Stress, social relations, and old age mortality in Taiwan

Employment in old age and all-cause mortality: A systematic review

Social participation promotes and maintains the health of older adults. Working is a type of social participation; however, the effect of employment in old age on health outcomes has not been established. This study aimed to review the relationship between employment in old age (≥60 years) and all-cause mortality. For this systematic review, a computerized search was performed using PubMed, CINAHL and PsycINFO for prospective studies published through June 2020. The observational studies were extracted according to the study participants, indicators, follow-up period, statistical approach and main results. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Of the 37 832 records identified, 14 studies were included in the systematic review based on the inclusion and exclusion criteria. Eight studies were derived from Asian countries (four from Japan, two from Taiwan and one from Thailand and South Korea), three were from the United States, two were from Israel and one was from Brazil. The baseline data of 13 studies were collected before 2000. Thirteen of the 14 studies reported any association between employment in later life and a lower risk of mortality. Four studies examined the sex-related differences in the effect of later-life employment on all-cause mortality, but the association was controversial. Overall, we revealed that working in old age would lower mortality risk. Although more findings based on recent data are required, this study indicates that working later in life is beneficial for promoting and maintaining health. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2022; ••: ••-••.

Grip Strength as an Indicator of Health-Related Quality of Life in Old Age-A Pilot Study

Over the last century life expectancy has increased dramatically nearly all over the world. This dramatic absolute and relative increase of the old aged people component of the population has influenced not only population structure but also has dramatic implications for the individuals and public health services. The aim of the present pilot study was to examine the impact of physical well-being assessed by hand grip strength and social factors estimated by social contact frequency on health-related quality of life among 22 men and 41 women ranging in age between 60 and 94 years. Physical well-being was estimated by hand grip strength, data concerning subjective wellbeing and health related quality of life were collected by personal interviews based on the WHOQOL-BREF questionnaires. Number of offspring and intergenerational contacts were not related significantly to health-related quality of life, while social contacts with non-relatives and hand grip strength in contrast had a significant positive impact on health related quality of life among old aged men and women. Physical well-being and in particular muscle strength—estimated by grip strength—may increase health-related quality of life and is therefore an important source for well-being during old age. Grip strength may be used as an indicator of health-related quality of life.

The Role of Intergenerational Relations in the Association between Life Stressors and Depressive Symptoms

This study investigates the association between intergenerational relations and depressive symptoms of older adults in Taiwan. Using data from two waves of the Surveys of Health and Living Status of the Elderly in Taiwan, a population-based sample of adults aged 60 and older, the links between intergenerational relations between parents and their adult children, life stressors (major life events and daily hassles), and depressive symptoms are examined. The authors find that higher reports of exposure to stressors—both daily hassles and major life events—are associated with higher levels of psychological distress. Intergenerational ties with children appear to have only a modest effect on levels of depressive symptoms that depends on both the kind of stressor and the aspect of the parent-child relationship

Verbal play as a discourse resource in the social interactions of older and younger communication pairs

Verbal play, or the playful manipulation of elements of language, is a pervasive component of social interaction, serving important interpersonal functions. We analyzed verbal play in the interactional discourse of ten healthy younger pairs and ten healthy older pairs as they completed a collaborative referencing task. A total of 1,893 verbal play episodes were coded. While there were no group differences in verbal play frequency, age-related differences in the quality and function of these episodes emerged. While older participants engaged in more complex, extended, and reciprocal episodes that supported the social nature of communicative interactions (e.g., teasing), younger participants were more likely to engage in verbal play episodes for the purpose of successful task completion. Despite these age-related variations in the deployment of verbal play, verbal play is a robust interactional discourse resource in healthy aging, highlighting an element of human cognition that does not appear to decline with age.

Does self-rated health predict death in adults aged 50 years and above in India? Evidence from a rural population under health and demographic surveillance

BACKGROUND

The Study on Global Ageing and Adult Health (SAGE) aims to improve empirical understanding of health and well-being of adults in developing countries. We examine the role of self-rated health (SRH) in predicting mortality and assess how socio-demographic and other disability measures influence this association.

METHODS

In 2007, a shortened SAGE questionnaire was administered to 5087 adults aged ≥50 years under the Health Demographic Surveillance System in rural Pune district, India. Respondents rated their own health with a single global question on SRH. Disability and well-being were assessed using the WHO Disability Assessment Schedule Index, Health State Score and quality-of-life score. Respondents were followed up every 6 months till June 2011. Any change in spousal support, migration or death during follow-up was updated in the SAGE dataset.

