subjective health indicators on downstream health outcomes and the benefits of using CDA in aging research.

OBJECTIVE:To assess the effectiveness of an mHealth neonatal intensive care unit (NICU) parent support smartphone application to improve psychosocial well-being, specifically reduced stress and anxiety, increased parenting competence, and improved social support among a diverse group of parents with infants born preterm in 3 Chicago-area NICUs. STUDY DESIGN:A time-lapsed, quasiexperimental design in which control participants were enrolled and then intervention participants enrolled. Data collection occurred at 3 timepoints: NICU admission (AD), discharge (DC), and 30 days post-DC (DC+30). Validated outcome measures included parenting sense of competence, stress, anxiety, and social support. RESULTS:Intention-to-treat analyses included 400 participants (156 intervention; 244 control). After covariate adjustment, a significant increase in parenting sense of competence (AD-DC, DC+30), decrease in stress (AD-DC+30), decrease in anxiety (AD-DC, DC+30), and increase in social support (AD-DC) were noted but did not differ by study arm. However, secondary analysis of parents with infants born at <32 weeks of gestational age (156 participants) showed decrease in stress (AD-DC+30) that was greater in intervention vs control group (P = .03). Among intervention participants who were Black, a significant increase in social support (AD-DC) total score (P = .01), and 2 subscales of emotional/informational support (P = .02) and positive social interaction (P = .02) were found. CONCLUSIONS:This novel mHealth intervention shows evidence of reduced stress and anxiety while increasing social support among some subsets of parents at high risk of negative psychosocial experiences in the NICU, potentially enhancing outcomes for infants born preterm by ensuring that parents are less stressed and better supported.

Objectives As medical interventions for cognitive decline and dementia continue to evolve, the identification of modifiable psychosocial factors has become increasingly important. Sense of purpose and loneliness represent potential targets for intervention. In this study, we aimed to understand the potentially reciprocal relationship between sense of purpose, loneliness, and cognitive function.Methods The current project draws upon data from the Memory and Aging Project and Minority and Aging Research Study led by the Rush Alzheimer's Disease Center, 2 longitudinal cohort studies of 3,118 older adults (Mage=78.4 years; 75% female; 31% Black) without dementia at enrollment. Participants completed annual assessments of cognitive function and completed self-report measures on sense of purpose and loneliness every year for up to 12 years. Using trivariate random intercept cross-lagged panel models, we examined between-person, prospective within-person, and concurrent within-person associations among sense of purpose, loneliness, and cognitive function.Results At the between-person level, a higher sense of purpose and lower loneliness were associated with better cognitive function. At the prospective within-person level, decreases in sense of purpose and increases in loneliness predicted subsequent cognitive decline, independent of ApoE genotype, race, sex, education, depressive symptoms, and social activity.Discussion Changes in both sense of purpose and loneliness independently predicted cognitive decline in older adults, suggesting these constructs are unique targets for potential interventions to promote cognitive health.

This study tested the feasibility and preliminary efficacy of Coping and Emotional Development for Adolescents to Reduce Stress (CEDARS) a positive psychological intervention (PPI), tailored for adolescents and administered in a classroom setting, in boosting CEDARS skill use and emotional well-being. Adolescents (N = 102, 45

Pilarz, Mary; Bleed, Elizabeth; Rodriguez, Victoria; Daniels, Latasha; Jackson, Kathryn; Nelson Sanchez-Pinto, L.; Foster, Carolyn Author Information

Abstract Psychosocial researchers have long sought to identify individual differences in early and middle adulthood that robustly predict health in later life. Our current pre-registered study builds on these efforts by assessing whether an individual’s subjective perception of their health is related to their cognitive health, both concurrently and later in life. Using the coordinated data analysis (CDA) methodological framework, we have identified 17 longitudinal studies (including 7 from the Gateway to Global Aging network) that had the requisite data to test our models. We conceptually harmonized all study variables and tested identical linear and logistic regression models across all study datasets. Our preliminary results suggest that individuals who have better subjective beliefs about their health have better cognitive function both concurrently and at longitudinal follow-up (ranging from 4 to 27 years after baseline). These associations were moderated by participant gender and age at baseline, and the results were somewhat robust to the inclusion of objective health indicators. We will discuss our results within the context of Lifespan Developmental Theory and the Health Behavior Model. Overall, our study serves to elucidate how subjective perceptions of health may manifest into later cognitive health outcomes, and if subjective perceptions of health could be used as an early risk factor for identifying individuals who may be vulnerable to cognitive senescence in later life.

