Sex-specific impacts of social isolation on loneliness, depressive symptoms, cognitive impairment, and biomarkers: Results from the social environment and biomarker of aging study

Vitality attributes and their associations with intrinsic capacity, resilience, and happiness in community-dwelling adults: Results from Gan-Dau Healthy Longevity Plan Wave 2

BACKGROUND

Vitality is a key domain of intrinsic capacity (IC) in healthy aging, but its measurement and relationships with other domains of IC and psychosocial constructs of well-being remain understudied. This study examined associations between different vitality attributes and other domains of IC as well as psychosocial constructs including resilience and happiness in middle aged and older adults, as these associations were fundamental for establishing evidence-based interventions to promote healthy aging.

METHODS

This cross-sectional analysis included 981 participants (75.0% female and 49.2% aged between 65-74 years) from the Gan-Dau Healthy Longevity Plan wave 2 cohort. We assessed four vitality attributes: nutritional status (self-reported appetite loss, self-reported weight loss, Mini Nutritional Assessment-Short Form (MNA-SF)), energy (self-perceived fatigue), neuromuscular function (low grip strength, defined by the Asian Working Group for Sarcopenia (AWGS) 2019 criteria), and circulating biomarkers of metabolism (elevated C-reactive protein (CRP)>0.5 mg/dL). Other IC domains were assessed based on the WHO ICOPE concept and existing literature. Psychosocial constructs were evaluated using the Brief Resilience Scale and Chinese Happiness Inventory. Comparisons of demographics and distribution of vitality attributes were performed with the chi-square or Fisher's tests for categorical variables and t-tests for continuous variables when appropriate. Multivariate logistic regression models and generalized linear models (GLMs) were used to investigate the association between impairments in different vitality attributes and other IC domains as well as psychosocial constructs, respectively.

RESULTS

Among vitality attributes, low grip strength was most prevalent (38.2%), followed by suboptimal nutritional status measured by MNA-SF (15.4%), and self-perceived fatigue (6.7%). Low grip strength was significantly associated with locomotion impairment (adjusted OR 1.70 [95% CI 1.25-2.31], p = 0.001) and psychological impairment (1.85 [1.26-2.73], p = 0.002). Although relatively uncommon, self-perceived fatigue also showed strong associations with impairments in locomotion (2.47 [1.44-4.23], p = 0.001) and psychological domains (8.34 [4.83-14.37], p < 0.001). All vitality attributes except self-reported weight loss and elevated CRP significantly correlated with psychosocial constructs.

CONCLUSIONS

Our findings demonstrate that low grip strength, suboptimal nutritional status and energy as vitality attributes showed strong link to other IC domains (mainly locomotion and psychological) as well as psychosocial constructs. This finding highlights the heterogeneity of the vitality domain for which it might not be evaluated by a single attribute only but by a combination. Importantly, social factors were strongly associated with vitality impairments, emphasizing the critical role of social determinants in IC assessment.

Multi-trajectories of physical activity and health in aging: A 20-year nationwide population-based longitudinal study

BACKGROUND

Although the beneficial effects of exercise in mitigating adverse health outcomes associated with aging are well-established, the optimal intensity, volume, and frequency of exercise, especially for older adults, remain to be fully elucidated. The aim of this study was to examine the longitudinal association between distinct trajectories of various aspects of physical activity and clinical outcomes (mortality and functional disability (Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) disability) at 4- and 8-year follow-ups among community-dwelling middle-aged and older adults.

METHODS

In this longitudinal cohort study, we identified 1914 community-dwelling adults from the Taiwan Longitudinal Study on Ageing, TLSA (1996-2015). Using group-based multi-trajectory modeling, we analyzed data from the third (1996) through the sixth (2007) wave of TLSA to identify distinct patterns across four self-reported physical activity aspects (frequency, duration, sweating intensity, and breathlessness intensity) among participants stratified by physical activity documented in the third wave survey (active vs. inactive). Cox proportional hazard models were used to examine the associations between these trajectory patterns and clinical outcomes (mortality, ADL/IADL disability) at 4-year (2011) and 8-year (2015) follow-ups.