RESULTS

In all, 410 respondents (8%) died in the 3-year follow-up period. Mortality risk was higher with bad/very bad SRH [hazard ratio (HR) in men: 3.06, 95% confidence interval (CI): 1.93-4.87; HR in women: 1.64, 95% CI: 0.94-2.86], independent of age, disability and other covariates. Disability measure (WHO Disability Assessment Schedule Index) and absence of spousal support were also associated with increased mortality risk.

CONCLUSION

Our findings confirm an association between bad/very bad SRH and mortality for men, independent of age, socio-demographic factors and other disability measures, in a rural Indian population. This association loses significance in women when adjusted for disability. Our study highlights the strength of nesting cross-sectional surveys within the context of the Health Demographic Surveillance System in studying the role of SRH and mortality.

Group-based trajectories of depressive symptoms and the predictors in the older population

PURPOSE

The goals of this study were to examine the group-based trajectories of depressive symptoms over an extended period among the older people and to identify the risk factors by gender.

METHODS

The 18-year data used in this study came from a multiple-wave nationwide survey of older Taiwanese population. A group-based trajectory analysis method was used to identify the trajectories, and risk factors at baseline and previous depressive symptoms were used as predictors for the trajectories.

RESULTS

Six trajectories were identified within the total sample, and females were more likely to be in the increasing and declining trajectories than males. When the data were divided by gender, four trajectories for males and four trajectories for females were identified: low, medium, declining, and increasing. Higher-level trajectories of depressive symptoms were related to more chronic diseases, lower physical function, lower economic satisfaction, and previous depressive symptoms for both the older men and women. Less social support and social participation were related to higher depressive symptom trajectories, particularly for men.

DISCUSSION

Older females may experience more emotional fluctuation than male elderly, thus changes in psychosocial health for female elderly need to be considered by health professionals and families. Social support and social participation are protective against depressive symptoms for the higher-level trajectory groups, and older men, in particular, are more sensitive to these two social-health-related variables.

Neuroendocrine biomarkers, social relations, and the cumulative costs of stress in Taiwan

Allostatic load (AL) is thought to represent the physiological toll that builds up over the life course as a consequence of the body's response to stress. An important aim of this paper is to test this widely held-but little investigated-understanding of what AL represents. More specifically, using the Social Environment and Biomarkers of Aging Study (SEBAS), a nationally representative survey of Taiwan conducted in year 2000, this paper scrutinizes the connection between stressful life histories and neuroendocrine allostatic load (NAL). Stressful life histories are operationalized through the use of two sets of indicators: one set makes use of respondents' subjective interpretations of various life domains and the other makes use of non-subjective data about conditions that are expected to be stressful (e.g., widowhood, living alone, and low education). NAL is an index of four neuroendocrine biomarkers (cortisol, dehydroepiandrosterone sulfate (DHEAS), epinephrine, and norepinephrine) collected in blood and urine samples under resting, basal states. The major findings of this paper are twofold. First, there is little evidence to support the hypothesis that baseline levels of the neuroendocrine markers stem from stressful life histories. Second, report of current stress (among women only) is positively correlated with higher NAL levels. Taken together, these findings question whether the neuroendocrine markers of the AL construct reflect long-term processes over the life course. Indeed, evidence here suggests that the neuroendocrine markers may reflect the exact opposite-a transient state at the time of the study.

The effect of social relationships on survival in elderly residents of a Southern European community: a cohort study

Background

Comparative evidence regarding the effects of social relationships on mortality in Mediterranean communities will increase our knowledge of their strengths and the ways in which they influence longevity across cultures. Men and women may benefit differently from social relationships because of cultural differences in gender roles. Psychosocial mechanisms such as social support, which may explain the effects of social networks, may also vary by culture.

Methods

Detailed information on the social relationships of a representative sample of 1,174 community-dwelling older adults was collected in Leganés, a city in central Spain. Mortality over a 6-year follow-up period was ascertained. Information on socio-demographic, health and disability variables was also collected. Cox proportional hazards models were fitted separately for men and women and for the combined sample.

Results

Having a confidant was associated with a 25% (95% CI 5–40%) reduction in the mortality risk. The hazard ratio for lack of social participation was 1.5 (95% CI 1.3–1.7). Being engaged in meaningful roles protected against mortality, while receipt of emotional support did not affect survival. These results were comparable for men and women. Having contact with all family ties was associated with reduced mortality only in men. Structural aspects of social networks make a unique contribution to survival, independently of emotional support and the role played in the lives of significant others.