Loneliness is a pervasive experience with adverse impacts on health and well-being. Despite its significance, notable gaps impede a full understanding of how loneliness changes across the adult life span and what factors influence these changes. To address this, we conducted a coordinated data analysis of nine longitudinal studies encompassing 128,118 participants ages 13 to 103 from over 20 countries. Using harmonized variables and models, we examined loneliness trajectories and predictors. Analyses revealed that loneliness follows a U-shaped curve, decreasing from young adulthood to midlife and increasing in older adulthood. These patterns were consistent across studies. Several baseline factors (i.e., sex, marital status, physical function, education) were linked to loneliness levels, but few moderated the loneliness trajectories. These findings highlight the dynamic nature of loneliness and underscore the need for targeted interventions to reduce social disparities throughout adulthood.

Background Caring for a loved one with Alzheimer’s disease can be stressful, resulting in poorer emotional and physical health among family caregivers. Although supportive resources for caregivers are available, distance, caregiver health, and the daily demands of caregiving are barriers to access. Based on research demonstrating the importance of positive emotions in coping with stress, our previous trial showed that dementia caregivers who participated in facilitated, web-based delivery of a positive emotion regulation intervention called LEAF (Life Enhancing Activities for Family caregivers) experienced increased positive emotion and decreased depression and anxiety. Building on this evidence, the LEAF 2.0 study aims to test whether web-based, self-guided delivery can confer similar benefits for caregivers of individuals with Alzheimer’s disease. Methods This paper presents the design and methods for LEAF 2.0, a 3-arm web-based randomized controlled trial ( N = 500) in which family caregivers of patients with Alzheimer’s disease (AD) are randomized to (1) the LEAF intervention facilitated remotely via the web ( N = 200), (2) the LEAF intervention self-guided online ( N = 200), or (3) an emotion reporting control ( N = 100), which then crosses over to the intervention after approximately 6 months, half to the facilitated arm and half to the self-guided arm. We aim to (1) compare the effect of the facilitated and self-guided LEAF positive emotion interventions to an emotion reporting control condition on AD caregiver well-being (positive emotion, depression, anxiety, and perceived stress) and secondary outcomes (caregiving burden, caregiving self-efficacy, positive aspects of caregiving, quality of care, and AD patient quality of life); (2) assess whether effects are mediated by improvements in positive emotion or other aspects of caregiver well-being; and (3) test whether caregiver age or gender or the care recipient’s dementia severity moderates the effects of the intervention. Discussion If demonstrated to be effective, LEAF can be widely disseminated and ultimately have a significant impact on the stress experienced by AD caregivers and the well-being of people living with Alzheimer’s disease. Trial Registration ClinicalTrials.gov NCT03610698.

OBJECTIVES To determine whether use of a language other than English (LOE) would be associated with medical complexity, and whether medical complexity and LOE together would be associated with worse clinical outcomes. METHODS The primary outcome of this single-site retrospective cohort study of PICU encounters from September 1, 2017, through August 31, 2022 was an association between LOE and medical complexity. Univariable and multivariable analyses were performed between demographic factors and medical complexity, both for unique patients and for all encounters. We investigated outcomes of initial illness severity (using Pediatric Logistic Organ Dysfunction-2), length of stay (LOS), days without mechanical ventilation or organ dysfunction using a mixed effects regression model, controlling for age, sex, race and ethnicity, and insurance status. RESULTS There were 6802 patients and 10 011 encounters. In multivariable analysis for all encounters, Spanish use (adjusted odds ratio [aOR], 1.29; 95% confidence interval [CI], 1.11–1.49) and language other than English or Spanish (LOES) (aOR, 1.36; 95% CI, 1.02–1.80) were associated with medical complexity. Among unique patients, there remained an association between use of Spanish and medical complexity in multivariable analysis (aOR, 1.26; 95% CI, 1.05–1.52) but not between LOES and medical complexity (aOR, 1.30; 95% CI, 0.92–1.83). Children with medical complexity (CMC) who used an LOES had fewer organ dysfunction-free days (P = .003), PICU LOS was 1.53 times longer (P = .01), and hospital LOS was 1.45 times longer (P = .01) compared with CMC who used English. CONCLUSIONS Use of an LOE was independently associated with medical complexity. CMC who used an LOES had a longer LOS.

