High prevalence and adverse health effects of loneliness in community-dwelling adults across the lifespan: role of wisdom as a protective factor

The Impact of Loneliness on Late-Life Depression and Anxiety During the COVID-19 Pandemic

OBJECTIVE

This study investigates the association of loneliness during the COVID-19 pandemic and the course of depressive, anxiety and sleep symptoms after psychological treatment in older adults.

METHODS

During the first wave of the pandemic in 2020, we assessed additional, original data of 132 participants aged ≥60 years who had completed psychological treatment for late-life depression (LLD) in the context of a multicenter, randomized controlled trial (CBT-late). We measured loneliness using the UCLA Loneliness Scale. Depression, anxiety and sleep symptoms were assessed using the Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), and Insomnia Severity Index (ISI).

RESULTS

Participants with higher loneliness scores (n = 44) experienced a significant worsening of depressive and anxiety symptoms during the pandemic (estimated marginal mean difference (emmd) of change in GDS between post-treatment and COVID-19 visit: GDSemmd= -4.61, [95% CI: -6.97 to -2.26], GAIemmd= -2.21, [95% CI: -3.76 to -0.65]), while those with low to moderate loneliness (n = 72) maintained stable mild symptoms (GDSemmd= -1.39, [95% CI: -3.00 to 0.22], GAIemmd= -0.49, [95% CI: -1.69 to 0.72]). All patients reported increased sleep disturbances during the pandemic regardless of loneliness, while remaining in the range for sub-threshold insomnia.

CONCLUSIONS

Our results suggest an association of significant loneliness during the COVID-19 pandemic and a clinically relevant worsening of depressive and anxiety symptoms in older adults. Loneliness assessments and interventions may be incorporated into treatments for LLD, particularly during pandemics or other crises.

Effects of loneliness and social isolation on sarcopenia among community-dwelling older adults: The mediating role of depressive symptoms and cognitive function

BACKGROUND

Although the effect of social relationships on sarcopenia has been explored, the underlying pathways remains to be elucidated. This study aimed to examine whether loneliness and social isolation influenced new-onset sarcopenia through depressive symptoms and cognitive function.

METHODS

A total of 5003 participants aged ≥60years from 2011 (Wave 1), 2013 (Wave 2) and 2015 (Wave 3) of China Health and Retirement Longitudinal Study (CHARLS) were included. Of these, 49.1 % were females, and mean age was 67.1 years at Wave 1. Generalized linear model and Cox proportional hazard regression model were carried out to test the associations among loneliness (Wave 1), social isolation (Wave 1), depressive symptoms (Wave 2), cognitive function (Wave 2), and new-onset sarcopenia (Wave 3). A four-way decomposition was applied with depressive symptoms and cognitive function as mediators to explore their mediation and interaction effects on social relationships and sarcopenia.

RESULTS

Loneliness (HR = 1.309, 95%CI = 1.073-1.596) and social isolation (HR = 1.115, 95%CI = 1.013-1.228) were associated with new-onset sarcopenia. Depressive symptoms (coefficient = 0.036, 95%CI = 0.030-0.042, attributable ratio = 23.5 %) and cognitive function (coefficient = 0.015, 95%CI = 0.010-0.019, attributable ratio = 9.8 %) mediated the association between loneliness and new-onset sarcopenia, while only cognitive function (coefficient = 0.015, 95%CI = 0.013-0.018, attributable ratio = 9.8 %) mediated the association between social isolation and sarcopenia.

LIMITATIONS

Although various confounding factors were adjusted for, we cannot rule out the possibility of residual confounders.

CONCLUSION

The pathways through which social relationships impact sarcopenia vary by the attributes of social relationships. Healthcare providers may address the mental and cognitive health issues to prevent and manage sarcopenia among lonely and socially isolated older adults.

[What is happiness? And what does ENT medicine have to do with it?]

Happiness is important to most people in our society, although it is given little importance in political and social objectives. However, happiness is an important topic in various philosophical schools and in Western philosophy, happiness goes back to Aristotelianism and Stoic philosophy. Recent longitudinal studies clearly suggest that happiness depends on interpersonal relationships. So what does otorhinolaryngology have to do with this? In our view, various basic skills that enable people to achieve social fitness, i.e., to establish short- and long-term relationships, are at the center of ENT medicine. Examples of this are hearing, olfaction, the voice, but also facial movements. The multisensory processing of various perception and expression channels creates a "social brain network" as a neuronal correlate of social skills and fitness. Consequently, otorhinolaryngology should play a central role in understanding these abilities in the context of happiness.

A three-arm randomized controlled trial protocol: Effects of telephone-based, layperson-delivered wisdom-enhancement narrative therapy and empathy-focused interventions on loneliness, social, and mental health in older adults

Background

Loneliness is an increasingly widespread issue among older adults globally, with significant implications on physical, social, and mental health. While various interventions exist to address this challenge, their long-term effects remain unclear. Using a 3-arm randomized controlled trial, this study aims to evaluate the efficacy of a telephone-based and layperson-delivered wisdom-enhancement narrative therapy (Tele-NT) and empathy-focused program (Tele-EP) against an active control group (ACG) in reducing loneliness.

Methods

282 community-dwelling lonely older adults will be recruited and randomly allocated into 1 of the 3 interventions. Older adults will receive two 30-min intervention per week, over the course of 4 weeks, delivered over the phone by a layperson. Assessments will be conducted in-person at baseline (T0), 1-month (T1), 6-month (T2), and 12-month (T3) post-intervention. The primary outcome will be assessed using the Chinese validated 6-item De Jong Gierveld Loneliness Scale and the Revised UCLA Loneliness Scale. The secondary outcomes will include sleep quality, perceived social support, and depressive symptoms. Potential mediators and moderators will also be explored. The data will be analysed using linear mixed models on an intention-to-treat basis.