Conclusion

In this elderly Southern European population, the beneficial effects of social networks, social participation, engagement in the life of significant others and having a confidant call for public policies that foster intergenerational and community exchanges.

Stress buffering effects of social support on depressive symptoms in middle age: reciprocity and community mental health

Little is known about the association between depression and the buffering effects of social support in mid-life crisis. The aim of this study is to determine the buffering effects of social support on depression concerning middle-aged individuals, while also taking reciprocity and gender differences into careful consideration. A cross-sectional survey of all middle-aged individuals (40-69 years of age) using a large sample (n = 4558) from a community-living population, who resided in Rokunohe town, Aomori prefecture in northern Japan (response rate = 69.8%), was undertaken. This town recently had a lot of suicides. Two-way anova was used to analyze the effects of stressor and social support on the Center for Epidemiologic Studies Depression scale scores. The authors found a stress buffering effect of social support on the depressive symptoms occurring in middle age, however, a significant difference in the stress buffer effect was only observed in male subjects. Moreover, when the authors take reciprocity into account, the effect of the buffer on depression was found not only in males receiving support but in males providing support as well. In conclusion, pertaining to males, social support reduces depressive symptoms under stressful circumstances in middle age, not only when they receive such support but also when they provide it. Therefore, these findings suggest that reciprocal social support is important for males in relation to community mental health.

Hot flushes, common symptoms, and social relations among middle-aged nonmenopausal French women in the GAZEL cohort

OBJECTIVE

Many symptoms, including hot flushes (HFs) may appear during the years preceding menopause. Hypotheses to explain these symptoms include biomedical, demographic, and cultural risk factors. Social relations are also associated with various aspects of health. The aim of this study was to analyze the association between social relations and the reporting of HFs and other common symptoms among middle-aged nonmenopausal French women taking into account other factors, including biomedical characteristics.

DESIGN

Data came from self-administered questionnaires mailed to 1,180 pre- or perimenopausal women aged 45 to 54 years participating in the French GAZEL cohort. Bivariate and multivariate analyses examined the association between symptoms (HFs, general, psychological, osteoarticular, and breast symptoms) and three scores of social relations (social network, social relations, and satisfaction with social relations).

RESULTS

After adjustment, low social support was associated with psychological symptoms (odds ratio [OR] = 2.65; 95% CI: 1.33-5.29) and unsatisfactory social relations were associated with psychological (OR = 2.04; 95% CI: 1.49-2.79) and breast symptoms (OR = 1.38; 95% CI: 1.03-1.84). HFs were not associated with social relations but were related to common symptoms (OR = 2.80; 95% CI: 1.94-4.03). Perimenopausal women were more likely to report HF than premenopausal women (OR = 2.63; 95% CI: 1.88-3.71).

CONCLUSION

Social relations were associated with psychological and breast symptoms, but not with HFs. The strong association between common symptoms and HFs suggests that biomedical factors have a greater influence than social relations on the occurrence of HFs.

Effects of social relationships on mortality among the elderly in a Japanese rural area: an 88-month follow-up study

BACKGROUND: The association between social relationships and lower mortality has been well documented in Western countries. This study aims to investigate that association among elderly Japanese in a rural area.

METHODS: An analysis was conducted with 1,994 subjects (58.1% women), 78.3% of the total elderly aged 65 and older in a town, who were independent in activities of daily living. A baseline survey was carried out in 1992, and subjects were followed until 1999. Cox proportional hazard models examined the association between social relationships (availability of casual friend/ support provider, group membership, job, living arrangement) and an 88-month mortality.

RESULTS: A significant association between social relationships and mortality was observed among the old-old (aged 75 and older). Among men, having a job and group membership were significantly associated with lower mortality with hazard ratios (95% confidence intervals) of 0.62 (0.41-0.94) and 0.60 (0.40-0.90), respectively, after adjustment for age, diagnosed illnesses, self-rated health, other social relationships, annual income, and home ownership. Among women, having a job and living alone were significantly associated with lower mortality with hazard ratios (95% confidence intervals) of 0.67 (0.45-0.99) and 0.35 (0.13-0.97), respectively.

CONCLUSIONS: Social relationships such as having a job and group membership were associated with lower mortality among the old-old. In addition, old-old women living alone were better off in terms of mortality after adjustment for possible confounders. This suggests the importance of considering family relationships in terms of quality in areas where multi-generation households prevail.