OBJECTIVES:Loneliness and social isolation are major public health concerns among older adults in Japan. Generativity, the concern for and commitment to future generations, may buffer older adults from loneliness. This study examined the cross-sectional and longitudinal associations between generativity and social asymmetry (the discrepancy between social isolation and loneliness) among older adults in Japan.METHODS:Data were from 2 waves (2008 and 2012) of the Midlife in Japan survey, a nationally representative longitudinal study of 645 adults aged 30-79 residing in the Tokyo metropolitan area. Generativity was measured using the 6-item Loyola Generativity Scale. Social asymmetry was computed as the residual score from regressing loneliness onto social isolation.RESULTS:Higher generativity levels were associated with lower social asymmetry scores (B=-0.21, SE=0.04), but generativity change across waves did not predict social asymmetry 4 years later (B=-0.04, SE=0.06).DISCUSSION:Generativity may play a protective role in buffering older adults from the adverse effects of social isolation on loneliness. Promoting generativity among older adults may be a potential intervention strategy to reduce loneliness and improve well-being in aging populations in Japan.

Abstract Dementia is the leading cause of disability in older adults worldwide. As of yet, there are no easily accessible cures. Thus, a wide range of research has focused on modifiable intra- and interpersonal factors that may contribute to lower risk for dementia and generally slow down cognitive decline. A promising protective intrapersonal factor from the well-being literature is sense of purpose, as higher levels of sense of purpose are tied to a swath of healthy cognitive aging outcomes. Meanwhile, greater experiences of loneliness are typically a risk factor for poorer cognitive aging. The current study calls upon data from the ongoing Memory and Aging Project from the Rush Alzheimer’s Disease Center (N = 1,736; waves: up to 18; age: M = 81.07, SD = 8.04, 65-101). Every year, participants complete an extensive cognitive battery and report on their sense of purpose and loneliness. Given the likely reciprocal relationship between these three constructs, the current project uses random intercept cross-lagged panel models to better establish the between- versus within-person and concurrent versus longitudinal processes behind these relationships. Findings highlight the bidirectional relationship of these variables across time metrics and levels. For example, lower levels than one’s average of sense of purpose predicts decreases in cognitive functioning a year later, and decreases in cognitive functioning also precede decreases in sense of purpose. Future research would benefit from exploring combined efforts to bolster sense of purpose and reduce loneliness, while continuing to mind the potential influence of cognitive decline on these constructs.