Discussion

This RCT is effective, Tele-NT and/or Tele-EP could serve as a model for broader implementation in the community, offering practical solutions to mitigate loneliness and its associated health burdens in the aging populations.

Trial registration

This trial is registered with the Chinese Clinical Trial Registry; ChiCTR2300070179 on April 4, 2024.

The 5D indicators of suicide risk in older adults who are lonely

Loneliness is associated with suicide ideation, attempts, and deaths in later life. The objective of this study is to describe characteristics of suicide risk among older adults who report clinically significant loneliness grounded in our conceptual model of the 5Ds of late life suicide. Our sample comprises 291 adults aged 60 years and older who screened positive for loneliness (UCLA 3-Item Loneliness Scale score of 6 and above) and subsequently completed baseline eligibility interviews for a clinical trial. Interviews obtained information on loneliness severity, suicide ideation, and the 5Ds of late life suicide: (1) depression (PROMIS depression), (2) deadly means (firearms access), (3) disease (number of chronic conditions), (4) disconnection (objective disconnection, Lubben Social Network Scale; subjective disconnection, UCLA Loneliness Scale), and (5) disability (World Health Organization Disability Assessment Schedule). Subjects demonstrated a high frequency of characteristics associated with suicide risk, with the most common presentation (38%) being the presence of 3Ds-subjective disconnection (loneliness), multimorbidity, and disability. While few subjects presented with only subjective disconnection (loneliness), there was diversity in which other Ds were present and in which combination, suggesting heterogeneous presentations. Upstream suicide prevention efforts could target older adults with loneliness to reach a population with numerous compounding indicators of risk.

Effects of Social Isolation and Loneliness on Heart Failure Self-care: A Cross-sectional Analysis

BACKGROUND

Patients with heart failure (HF) who engage in effective HF self-care have better quality of life, and lower risks of all-cause and HF-related hospital readmission and mortality. It is unclear whether social isolation and loneliness, which are prevalent among patients with HF and known to affect other self-care behaviors, can predict HF self-care.

OBJECTIVE

The aim was to explore the relationship between social isolation, loneliness, and HF self-care.

METHODS

This was a cross-sectional secondary analysis (n = 49) of the GEtting iNTo Light Exercise for HF randomized controlled trial, a 6-month home-based live group gentle exercise intervention for patients with HF. Measures included the following: 6-item Lubben Social Network Scale for social isolation, Patient-Reported Outcomes Measurement Information System Social Isolation survey for loneliness, Self-Care of Heart Failure Index, and Patient-Reported Outcomes Measurement Information System Depression survey. Multiple linear regression modeling was used to examine the relationships of 4 HF self-care processes to social isolation and loneliness, adjusting for depression and grouping (control group or intervention group).

RESULTS

Scores indicating less social isolation predicted higher self-care maintenance ( B = 0.937, P = .015), monitoring ( B = 0.799, P = .041), and management ( B = 1.812, P < .001). Loneliness did not predict HF self-care.

CONCLUSIONS

To our knowledge, this is the first study to predict HF self-care using distinct measures for social isolation and loneliness. Patients who were less socially isolated engaged in better HF self-care; loneliness had no relationship with HF self-care. Prospective studies are needed to investigate causal relationships between social isolation and HF-self-care engagement to determine the effect on outcomes such as hospital readmission and mortality.

Racial and ethnic differences in loneliness among older adults: evidence from California

OBJECTIVES

Loneliness is a common experience in older adulthood and is associated with mortality. However, it is still unclear how demographic and health characteristics associated with loneliness vary between racial/ethnic groups. This study aims to understand the intra- and intergroup racial/ethnic differences in the characteristics associated with loneliness in a sample of older adults from a California Department of Aging program.

METHOD

Pooled and stratified descriptive statistics and stratified logistic regression models with multiple imputation (N = 1436).

RESULTS

Non-Hispanic White older adults reported the highest percentage of loneliness (38.0%) while Asian American/Pacific Islander older adults reported the lowest percentage of loneliness (18.0%). Self-rated health was associated with lower likelihood of loneliness among non-Hispanic Black (OR = 0.37, p = 0.001) and Asian American/Pacific Islander (OR = 0.50, p = 0.030) older adults. Depression symptoms were associated with higher likelihood of loneliness among non-Hispanic White (OR = 2.40, p = 0.007), Hispanic/Latino (OR = 2.24, p = 0.004), and Asian American/Pacific Islander (OR = 5.64, p = 0.001) older adults.

CONCLUSION

Although there are some similarities in characteristics associated with loneliness among racially/ethnically diverse groups of older adults, there are notable differences including self-rated health, depression symptoms, and anxiety symptoms.

Life-Space Mobility Is Related to Loneliness Among Living-Alone Older Adults: Longitudinal Analysis With Motion Sensor Data

BACKGROUND

Life-space mobility can be a behavioral indicator of loneliness. This study examined the association between life-space mobility measured with motion sensors and weekly vs. annually reported loneliness.

METHODS

Participants were older adults who lived alone. Passive infrared motion sensors were placed in the bathroom, bedroom, kitchen, and living room. Time spent in each room and out-of-home across the day was derived and used as the measure of life-space mobility. Participants reported via weekly questionnaires whether they felt lonely. In annual visits, the UCLA loneliness scale was administered to a subsample (n = 71), and the scores were categorized into high, moderate, and low groups. We used generalized estimating equations (GEE) to correlate life-space mobility with weekly and yearly loneliness. Repeated observations from each individual were bootstrapped for 1000 rounds to associate annual and weekly loneliness measures.