Social relationships and allostatic load in Taiwanese elderly and near elderly

Despite the increasing evidence linking aspects of the social environment to a range of health outcomes, important questions remain concerning the precise mechanisms or pathways through which social circumstances exert their influence. Biological pathways are one important area of current research interest. Using data from the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan, we examined relationships between social environment characteristics and an index of cumulative biological dysregulation ("allostatic load," AL) in near elderly (NE) (aged 54-70) and elderly Taiwanese (aged 71+). Longitudinal data on levels of social integration and extent of social support were used to predict cumulative AL at the final survey year. Linear regression analyses revealed that among the NE, presence of a spouse between 1996 and 2000 was associated with lower AL in 2000 among men, but not women. Among the elderly, ties with close friends and/or neighbors were found to be significantly related to lower AL for both men and women. Perceived qualities of these social relationships did not show consistent associations with AL. This relatively modest set of significant relationships stands in contrast to somewhat stronger patterns of findings from studies in Western societies. Cross-cultural differences between Western societies and an East Asian society such as Taiwan raise the intriguing possibility that contextual, normative influences on social experience affect the patterns of association between features of these social worlds and the physiological substrates of health.

The Israeli kibbutz as a venue for reduced disability in old age: lessons from the Cross-sectional And Longitudinal Aging Study (CALAS)

It is important to identify ways to moderate disability in old age. We assessed whether the kibbutz way of life results in reduced disability by examining risk factors for disability in three comparable populations: kibbutz members (lifetime kibbutz exposure); parents of kibbutz members who came to live on the kibbutz in old age due to health and social needs (old age exposure); and comparable Israelis in the general population (no exposure). Kibbutz members were less disabled, defined as needing help with at least one of five activities of daily living, than the other groups. Kibbutz members had 30% lower risk of disability, after controlling for sociodemographics and social networks, health and health behaviors, and life history and background. Introducing length of residence in current home and death of a child to the analysis reduced this finding to non-significance. Overall, risk of disability was significantly higher for older age groups, women, homemakers, people with more comorbid conditions, those with more children, and those with a child that had died, while risk of disability was significantly lower for those with larger social networks, those who had engaged in physical activity at midlife, and those who had lived in their homes longer. Since occupations on the kibbutz (primarily agricultural and blue collar) have equal pay, and kibbutz members have complete economic security, our results suggest that it is not such occupations themselves but their association with low incomes that have contributed to previous associations of blue collar and agricultural occupations with poor health and high disability. Lower disability among kibbutz members may be due to the social, economic, and instrumental support provided on the kibbutz, as well as to an active life style, suggesting features of kibbutz life that can be replicated elsewhere to reduce disability.

Social networks and self-rated health in two French-speaking Canadian community dwelling populations over 65

The objective was to evaluate the associations between older persons' health status and their social integration and social networks (family, children, friends and community), in two French-speaking, Canadian community dwelling populations aged 65 years and over, using the conceptual framework proposed by Berkman and Thomas. Data were taken from two 1995 surveys conducted in the city of Moncton (n = 1518) and the Montreal neighbourhood of Hochelaga-Maisonneuve (n = 1500). Social engagement (a cumulative index of social activities), networks consisting of friends, family and children and social support were measured using validated scales. Multiple logistic regressions based on structured inclusion of potentially mediating variables were fitted to estimate the associations between health status and social networks. Self-rated health was better for those with a high level of social integration and a strong network of friends in both locations. In addition, in Hochelaga-Maisonneuve family and children networks were positively associated with good health, though the effect of friend networks was attenuated in the presence of disability, good social support from children was associated with good health. Age, sex and education were included as antecedent variables; smoking, alcohol consumption, exercise, locus of control and depressive symptoms were considered intermediary variables between social networks and health. In conclusion, social networks, integration and support demonstrated unique positive associations with health. The nature of these associations may vary between populations and cultures.

Prediction of survival: a comparison between two subjective health measures in an elderly population

A large amount of evidence shows that the subjective evaluation of health is a predictor of survival in many different populations. Subjective health (SH) is measured using different types of measures such as a general evaluation of health or a comparative evaluation of health. The aim of this study was to compare the prediction of survival by two measures of SH (a general measure and an age-related measure) and evaluate the association with other variables in an elderly population. The baseline survey was conducted during 1994, covering 1138 men and women aged over 70. The survival status was ascertained 7 years later. After adjustment for age, sex, education, marital status, perceived socioeconomic status and presence of diseases the two SH measures were found to be predictors of mortality, but only in men. In men, there was no significant difference between the two types of SH measures in their prediction of mortality. Also in men, when there was only one or no disease, being married had a protective effect compared with not being married when both types of SH measures were used. In elderly women, the association between the two types of SH and survival diminished after adjusting for the various variables. However, the general SH measure may be the preferable measure to use when needed. Education in women was associated with mortality only via the age-related SH measure.