RESULTS

Among initially active participants, we identified three trajectories: "Declining Active" (n = 177), "Re-Engaged Active" (n = 200), and "Maintained Active" (n = 622). The "Maintained Active" group showed lower mortality risk at both 4-year (adjusted HR = 0.64, 95 %CI 0.44-0.93) and 8-year (adjusted HR = 0.65, 95 %CI 0.50-0.86) follow-ups compared to the "Declining Active" group. Among initially inactive participants, the "Emerging Active" group (n = 637) demonstrated lower mortality risk compared to the "Chronically Inactive" group (n = 278) at both time points (4-year: adjusted HR = 0.62, 95 %CI 0.43-0.90; 8-year: adjusted HR = 0.68, 95 %CI 0.52-0.89). The "Re-Engaged Active" group showed lower risk of ADL impairment (adjusted HR = 0.44, 95 %CI 0.21-0.87) at 8-year follow-up.

CONCLUSION

Maintaining active physical activity or transitioning from inactive to active status was associated with reduced mortality risk. These findings support promoting regular physical activity among older adults, regardless of baseline activity levels.

Exome sequencing identifies protein-coding variants associated with loneliness and social isolation

BACKGROUND

Loneliness and social isolation are serious yet underappreciated public health problems, with their genetic underpinnings remaining largely unknown. We aimed to explore the role of protein-coding variants in the manifestation of loneliness and social isolation.

METHODS

We conducted the first exome-wide association analysis on loneliness and social isolation, utilizing 336,115 participants of white-British ancestry for loneliness and 346,115 for social isolation. Sensitivity analyses were performed to validate the genetic findings. We estimated the genetic burden heritability of loneliness and social isolation and provided biological insights into them.

RESULTS

We identified six novel risk genes (ANKRD12, RIPOR2, PTEN, ARL8B, NF1, and PIMREG) associated with loneliness and two (EDARADD and GIGYF1) with social isolation through analysis of rare coding variants. Brain-wide association analysis uncovered 47 associations between identified genes and brain structure phenotypes, many of which are critical for social processing and interaction. Phenome-wide association analysis established significant links between these genes and phenotypes across five categories, mostly blood biomarkers and cognitive measures.

LIMITATIONS

The measurements of loneliness and social isolation in UK Biobank are brief for these multi-layer social factors, some relevant aspects may be missed.

CONCLUSIONS

Our study revealed 13 risk genes associated with loneliness and 6 with social isolation, with the majority being novel discoveries. These findings advance our understanding of the genetic basis of these two traits. The study provides a foundation for future studies aimed at exploring the functional mechanisms of these genes and their potential implications for public health interventions targeting loneliness and social isolation.

Analyzing sex-specific differences in sleep quality, resilience, and biomarkers among older adults in the Gan-Dau Healthy Longevity Plan

BACKGROUND

Limited knowledge exists regarding the interrelations between sleep quality and resilience within the demographic of healthy, community-residing middle-aged and older adults, with a particular dearth of information regarding sex-specific associations. This study aimed to examine the sex-specific associations between sleep quality, resilience, and biomarkers in community-dwelling middle-aged and older adults.

METHODS

This cross-sectional study was conducted using data from the 2022 Gan-Dau Healthy Longevity Plan survey initiated by the locality-based community hospital, Taipei Municipal Gan-Dau Hospital (TMGDH). A total of 770 participants (240 men, 530 women) who met the inclusion criteria were included in the study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while resilience was measured using the Brief Resilience Scale (BRS). Patient demographic data, including age, education, marital status, and depression level, were also collected. The sex-specific associations between sleep quality and resilience were first examined using multivariate generalized linear models (GLMs). In addition, the associations between sleep quality, resilience, and selected biomarkers were examined using multivariate GLMs.