RESULTS

We analyzed 4995 weeks of data from 139 participants (age = 78.1 ± 8.6, 74% female, 23% African Americans, 14% with MCI diagnosis). An additional hour in the bedroom in the afternoon was associated with a 21.4% increased odds (OR = 1.214, p = 0.049) of experiencing loneliness in the week. An additional hour out-of-home in the morning and in the afternoon was associated with 18.2% (OR = 0.818, p = 0.040) and 15.3% (OR = 0.847, p = 0.018) fewer odds of experiencing weekly loneliness. In the subsample with annual loneliness assessments, an additional hour out-of-home was associated with 38.1% (OR = 0.619, p = 0.006) fewer odds of being in the high UCLA loneliness group. Compared with the low UCLA group, those with high UCLA scores were five times more likely to report loneliness weekly (OR = 5.260, p = 0.0004).

CONCLUSIONS

Frequent and objective measurements of mobility combined with self-reported social wellbeing information can offer new insights into the experience of loneliness and provide opportunities for timely interventions.

Chronic loneliness and longitudinal changes in cognitive functioning

BACKGROUND

Loneliness is a worldwide concern with significant health implications that may be a significant risk factor for Alzheimer's disease and related dementias. In light of the importance of detecting early cognitive changes and risk factors influencing cognitive health, this study examined whether chronic loneliness predicted cognitive changes among young and middle-aged adults.

METHODS

This study utilizes data from a longitudinal measurement burst study spanning over two years, comprising three waves of data collection. A systematically recruited young to mid-life adult sample (25- 65 years) included 172 racially and economically diverse participants who provided information about loneliness for at least two consecutive waves. Chronic loneliness was defined based on the validated multi-item PROMIS Social Isolation scale. We assessed working memory, processing speed, and spatial memory in a measurement burst design using mobile cognitive assessments. Multilevel growth models were conducted to examine whether chronic loneliness was associated with changes in cognitive performance during the study period of up to two years.

RESULTS

Results revealed that chronic loneliness was not associated with baseline performance of working memory, processing speed, spatial memory or global cognitive performance, but chronic loneliness was associated with differential cognitive trajectories, specifically a lack of retest related improvement. There were no significant changes in cognitive performance for the chronic loneliness group across waves, whereas significant improvements were observed in those who were not chronically lonely.

CONCLUSIONS

This study offers insights into the impact of chronic loneliness on cognitive changes in young and middle-aged adults, revealing that chronically lonely individuals did not exhibit the practice-related improvements that are commonly observed in longitudinal studies. Findings suggest the potential significance of identifying and addressing chronic loneliness promptly to prevent potential cognitive consequences of chronic loneliness.

Social relationship patterns and their association with emotional and social loneliness in older adults with cognitive impairments

OBJECTIVES

This study explores the association between specific social relationship patterns and emotional and social loneliness among older adults with cognitive impairments, including dementia.

METHOD

Data from the 2018 Health and Retirement Study (HRS) were used to conduct a Latent Profile Analysis on 642 older adults with cognitive impairments, classifying social relationships based on contact frequency, network size, and perceived support. Associations between these patterns and levels of social and emotional loneliness were analyzed.

RESULTS

Five distinct social relationship patterns were identified: Weak friends, Weak children, Strong friends, Weak family, Diverse - Virtual, and Diverse - high tension. Emotional loneliness was highest in groups with limited or negative close relationships, particularly in the Diverse - high tension patterns. Social loneliness, however, was more prominent in groups with restricted broader connections, such as Weak family and Weak friends.

CONCLUSION

Findings indicate that cognitive decline does not necessarily weaken social connections; many older adults with impairments maintain diverse relationships and benefit from virtual and positive support. Addressing social and emotional loneliness as distinct issues allows for targeted interventions, promoting well-being in this population.

Experiences of a digital group intervention 'the health web': a case study of older adults

BACKGROUND

Within the development of new interventions, it is of highly important to address social participation since it is associated with improved physical and mental health. Therefore, a new intervention in occupational therapy, 'The health Web' was developed.

AIM

The aim of this study was to explore and describe how older adults experienced the intervention process of 'The Health Web' provided by an occupational therapist, and whether the intervention has the potential to promote social participation.

MATERIAL AND METHODS

An exploratory descriptive case study was designed. Five older adults and an occupational therapist were included. Interviews, self-assessments, registration forms and field-notes were used to collect data. The data were analysed using pattern-matching.

RESULTS

The results consist of two cases: A) Continuous engagement promoted the development of strategies and: B) Uneven engagement inhibited the development of strategies. Each case is described with three categories representing the experienced intervention process of the older adults in the respective case.

CONCLUSIONS AND SIGNIFICANCE

The results suggest that the intervention has some potential to support older adults' in using strategies supporting social participation. This study provides valuable insights for the continued development of the intervention.

The impact of resilience and coping strategies on depressive symptoms among Korean American older adults during COVID-19

OBJECTIVES

This study examined how resilience and coping strategies were associated with depressive symptoms among Korean American older adults during COVID-19. The prevalent depressive symptoms and low use of mental health services in this population have raised significant concerns among healthcare professionals. Therefore, this study aims to understand the relationships between resilience and coping types on depressive symptoms and provide valuable insights into addressing these issues within this ethnic group.

METHOD

A cross-sectional survey was conducted with 132 Korean American older adults. Hierarchical linear regression analyses were performed to assess the effect of sociodemographic factors (age, gender, marital status, years of living in the U.S., self-rated health, financial security), resilience, and coping strategies (problem-focused coping, emotion-focused coping, avoidant coping) on depressive symptoms. Next, the interactions between resilience and three coping strategies for depressive symptoms were tested.