INTRODUCTION:Burnout poses a substantial, ongoing threat to healthcare worker (HCW) wellbeing and to the delivery of safe, quality healthcare. While systemic and organization-level changes in healthcare are critically important, HCWs also need individual-level skills to promote resilience. The objective of this trial is to test feasibility, acceptability, and efficacy of PARK, an online self-guided positive affect regulation intervention, in a sample of healthcare workers during the COVID-19 pandemic. DESIGN AND METHODS:In the context of the unprecedented rise in burnout during the COVID-19 pandemic, we conducted a randomized waitlist-controlled trial of the Positive Affect Regulation sKills (PARK) program-a five-week, online, self-guided coping skills intervention nested within an ongoing cohort of HCWs. N = 554 healthcare workers were randomly assigned to receive the intervention immediately or to receive the intervention after approximately 12 weeks. Outcomes included change in burnout, emotional wellbeing (positive affect, meaning and purpose, depression, anxiety) and sleep over approximately 12 weeks. Analyses included mixed-effects linear regression models comparing change over time in outcomes between intervention and control conditions. RESULTS:One third (n = 554) of the participants in the cohort of HCWs consented to participate and enrolled in PARK in April 2022. Compared to those who did not enroll, participants in the trial reported higher burnout, poorer emotional wellbeing, and poorer sleep at baseline (April, 2022; all ps < .05). Intent-to-treat analyses showed that participants randomly assigned to the intervention immediately (PARK-Now) improved significantly on anxiety (within-group change on PROMIS T-score = -0.63; p = .003) whereas those in the waitlist (PARK-Later) did not (within group T-score change 0.04, p = 0.90). The between-group difference in change, however, was not statistically significant (B = -0.67 p = 0.10). None of the other wellbeing outcomes changed significantly in the intervention group compared to the waitlist. Additional as-treated analyses indicated that those participants who completed all 5 of the weekly online lessons (N = 52; 9.4%) improved significantly more on the primary outcome of positive affect compared to those who enrolled in PARK but completed zero lessons (n = 237; 42.8%; B = 2.85; p = .0001). CONCLUSIONS:Online self-guided coping skills interventions like PARK can be effective in targeted samples and future work will focus on adaptations to increase engagement and tailor PARK for HCWs who could most benefit.

BackgroundMindfulness meditation is ubiquitous in health care, education, and communities at large. Mindfulness-Based Interventions (MBIs) are the focus of hundreds of NIH-funded trials given the myriad health benefits associated with this practice across multiple populations. Notwithstanding, significant gaps exist in how mindfulness concepts are measured using currently available self-report instruments. Due to the number of available mindfulness measurement tools, each measuring different aspects, it is difficult to determine the extent to which individuals develop comparable mindfulness skills and attitudes and which health benefits can be attributed to which gains in mindfulness. The Patient-Reported Outcomes Measurement Information System (Puerto RicoOMIS (R)) has established a rigorous instrument development methodology to create brief, precise, and clinically relevant outcomes tools.ObjectiveThis is the first of 4 papers representing an NCCIH-funded initiative (R01AT009539), which has applied Puerto RicoOMIS (R) instrument development methodologies to mindfulness measurement to improve the rigor, relevance, and reproducibility of MBI research results.Methods/ResultsThis introductory paper sets the stage for why improved mindfulness measurement tools are needed and briefly describes the Puerto RicoOMIS (R) development approach. The second 2 papers highlight results from a national survey, focus groups, and expert interviews to identify and organize relevant mindfulness concepts, domains, and items for eventual item bank creation. The fourth paper reviews the item writing and development process of these new instruments, including results from stakeholder cognitive interviews and a translatability review.ConclusionTogether these papers feature the rigorous development approach, rationale, logic, and significance that supports the development, calibration, and validation of new Puerto RicoOMIS (R) measures of mindfulness and related concepts.

BACKGROUND:Although active surveillance (AS) is an increasingly adopted treatment paradigm for management of very low risk prostate cancer, many men and their partners face a variety of AS-related psychosocial stressors. Stressors may include anxiety and fear of progression, which may negatively affect short- and long-term psychosocial adjustment and influence early withdrawal from AS in order to seek definitive therapies such as surgery or radiation. Here we describe the protocol for an NCI-funded trial, which seeks to examine the efficacy of mindfulness training compared with a time/attention-matched health promotion control condition in a geographically generalizable sample of men on AS and their spouses. METHODS:Using a randomized, controlled, partially double-blinded study design, this study involves the delivery of 8 weeks of standardized mindfulness training (MBSR; mindfulness-based stress reduction) and patient reported outcomes over a 12-month period (proposed enrollment of 80 men on AS and spouses), compared with a health promotion control (proposed enrollment of 80 men on AS and spouses) that has been matched for time and attention. Baseline (T1) measures (e.g., anxiety, fear of progression, quality of life) are administered just prior to randomization to the two study arms, followed by repeated assessments at 2 months (T2), 6 months (T3) and 12 months (T4). CONCLUSION:This study has the potential to offer men and their partners on AS with important educational and self-regulatory skills to better cope and adjust with known stressors related to being placed on this protocol.