RESULTS

Approximately 55% of men and 60% of women reported poor sleep quality. Individuals with good sleep quality had significantly lower levels of depressive symptoms ( p = 0.028 for men, p = 0.002 for women) and fewer chronic conditions ( p = 0.002 for men, p < 0.001 for women). Notably, women in the "poor sleep quality" group exhibited higher proportions of low habitual sleep efficiency (women 35.9% vs men 29.8%) and frequent use of sleeping medications (women 23.2% vs men 9.9%) than men. Good sleep quality was associated with better resilience in both men (mean BRS score: good sleep quality = 25.1 [SD: 4.3] vs poor sleep quality = 23.4 [SD: 4.7], p = 0.004) and women (mean BRS score: good sleep quality = 24.3 [SD: 5.1] vs poor sleep quality = 22.3 [SD: 5.4], p < 0.001). After adjusting for depressive symptoms and chronic conditions, this association remained significant for men ( p = 0.022) and women ( p = 0.001). In addition, greater depressive symptoms were associated with poorer resilience in both sexes ( p < 0.001). No significant associations were noted between sleep quality or resilience and the selected biomarkers.

CONCLUSION

This study highlights the association between sleep quality and resilience in older adults. Good sleep quality is related to better resilience, but greater depressive symptoms are also linked to poorer resilience in both sexes. Nevertheless, the low habitual sleep efficiency and frequent use of sleeping medications in women but not men with poor sleep quality highlight the need to explore sex-specific approaches to address the interplay of sleep quality, resilience, and other factors (such as depressive symptoms) in healthy aging.

Multi-trajectories in different domains of social supports and subjective motoric cognitive risk syndrome: a 16-year group-based multi-trajectory analysis

OBJECTIVE

The aim of this study was to examine the longitudinal relationships between the trajectories of distinct subtypes of various domains of social supports and risk of subjective motoric cognitive risk (MCR) syndrome.

DESIGN

Longitudinal cohort study.

SETTING AND PARTICIPANTS

2,279 participants in the Taiwan Longitudinal Study on Aging (TLSA) between 1999 and 2011.

METHOD

A group-based multi-trajectory modeling (GBMTM) was implemented to identify distinct trajectory subtypes within various social support domains, encompassing social networks, emotional support, instrumental support, as well as working and economic status. Logistic regression models were then utilized to evaluate the associations between these trajectory subtypes and the risk of subjective MCR.

RESULTS

Among 2,279 participants, GBMTM identified four distinct trajectory subtypes: "low social support" (n = 371), "medium social support " (n = 862), "high social support" (n = 292), and "high social support with employment" (n = 754). The incidence rates of subjective MCR for these groups were 9.4%, 9.0%, 4.1%, and 0.8%, respectively. After adjusting for age, sex, education level, and comorbidities, both "low social support" (adjusted odds ratio (aOR) 4.07, 95% CI [1.60-10.34]) and "medium social support" (aOR 3.10, 95% CI [1.26-7.66]) were significantly associated with an increased risk of subjective MCR compared to the "high social support with employment" group.

CONCLUSIONS AND IMPLICATIONS

The current study demonstrates that social support significantly reduces the risk of subjective MCR, with lower support levels correlating to higher risk, necessitating further intervention studies to confirm the link between social support and risk of subjective MCR.

The distinct impacts of sarcopenic and dynapenic obesity on mortality in middle-aged and older adults based on different adiposity metrics: Results from I-Lan Longitudinal Aging Study

BACKGROUND & AIMS

Sarcopenic obesity (SO) and dynapenic obesity (DO) represent two manifestations of excessive fat accumulation concurrent with compromised muscle mass and function, thereby necessitating an examination of their implications for health. This study aims to investigate the relationship between SO/DO and mortality, taking into account various adiposity measures and existing sarcopenia criteria, with further stratified analyses based on age and gender.

METHODS

The study sample comprised 1779 older adults residing in the community from the I-Lan Longitudinal Aging Study (ILAS). Body composition was assessed via dual-energy X-ray absorptiometry. The diagnosis of sarcopenia was adhered to the 2019 consensus of the Asian Working Group for Sarcopenia, while adiposity was measured by waist circumference (WC), body mass index (BMI), and fat percentage. SO/DO was defined as the coexistence of sarcopenia/dynapenia and obesity. Multivariate Cox proportional hazard regression models were adopted to examine the association between SO or DO, defined by WC, BMI, fat percentage, and mortality.