RESULTS

The findings show that depressive symptoms were associated with financial security and avoidant coping. Also, resilience interacted with avoidant coping and emotion-focused coping. Among the participants with low resilience, depressive symptoms increased rapidly when avoidant and emotion-focused coping strategies increased, respectively.

CONCLUSION

This study emphasizes the importance of culturally tailored interventions to promote resilience and decrease avoidant and emotion-focused coping among Korean American older adults.

"Loneliness is a sad disease": oldest old adults' empirical definition of loneliness and social isolation from a mixed-method study in Northern Italy

BACKGROUND

Loneliness and social isolation can occur at any stage of life, but some predictors may be more common among older adults. Due to growing population ageing, loneliness and social isolation are relevant social issues. Many studies apply the main definitions of loneliness and social isolation offered by the literature without considering how individual representations, socio-cultural context and the culture of care may influence their perception. This study wishes to fill in these literature gaps by analysing empirical definitions of loneliness and social isolation arising from a mixed-gender randomized sample of Italian oldest old people.

METHODS

Between January and March 2019, 132 older people, most aged 80+, living in a northern Italian town, were asked to answer a questionnaire and a semi-structured interview. According to a mixed-method analysis the definitions of loneliness and social isolation were analysed by respondents' gender, living arrangement (e.g., living alone or with partners or other people), and years of education to find possible associations to the meanings attributed to the two concepts.

RESULTS

The sample was gender-balanced and mid-low educated; more than one fourth of respondents lived alone. The results underline how the empirical definitions of loneliness and social isolation are closer to each other than the academic ones. The two concepts are often perceived by participants as distinct, but they are strongly interconnected so that they can be used interchangeably by older Italian people. The two main themes identified by the analysis are loneliness as "death" and social isolation as "guilt". In the respondents' opinion, the main loneliness driver is the loss of loved, close persons, while social isolation is driven by disability. Age, educational level, and living arrangements did not influence the meanings attributed to social isolation. On the contrary, living arrangement (P = 0.002) and educational level (p = 0.023) seem to influence the empirical definitions of loneliness.

CONCLUSION

The knowledge of the meanings that oldest old give to the two concepts may inspire advanced intervention aimed at buffering the psychological and social consequences of loneliness and social isolation in the older population.

Understanding mental health in older adults: exploring the interplay of wisdom, perceived poor health, and attitudes toward aging

OBJECTIVES

Late adulthood is marked by challenges that impact well-being. While perceived health, wisdom, and positive attitudes toward aging correlate with better mental health in later life, their interrelations are not well understood. This study explored if three-dimensional wisdom could buffer the negative impact of poor physical health on mental health, and if positive attitudes toward aging mediated the effects of wisdom and poor health on mental health.

METHOD

A survey of 500 Polish older adults aged 60-86 included the Personal Wellbeing Index, Geriatric Depression Scale, Three-Dimensional Wisdom Scale, Attitudes to Aging Questionnaire, perceived health, and sociodemographic questions.

RESULTS

Wisdom buffered the negative association between poor physical health on mental health and had a significantly stronger effect on mental health if perceived physical health was very poor. The relations of wisdom, poor health, and the interaction between wisdom and poor health on mental health were partially mediated by attitudes toward aging.

CONCLUSION

Wisdom seems to mitigate the negative effects of poor health on mental health, and wise older adults tend to have more positive attitudes toward aging, leading to better mental health outcomes. Those findings support the important role played by wisdom and attitudes toward aging in healthy aging interventions.

Wisdom and socio-cognitive mindfulness as predictors of loneliness in late adulthood: the mediating role of meaning in life

OBJECTIVES

This research aimed to examine whether (1) socio-cognitive mindfulness, defined as actively noticing novel distinctions in events and situations, negatively predicted loneliness in older adults and whether (2) meaning in life mediated the relationships between wisdom and loneliness and between socio-cognitive mindfulness and loneliness.

METHOD

Two cross-sectional studies were conducted. In Study 1 (N = 76), participants aged 60 to 85 years completed questionnaires measuring wisdom, loneliness, meaning in life, and self-rated health. In Study 2 (N = 117), care home residents aged 60 to 87 years completed measures of socio-cognitive mindfulness, loneliness, meaning in life, and self-rated health.

RESULTS

Study 1 found a negative relationship between wisdom and loneliness, even after accounting for socio-demographic factors and meaning in life. Study 2 revealed a negative relationship between socio-cognitive mindfulness and loneliness. The relationships of both wisdom and socio-cognitive mindfulness to loneliness were mediated by meaning in life.

CONCLUSION

The two studies indicate that attributes associated with wisdom and socio-cognitive mindfulness, such as perceiving events from multiple perspectives and maintaining a compassionate attitude, contribute to an increase in meaning in life, which in turn reduces loneliness in late adulthood.

Psychosocial wellbeing and risk perception of older adults during COVID-19 pandemic in Nigeria: perspectives on the role of social workers

Background

The COVID-19 pandemic presented a 'double-edged sword' for older adults: not only were they more susceptible to the virus, but its broader consequences also exacerbated other challenges, particularly those related to psychosocial well-being. Limited evidence exists on how older adults perceive the pandemic and its impact on their well-being and the role of social workers in addressing these challenges, particularly in resource-limited settings like Nigeria.

Aim

This study explored older adults' perceived risks regarding COVID-19, its impact on their psychosocial well-being, and the role of social workers in addressing these challenges in Nigeria.

Methods

A phenomenological and exploratory research design was used. In-depth interviews (IDIs) were conducted with 16 older adults and 4 social workers in Onitsha metropolis, Anambra State, Southeast Nigeria. Data were analyzed through reflexive thematic analysis.