To the Editor: Skin disorders are often highly visible, pruritic, and painful, leading to considerable burden. Patient-reported symptoms and impacts of skin disease are important in determining well-being but are often missed in physician assessments and do not correlate well with visible signs of disease. 1 Chren M.M. Lasek R.J. Quinn L.M. Mostow E.N. Zyzanski S.J. Skindex, a quality-of-life measure for patients with skin disease: reliability, validity, and responsiveness. J Invest Dermatol. 1996; 107: 707-713https://doi.org/10.1111/1523-1747.ep12365600 Abstract Full Text PDF PubMed Scopus (587) Google Scholar The Skindex-29, Skindex-16, and Skindex-Teen are validated instruments that measure patients’ perceptions of the impact of skin disease on quality of life. 1 Chren M.M. Lasek R.J. Quinn L.M. Mostow E.N. Zyzanski S.J. Skindex, a quality-of-life measure for patients with skin disease: reliability, validity, and responsiveness. J Invest Dermatol. 1996; 107: 707-713https://doi.org/10.1111/1523-1747.ep12365600 Abstract Full Text PDF PubMed Scopus (587) Google Scholar The Skindex-Mini, a 3-item questionnaire assessing 3 domains (symptoms, emotions, and function), was created to retain the validity and reliability of its Skindex predecessors while prioritizing ease of use at in-office visits. 2 Dizon M.P. Topham C. Haynes D. Brazil M. Chren M.M. Simpson E. Validity of the Skindex Mini in patients with atopic dermatitis. Dermatitis. 2021; https://doi.org/10.1097/DER.0000000000000820 Crossref PubMed Scopus (2) Google Scholar

Abstract Loneliness in the aging population is a concern, as increased loneliness is associated with decreased cognitive function and increased neuropathology. Less is understood about the relationship between loneliness and cognitive resilience. Cognitive resilience is defined as the discordance between a person’s actual and expected cognition given their neuropathology and can be estimated by extracting residuals from a model regressing cognition on neuropathology. Using data from two longitudinal aging cohorts (MAP/MARS), we estimated cognitive resilience proximate to death and cognitive resilience over time to use as the key outcomes. We then regressed these two cognitive resilience indicators onto loneliness level and slope. Higher baseline loneliness and increasing loneliness over time were both associated with lower cognitive resilience. Our results suggest that loneliness should be included into resilience-based prevention models, and interventions aimed at optimizing cognitive function across older adulthood should include loneliness reduction as a potential area of focus.

More than half of the population will belong to a minority group by the year 2044. Further research needs to be done into the perceptions of those with skin of color regarding their dermatologic care. This study assessed the perceptions and preferences of communities of color regarding the care of their skin and hair. An anonymous, cross-sectional, multiple-choice, online survey was administered from August through October 2021. Participants were recruited using ResearchMatch, a national volunteer health registry supported by the US National Institutes of Health. Eligibility criteria included being 18 years or older, identifying with at least one racial/ethnic group within skin of color, and living in the United States. A total of 547 participants completed the survey, 463 women (84.6%) and 84 men (15.4%) with a mean (standard deviation) age of 44.1 (15.4) years. 301 self-identified as Black (55.0%), 84 Latinx (15.4%), 90 Asian (16.5%), and 72 Multiracial (13.2%). Participants did not feel like dermatologists are trained to treat skin of color (69.5%, n = 380) or ethnic hair (75.1%, n = 411). Participants believed that all dermatologists should have training in skin of color (92.3%, n = 505) and would be more likely to see a dermatologist if they had skin of color training (80.1%, n = 438) as they felt dermatologists who have skin of color training are better equipped to treat their conditions (67.1%, n = 367). Participants were more comfortable receiving treatment at clinics that specialize in skin of color (75.1%, n = 411), but overwhelmingly had never heard of skin of color clinics (94.1%, n = 515). Participants were willing to contribute non-identifiable photos (96.3%, n = 527) and stories about skin and hair diseases (94.1%, n = 515) to create skin of color resources to train dermatologists. Overall, perceptions of communities of color on dermatologic care need to be improved. Greater skin of color training including all races/ethnicities and skin tones is imperative, and greater visibility and resources should also be put into skin of color clinics and formal skin of color research.