RESULTS

This 11-year follow-up study of 1779 participants aged 63.9 ± 9.2 years involved 15,068 person-years and 229 deaths. WC-defined SO (HR 1.9, 95% CI 1.1-3.3, p = 0.021) and WC-defined DO (HR 1.4, 95% CI 1.1-1.9, p = 0.022) significantly increased mortality risk, whereas definitions employing alternative adiposity metrics exhibited no statistical significance. WC-defined SO was associated with increased risk of mortality among middle-aged adults, while WC-defined DO was associated with increased risk of mortality among older adults. In sex-specific analysis, WC-defined DO was also associated with increased risk of mortality in men (HR 1.6, 95% CI 1.1-2.4, p = 0.019), while defined by other measurements showed no associations in both sexes.

CONCLUSIONS

The study identified a significant link between SO/DO, defined by WC, and an 11-year mortality risk, advocating for WC-defined adiposity as an obesity measure and personalized interventions considering SO and DO's distinct impacts on mortality in middle-aged and older adults.

The Impact of Social Vulnerability on Alcohol Consumption and Mortality: A 20-year Age, Sex-stratified Analysis from the Taiwan Longitudinal Study of Aging

OBJECTIVE

This study aimed to use the Social Vulnerability Index (SVI) to encapsulate the complex and multidimensional nature of social determinants and their influence on alcohol intake and mortality in middle-aged and older individuals.

DESIGN

Cohort study.

SETTING AND PARTICIPANTS

Data were obtained from the Taiwan Longitudinal Study on Aging (TLSA), with 3945 study participants aged 50 years and older.

METHODS

The TLSA questionnaire defined SVI (51 items including living conditions, social support, socially oriented activities of daily living, social engagement and leisure, empowerment of life, satisfaction about life, and socioeconomic status) and alcohol intake (behavior as well as type and frequency of alcohol intake). Multivariate Cox proportional hazard models were used to estimate the association between alcohol intake and mortality, stratified by sex and SVI groups.

RESULTS

Men with high social vulnerability and high alcohol intake exhibit an elevated mortality risk [adjusted hazard ratio (aHR), 1.51; 95% CI, 1.01-2.24], whereas notably, women in similar social circumstances but with moderate alcohol intake face a quintupled mortality risk (>35 g/wk; aHR, 5.67; 95% CI, 2.37-13.61). The impact of alcohol and social vulnerability on mortality was more pronounced in men younger than 65. Among them, those with high social vulnerability and moderate (35-140 g/wk; aHR, 2.83; 95% CI, 1.50-5.36) to high (>140 g/wk; aHR, 2.24; 95% CI, 1.15-4.35) alcohol intake was associated with an increased risk of mortality.

CONCLUSIONS AND IMPLICATIONS

Various factors throughout the life course of both men and women significantly impact the risk of all-cause mortality due to alcohol intake, underscoring the importance of social vulnerability as a determinant of both alcohol intake behavior and mortality risk.

Unveiling the multifaceted nexus of subjective aging, biological aging, and chronological age: Findings from a nationally representative cohort study

OBJECTIVES

This study aims to investigate how subjective aging influences the psychological and behavioral responses of older individuals, specifically focusing on the associations between subjective aging and longitudinal changes in biological age.

METHODS

This is a retrospective cohort study retrieving data from the Taiwan Longitudinal Study on Aging (TLSA), over a 4-year follow-up period. Subjective aging is assessed by asking participants if they perceive themselves as old, while frailty is measured using a frailty index comprising 34 deficits from various domains. Participants are categorized into three groups based on their chronological age. The association between subjective aging and transition of biological age (as indicated by an increased frailty index) from 2011 to 2015 is examined using logistic regression models.

RESULTS

The study consisted of 2412 participants, who were categorized into middle-age (n = 1,082), young-old (n = 779), and old-old (n = 551) groups. Among them, individuals exhibiting subjective aging at baseline were more likely to be older in chronological age, female, illiterate, and unemployed, compared to those without subjective aging. The adjusted odds ratios (aORs) for the association between subjective aging and an increased biological age were 1.72 [95% CI: 0.88-3.34], 1.61 [0.77-3.37], and 1.08 [0.65-1.80], in the middle-age, young-old, and old-old groups, respectively.

DISCUSSIONS

No significant associations were found between changes in biological age and subjective aging across various chronological age groups. Notably, within the younger age group, a discernible trend towards an association was observed, indicating the potential age-related nuances in the complex interrelation between subjective age, biological aging, and chronological aging.