Results

The findings revealed that the COVID-19 restrictive measures negatively impacted the psychosocial well-being of older adults, where social isolation, lack of support, the inability to engage in wellbeing activities, and emotional trauma collectively contributed to a significant decline in their mental and emotional health. Additionally, widespread misconceptions about the origin of COVID-19 led to reluctance in adopting preventive measures. While social workers provided some awareness and counselling sessions, their involvement was limited. Social workers were not recognized as part of the frontline response team, and their efforts were primarily constrained by governmental and institutional neglect.

Conclusion

The findings highlight the need for policy initiatives to enhance social workers involvement in strengthening the psychosocial resilience of older adults and addressing misconceptions during public health emergencies. Comprehensive strategies are essential for safeguarding the psychosocial well-being of older adults in future pandemics or similar crises.

Effects of Wisdom-Enhancement Narrative-Therapy and Empathy-Focused interventions on loneliness over 4 weeks among older adults: A Randomized Controlled Trial

OBJECTIVE

In this three-armed RCT, we tested the effects of a telephone-delivered wisdom enhancement narrative therapy-based intervention (Tele-NT) and a telephone-delivered empathy-focused intervention (Tele-EP) in reducing loneliness against an active control group that received regular call (ACG) at the 4-week follow-up assessment.

DESIGN, SETTING, INTERVENTION, AND PARTICIPANTS

To evaluate the effects of the interventions on loneliness, we randomized 287 older adults based in Hong Kong, ages 65 to 90, into Tele-NT (N = 97), Tele-EP (N = 95), or ACG (N = 95).

MEASUREMENT

The primary outcome was loneliness, calculated using the De Jong Gierveld Scale and the UCLA Loneliness Scale. Secondary outcomes were sleep quality, depressive symptoms, social network engagement, and perceived social support. Assessments were done before training and 4 weeks after the intervention period.

RESULTS

Results from linear mixed models showed significant positive effects of Tele-NT on loneliness measured by the De Jong Gierveld Loneliness Scale compared to ACG. Compared to the ACG, the Tele-NT group significantly reduced loneliness at the 4-week follow-up (mean difference = -0.51, p = 0.019, Cohen's d = 0.60). However, the difference between Tele-EP and the ACG at the 4-week follow-up was not significant (MD = -0.34, p = 0.179, Cohen's d = 0.49). Tele-NT and Tele-EP did not show significant effects on the secondary outcomes, compared to the ACG.

CONCLUSIONS

In this randomized clinical trial, we found that a 4-week wisdom enhancement narrative therapy program significantly reduced feelings of loneliness. This effective telephone-based, lay-therapist-delivered program is scalable for broader implementation.

Loneliness in older persons with schizophrenia

BACKGROUND

In tandem with the rise in numbers of older adults in the general population, more people with schizophrenia (PwS) are also living longer. This vulnerable population has several trajectories of ageing driven by a number of social determinants of health, including the experience of loneliness and they may be more at risk of experiencing loneliness.

AIM

This study aimed to examine demographic, psychosocial and clinical variables and their relative contribution to the loneliness of older PwS (OPwS) in a large New Zealand community sample.

METHOD

New Zealanders 65 years and older who completed their first interRAI assessment during the study period were included. Data from 1,883 OPwS participants was analysed [mean age, 75.1 + 7.7 years; 1,132 (60.3%) females]. The majority were of European ethnicity (64.8%; Māori 15.7%, Pacifica 5.7%) and only a minority were married (20.6%). Chi-square analysis was used to examine relationships between loneliness and demographic and psychosocial variables. Logistic regression was used to measure the relative contribution of these variables to loneliness.

RESULTS

Being lonely was reported for 25.9% of OPwS, a significantly higher rate than that reported in the general population of people over 65 years-of-age. A relationship with loneliness was found for marital status, depression and living arrangements but not gender, ethnicity or social engagement. Co-morbid depression and not being in a marital-type partnership were identified as significant predictors of being lonely. Conversely, living with someone predicted being not lonely.

CONCLUSIONS

Older community dwelling PwS experience higher rates of loneliness than older adults in a general population. Addressing loneliness, as well as its correlates, co-morbid depressive symptoms and living arrangements, is crucial to supporting the wellbeing of OPwS.

Reducing loneliness and depressive symptoms in older adults during the COVID-19 pandemic: A pre-post evaluation of a psychosocial online intervention

BACKGROUND

Loneliness is related to worse mental health, particularly in people with poor social support. The COVID-19 pandemic altered our lives and ways of social interaction, especially among vulnerable populations such as older adults.

METHODS

We designed a group-based psychosocial online intervention for older adults (≥ 65 years) facilitated by gerontologists addressing loneliness consisting of: (i) sharing experiences and promoting peer support to overcome feelings of loneliness and (ii) increasing the chances of establishing successful social relationships. This was a feasibility non-controlled prospective pilot study carried out during the COVID-19 pandemic with a pre-post evaluation. Interviews before and after the intervention assessed loneliness (emotional and social), social support, depressive and anxiety symptoms, quality of life, and perceived health. Groups of 6-8 participants and 2 facilitators met once a week for 8 weeks through videoconferencing. The intervention effectiveness was assessed with multilevel models for repeated measures.

RESULTS

The study sample (N = 27) was mainly composed of females (74%) and the mean age was 74.26 years. 21 participants completed the intervention (22% drop-out rate). Statistically significant (p<0.01) decreases in emotional loneliness and depressive symptoms were observed following the intervention. Qualitatively, participants positively evaluated the intervention and found in the group a space for personal growth where they could meet new people and express themselves with confidence and security.