Social relations and self-reported health: a prospective analysis of the French Gazel cohort

Social networks and social support are strongly associated with health, yet the pathways between social relations and health are not well understood. In one of the very few studies on this issue conducted in France, we used data from the French GAZEL cohort of employees of the national gas and electricity company, to (1) explore the relationship between the structure and function of the social environment upon self-reported health and (2) test the hypothesis that social relations directly affect health. In a prospective analysis over a 12-month follow-up period, we found that a lack of social support and dissatisfaction with social relations are predictive of poor health status, while weak social networks are not. Thus, functional aspects of social relations are better predictors of poor health than the structure of social interactions. Low social support was an independent risk factor for poor health in men and women: for men the effect was strongest among individuals who held a high occupational status, for women among those in high and low occupational groups. This study suggests that in France social relations exert an independent effect on health, modified by gender and socio-economic factors. Our results indicate that both clinicians in their practice and researchers may do well to focus increased attention on the health impact of social support.

Support from children, living arrangements, self-rated health and depressive symptoms of older people in Spain

OBJECTIVE

To assess the association between emotional and instrumental support from children and living arrangements with the physical and mental health of older people in Spain.

METHODS

A face-to-face home interview was carried out with 1284 community-dwelling people over 65 (response rate = 83%) randomly sampled according to an age- and sex-stratified sampling scheme in 1993 at Leganés (Spain). Close to 93% of the participants had children and 45% of them coresided with them. Depressive symptoms were assessed by the CES-D (Center for Epidemiologic study depression scale) and self-rated health (SRH) by a single-item question. Emotional support was measured with a six-item scale on affection and reciprocity. Instrumental support was assessed by help received from children in 17 activities of daily living. Four living arrangements were considered: Living with spouse only, living with a spouse and children, widower living alone, and widower living with children.

RESULTS

Multivariate analysis controlling for age, gender, education and functional status showed that low emotional support and reception of instrumental aid were significantly associated with poor SRH. Being a widower and sharing living arrangements with children was associated with good SRH. Living arrangements modify some of the associations of support of children with SRH. Depressive symptoms were associated with low emotional support, reception of instrumental help and being a widower who did not share living arrangements with children. For widowers who do not cohabit with children, reception of instrumental aid is associated with low depressive symptomatology.

DISCUSSION

Emotional support from children seems to play an important role in maintaining the physical and mental health of elderly people in Spain. Instrumental support is widely available. Coresidence with children is very common and it is associated with good self-perceived health and low prevalence of depressive symptoms in a culture where family interdependence is highly valued. Families should be protected and encouraged to continue care-giving through a variety of community services and respite care, adapted to their needs and preferences. Research should be undertaken to find more efficient ways to help family caregivers in the Mediterranean context.

Depression, depressive symptoms and mortality in persons aged 65 and over living in the community: a systematic review of the literature

BACKGROUND

No recent attempt has been made to synthesize information on mortality and depression despite the theoretical and practical interest in the topic. Our objective was to estimate in the older population the influence on mortality of depression and depressive symptoms.

METHODS

Data sources were: Medline, Embase, personal files and colleagues' records. Studies were considered if they included a majority of persons aged > or = 65 years at baseline either drawn from a total community sample or drawn from a random sample from the community. Samples from healthcare facilities were excluded. Effect sizes were extracted from the papers; if they were not included in the published papers, effect sizes were calculated if possible. No attempt was made to contact authors for missing data.

RESULTS

We found 21 reports on 23 cohorts using depression diagnosis. For 15 of these, odds ratios were pooled using the Greenland method based on confidence intervals (CIs), giving an estimated odds ratio for mortality with depression of 1.73 (95% CI 1.53 to 1.95). A fixed effects meta-regression of these studies suggested that longer follow-up predicted smaller effect sizes (log odds ratios -0.096 per year (95% CI -0.179 to -0.014)). There is a weak suggestion of a reduced effect of depression on mortality for women. We were unable to pool effect sizes from the 17 studies using symptom totals and scales, or from eight studies of specific symptoms.

CONCLUSIONS

The studies show that diagnosed depression in community-resident older people is associated with increased mortality. The picture for sex differences is still unclear.