Effects of declines in personal mastery on self-perceived mobility, physical function, cognitive function, and depressive symptoms: a 6-year follow-up study from the Social Environment and Biomarkers of Aging Study

OBJECTIVES

As the psychosocial competence, personal mastery helps individuals to cope with stressful life events, and this study aims to examine impacts of declines in personal mastery on healthy aging among community-dwelling middle-aged and older adults using a nationally representative cohort.

METHODS

Data from 648 study participants in the Social Environment and Biomarkers of Aging Study (SEBAS) were retrieved for analysis. All participants were divided into four groups based on their baseline and changes of personal mastery (measured by the Pearlin mastery score) during the 6-year follow-up. Multivariate logistic regression models were adopted to examine associations between declines in personal mastery and indicators for healthy aging (declines in self-perceived mobility, physical function (activities of daily living (ADLs) and instrumental activities of daily living (IADLs)), cognitive function and depressive symptoms).

RESULTS

After adjustments for demographics and comorbidities, those with declines in personal mastery were associated with greater risks of declines in self-perceived mobility (adjusted odds ratio (aOR) 1.50 [95% confidence interval 1.01-2.22], p < 0.05). Although the point estimate in the unadjusted models indicated similar associations between declines in personal mastery and declines in ADLs, IADLs, cognitive function or depressive symptoms, these outcomes did not reach statistical significance in the adjusted model.

CONCLUSIONS

Declines in personal mastery were negatively associated with indicators related to healthy aging (particularly locomotion) in a 6-year follow-up. Further investigations are needed to explore the effects of preventing declines in personal mastery in promoting healthy aging over time.

The Association between Adverse Childhood and Adulthood Experiences, Social Isolation, Loneliness, and Depression among Young Adults in South Korea

This study examined the association between social isolation, loneliness, and depressive symptoms among young adults in South Korea after controlling for sociodemographic variables, adverse child and adult experiences, and perceived health status. The researcher analyzed the data of 2014 young adults aged 18-34 years from the Youth Social Economic Survey using hierarchical multiple regression analysis conducted with IBM SPSS Statistics 28.0. Among the sociodemographic variables, sex, education, and household income were significantly related to depressive symptoms. Females reported higher levels of depressive symptoms than males, and those attending college or having a college (or higher) degree reported lower levels of depressive symptoms than those with a high-school diploma or lower. Higher household income was associated with lower levels of depressive symptoms. Perceived health status was negatively associated with depressive symptoms, while adverse childhood and adulthood experiences, social isolation, and loneliness were positively associated with it. Among the major independent variables, loneliness was most strongly related to depressive symptoms, whereas social isolation had the weakest relevance to it. The prediction model proposed explained 32.7% of the variance in depressive symptoms and was considered good. Therefore, focusing on loneliness may be more important than focusing on social isolation to prevent and deal with depressive symptoms among young adults.

Gender differences in the association between sensory function and CIND among Chinese elderly: Based on CLHLS

OBJECTIVE

To explore the gender differences of the association between sensory impairment (SI) and the risk of cognitive decline and possible cognitive impairment, no dementia (CIND).

METHOD

Data were drawn from three waves of the nationally representative survey of China Longitudinal Healthy Longevity Survey (CLHLS) between 2011/12-2018 surveys, involving 6138 participants aged 65 or older who had no CIND at the baseline. Multivariate linear or logistic regression models were employed to examine the effect of SI on cognitive decline and CIND risk by gender stratification, respectively.

RESULTS

Hearing impairment and visual impairment were associated with lower MMSE scores, and the strength of the association was stronger in men than in women. Hearing impairment was related to an elevated risk of CIND both in men and women (Men: OR=2.46; 95% CI=1.81, 3.35; Women: OR=1.43; 95% CI=1.09, 1.88). However, the effect of visual impairment on CIND was statistically significant only in men (OR=1.43; 95% CI=1.09, 1.88). The risk of cognitive decline and CIND were significantly higher with single and dual SI than those without SI, except for women with single visual impairment.

CONCLUSION

SI is independently associated with cognitive decline and CIND risk, and the association differed by gender. Further researches should clarify the mechanism between SI and cognitive function among older adults, especially for gender differences.