CONCLUSIONS

Interventions overcoming social distancing restrictions through online tools and targeting vulnerable population sectors (e.g., older adults) can become essential to lessen the collateral consequences of the COVID-19 pandemic on social behaviour and mental health.

Understanding loneliness and its correlates among people with spinal cord injury

PURPOSE

To conduct the first known comprehensive examination of loneliness and its correlates in a diverse sample of people with spinal cord injury (SCI).

METHODS

A cross-sectional sample of 343 people with SCI provided responses to the 20-item UCLA Loneliness Scale-Version 3. We examined the relation of loneliness to measures of demographic, disability, physical health, and social characteristics.

RESULTS

The majority (56%) of respondents had scores indicating high levels of loneliness. At least a quarter of respondents indicated that they often felt alone, left out, isolated, and lacking in companionship. At least a quarter rarely or never felt there were people who really understood them, with whom they could talk, and with whom they had a lot in common. In univariate analyses, loneliness was associated with several demographic, disability, and health characteristics suggesting potential risk factors. In multiple regression analyses, social characteristics (social integration, social support, satisfaction with social roles) were the most strongly associated with loneliness.

CONCLUSIONS

Our findings underscore the high prevalence of loneliness among people with SCI. Given the adverse health consequences of loneliness documented in the general literature, there is an urgent need for researchers, healthcare providers, and policy makers to address the loneliness crisis in this population.

Psychometric properties of the variants of the Chinese UCLA Loneliness Scales and their associations with mental health in adolescents

Loneliness is a pervasive and distressing emotional experience that affects individuals of all ages and can have significant consequences for both physical and mental health. The UCLA Loneliness Scale (UCLA-LS) is widely used to assess the subjective feelings of loneliness, but concerns have been raised about its structure and applicability in diverse cultural contexts. This study analysed the reliability and validity of the five Chinese versions of the UCLA-LS in a representative sample of 2,643 adolescents and young adults with Chinese as their first language in Hong Kong. The results showed high internal consistency across all versions and content validity for most items. Factor analysis revealed a two-factor structure for the longer versions and a unidimensional structure for the shorter versions. However, the fit statistics suggested that the models did not meet good fit criteria, indicating item loading or model specification requires further review. The scales demonstrated strong associations with mental health conditions such as depression and anxiety, as well as psychosocial factors like hopelessness and aggression. Notably, the 8-item version's total scores were associated with mental health and psychological attributes comparable to those of the 20-item version, suggesting its potential suitability as a screening tool in population settings. Future research is needed to improve the generalisability of these scales to other Chinese populations, particularly for items with lower content validity.

The "central" importance of loneliness in mental health: A network psychometric study

Loneliness is linked to negative mental health outcomes like depression and social anxiety. However, it is unclear how loneliness and these conditions are connected. This study aims to address two questions: (a) Are there pathways connecting loneliness to these conditions? (b) What symptoms play a role in these pathways? Using network analyses, the study examined a representative sample of 962 adults from the UK (mean age = 46, females = 492). The network analysis revealed four dimensions: depression, social anxiety and two dimensions for loneliness (isolation and social connectedness). Two distinct pathways were identified for the transmission of symptoms between loneliness, social anxiety and depression. The depression-isolation pathway involved a node representing the perceived loss of social connections. The social anxiety-social connectedness pathway was characterised by intimate interaction contexts. These findings suggest that loneliness is associated with different symptom pathways, potentially contributing to comorbidity between loneliness, social anxiety and depression.

Decoding loneliness: Can explainable AI help in understanding language differences in lonely older adults?

STUDY OBJECTIVES

Loneliness impacts the health of many older adults, yet effective and targeted interventions are lacking. Compared to surveys, speech data can capture the personalized experience of loneliness. In this proof-of-concept study, we used Natural Language Processing to extract novel linguistic features and AI approaches to identify linguistic features that distinguish lonely adults from non-lonely adults.

METHODS

Participants completed UCLA loneliness scales and semi-structured interviews (sections: social relationships, loneliness, successful aging, meaning/purpose in life, wisdom, technology and successful aging). We used the Linguistic Inquiry and Word Count (LIWC-22) program to analyze linguistic features and built a classifier to predict loneliness. Each interview section was analyzed using an explainable AI (XAI) model to classify loneliness.

RESULTS

The sample included 97 older adults (age 66-101 years, 65 % women). The model had high accuracy (Accuracy: 0.889, AUC: 0.8), precision (F1: 0.8), and recall (1.0). The sections on social relationships and loneliness were most important for classifying loneliness. Social themes, conversational fillers, and pronoun usage were important features for classifying loneliness.

CONCLUSIONS

XAI approaches can be used to detect loneliness through the analyses of unstructured speech and to better understand the experience of loneliness.

Frailty Assessment and Its Impact on Loneliness among Older Adults Receiving Home-Based Healthcare during the COVID-19 Pandemic

The purpose of this study was to identify the effect of frailty on loneliness among older adults receiving home care, in correlation to their socioeconomic and homebound statuses. This cross-sectional study recruited 218 individuals aged ≥65 years receiving home-based health services from the "Help at Home" program in the Region of Evrytania, Greece through an open invitation from the municipality authorities from March to June 2022. The Tilburg Frailty Indicator (TFI) was used for the evaluation of frailty, the UCLA Loneliness Scale version 3 was used for loneliness, and social isolation was accessed through five questions (living alone, frequency of interaction with children, relatives, friends, and participation in social organizations). The mean age of the participants was 81.48 ± 9.06, 61.9% were female, 54.1% experienced high levels of loneliness (UCLA-3 mean 45.76 ± 11.10 [range 20-68]), and 46.3% of the participants were found to be socially isolated. Also, 58.3% of the individuals were identified as frail (TFI mean 5.95 ± 3.07) [TFI range 0-13], with 57.3% experiencing physical frailty, 43.6% experiencing psychological frailty, and 27.1% experiencing social frailty. An analysis of covariance (ANCOVA) using UCLA-3 as the dependent variable revealed that loneliness across all domains of TFI was significantly higher in participants with frailty (total frailty [Yes] 49.27 vs. [No] 40,87 p < 0.001) (physical frailty [Yes] = 48.99 vs. [No] = 41.42, p < 0.001, psychological: 48.60 vs. 43.57 p < 0.001, and social: 53.38 vs. 42.94 p < 0.001), particularly compared to non-frail individuals, even after adjusting for potential confounding effects (covariates: gender, age, marital status, family status, living status, educational level, annual income, chronic diseases, homebound status, and social isolation). Our findings indicate that frail older adults experienced higher levels of loneliness, suggesting that frailty and loneliness are independently associated among older adults who receive home-based healthcare.

The association of social isolation and loneliness with sarcopenia among the middle-aged and elderly in China

OBJECTIVES

This study examined the relationship of social isolation and loneliness on sarcopenia among Chinese middle-aged and elderly people.

METHODS

Social isolation, loneliness, and sarcopenia were measured at baseline. Follow-up measures of new-onset sarcopenia were obtained 4 years later. Then used logistic regression to evaluate the association between social isolation, loneliness and sarcopenia.

RESULTS

In cross-sectional analysis, social isolation and loneliness are significantly associated with sarcopenia [OR = 1.88 (95% CI = 1.54-2.28)]. In longitudinal analysis, social isolation and loneliness are significantly associated with sarcopenia [OR = 1.09 (95% CI = 0.71-1.69)]. Social isolation and loneliness have a synergistic effect. Among them, individuals over 60 years old [OR = 2.01 (95% CI = 1.37-2.96)] and those without social support [OR = 2.64 (1.61-4.32), P-for interaction < 0.001] are at higher risk.

CONCLUSION

Social isolation and loneliness were significantly associated with sarcopenia, and there was a synergistic effect between social isolation and loneliness.

The Associations Between Physical Activity and Mental Health Problems in Middle-aged Indonesians

OBJECTIVES

Mental health issues have become a growing concern worldwide. Research has shown that regular physical activity (PA) can positively affect mental health. This study investigated the associations between PA and mental health problems (MHPs) in middle-aged Indonesians.

METHODS

The study utilized data from the 2018 Indonesian Basic Health Research Survey and used a cross-sectional approach. The participants included individuals aged 40-60 years who completed the 20-question Self-Reporting Questionnaire. A logistic regression was performed to analyze a sample of 263 930 data points.

RESULTS

Nearly 10.4% of the participants suffered from mental health issues. Notably, among those who did not engage in moderate and vigorous PA, a sign of MHPs was found in 12.5% of participants. Those who met World Health Organization standards for PA were less likely to experience MHPs (10.1%). This study found a significant association between PA and mental health. After adjusting for smoking, alcohol consumption, non-communicable diseases, and socio-demographic variables like age, sex, education, occupation, marital status, and residence, the connection between PA and mental health became even stronger (adjusted odds ratio, 0.81; 95% confidence interval, 0.78 to 0.85; p<0.001).

CONCLUSIONS

Regular PA has been shown to affect mental health positively. Therefore, it is important to improve health education and efforts to raise awareness among middle-aged Indonesians about the importance of PA in maintaining good mental health.

Growth mindset and well-being in social interactions: countering individual loneliness

Introduction

Loneliness is a prevalent negative emotion experienced by college students. This study explores the relationship between a growth mindset and loneliness among college students.

Methods

A total of 560 college students completed the Growth Mindset Scale (GMS), UCLA Loneliness Scale (UCLA), Interpersonal Relationships Assessment Scale (IRS), and two measures assessing distinct facets of well-being the Satisfaction with Life Scale (SWLS) and the revised Positive Affect and Negative Affect Scale (PANAS).

Results and discussion

The results found a significant negative correlation between a growth mindset and loneliness. A growth mindset negatively predicted loneliness through the chain-mediated effects of interpersonal distress and well-being. These findings underscore the important role of a growth mindset in influencing loneliness, providing teachers and practitioners a new perspective to understand and intervene college students' psychological challenges.

Loneliness in OCD and its determinants

Obsessive-compulsive disorder (OCD) is a psychiatric condition characterized by intrusive thoughts and repetitive behaviors, affecting approximately 1.3 % of the population. Loneliness has serious consequences for future health outcomes. Although it has been extensively studied in depression, its prevalence in obsessive-compulsive disorder (OCD) has hardly been investigated. The current study sought to examine the association between loneliness and OCD, through an exploratory investigation of their demographic and clinical correlates. This cross-sectional study utilized data from the Netherlands Obsessive-Compulsive Disorder Association (NOCDA) study, designed to investigate determinants, course, and consequences of OCD in a large clinical sample. In this data base, a cohort of 363 OCD adult patients underwent assessment for loneliness severity, OCD symptomatology, comorbid conditions, and demographic variables. Findings reveal a high prevalence of loneliness among OCD patients, with nearly three-quarters (73.6 %) experiencing elevated levels. Loneliness was associated with greater depression severity and specific demographic factors such as gender, age, and education level. However, the relationship between OCD severity and loneliness was explained by depression severity. Clinical and theoretical implications are discussed as well as limitations and directions for future research.

Interaction of widowhood, gender, and age in predicting loneliness among older adults in China

BACKGROUND

Loneliness is a significant issue for the elderly, and widowhood is considered a major risk factor. However, research on the intersectional effects of gender, age, and widowhood on loneliness is limited, especially within the Chinese cultural context.

METHODS

Using six waves (2002-2018) of national longitudinal data from the Chinese Longitudinal Healthy Longevity Survey (N = 22,777), this study employed multilevel mixed-effects ordered logistic regression to analyze the impact of widowhood on loneliness. Moderating roles of gender and age were examined through interaction effects.

RESULTS

Widowhood significantly increased loneliness across genders and age groups, but this effect diminished with age. Widowed men experienced greater loneliness than women, but this difference converged by age 90. The buffering effect of age on the widowhood-loneliness link was less pronounced among older women.

CONCLUSION

The study unravels the complexity of how gender, age, and widowhood interact to shape loneliness in later life. Targeted interventions considering these intersections are needed to alleviate loneliness among Chinese widowed elderly.

Joint trajectories of loneliness, social isolation and sarcopenia and associations with adverse outcomes: A prospective cohort study

This study aimed to examine joint trajectories of loneliness, social isolation and sarcopenia and their associations with adverse outcomes. A total of 4701 participants aged ≥60 years who had a baseline and at least one follow-up assessment of loneliness, social isolation and sarcopenia across 2011, 2013 and 2015 waves in China Health and Retirement Longitudinal Study. Adverse outcomes were obtained in 2018 wave. Joint trajectories were fit using the parallel process latent class growth analysis, and their associations with adverse outcomes were evaluated using modified Poisson regression. Joint trajectory patterns for social relationship and sarcopenia did not vary by the assessment for sarcopenia, but did vary by the assessment for social relationship. Older adults exhibit distinct joint trajectories and those with persistent combination of loneliness or social isolation and sarcopenia experience greatest risk of adverse outcomes. These findings implicate integration of health care and social care for community-dwelling older adults.

Exploring Loneliness, Trust, and Psychosocial Meanings Among Primary Care Attendees: A Cross-Sectional Study From a General Practice Setting in Crete, Greece

INTRODUCTION

Loneliness is often associated with behavioral, psychological, social, and mental and physical health aspects, while the relationship between trust and loneliness is still challenging in terms of research. The present study aimed to investigate to what extent loneliness and trust interact and if there is any association between loneliness and routine events or behaviors that affect overall well-being.

METHODS

This cross-sectional sample of 120 participants, aged between 40 and 75 years, was collected from an urban Primary Health Care Unit, between May and July 2023, in a consecutive manner, after criteria application. The University of California, Los Angeles (UCLA) Loneliness Scale (Version 3) and the Personal Trust and Connections Scale (PerTC) were completed. Hierarchical multiple linear regression analysis in steps and multiple logistic regression analysis were performed.

RESULTS

The mean age of the participants was 59.8 years and the majority were females (73.3%). Only 10.8% were found to have no Behavioral Risk Factors (BRFs). A higher sense of loneliness was associated with being widowed/unmarried/divorced (unstandardized β=-4.10, p=0.045), not having children (β=-2.80, p=0.038), having more BRFs (β=2.03, p=0.032), or being in contact with fewer friends (β=-0.56, p<0.001). A higher sense of loneliness was related to lower levels of trust (β=-1.29, p=0.032). Lower odds of demonstrating high levels of loneliness were found among married individuals (odds ratio (OR): 0.38; 95% confidence interval (CI) 0.15, 0.95; p=0.039) and those who reported six or more routine contacts or meetings with friends (OR: 0.31; 95% CI 0.13, 0.74; p=0.008). A lower score on the total PerTC scale was related to higher odds of increased loneliness (OR: 2.78; 95%CI 1.01, 7.62; p=0.048).

CONCLUSION

Being married and coming in contact or meeting with more friends was associated with lower odds of reporting high feelings of loneliness, while lower trust was correlated with increased odds of loneliness. Also, persons with more BRFs were found to have a higher loneliness score. Given their inverse correlation, tools that measure levels of loneliness and trust, like the UCLA and PerTC scales, may be used within primary care consultation to offer new insights on health risk behaviors and their possible synergistic influences.

Association between Levels of Loneliness, Laboratory Measurements, and Behavioral Aspects in a Primary Care Setting in Crete, Greece

This paper examines potential associations of loneliness with laboratory data and specific psychosocial and behavioral attitudes. The sample collection took place in an urban Primary Health Care unit between May and July 2023, consecutively, and once exclusion criteria were implemented. Participants were aged between 40 and 75 years. Routine laboratory test results upon study initiation and six months before were used. The University of California, Los Angeles (UCLA), Loneliness Scale (Version 3), blood glucose, serum lipids, Fibrosis-4 index, and Creatinine Clearance (CrCl) were assessed through hierarchical multiple logistic regression analysis. Based on full model (3rd) analysis, those who were engaged in an individual sport or activity or had contacts with more friends presented significantly lower odds for increased loneliness levels (odds ratio (OR): 0.28 [95% confidence interval (CI) 0.09-0.91], p = 0.034 and OR: 0.76 [95%CI 0.66-0.88], p < 0.001, respectively). The consumption of alcohol was associated with increased loneliness (OR: 5.55 [95%CI 1.42-21.63], p = 0.014). Elevated triglyceride levels were linked with moderate or no loneliness (OR: 0.20 [95%CI 0.05-0.83], p = 0.026), while an increased LDL/HDL atherosclerotic index was related to increased subjective loneliness (OR: 4.50 [95%CI 1.12-18.13], p = 0.035). The need for holistic approaches-involving primary care personnel-in understanding and addressing loneliness, recognizing its multifaceted nature as well as the diverse factors that contribute to this issue, is considered challenging.

Psychosocial Problems in Community-dwelling Older Adults: A Cross-sectional Study

BACKGROUND

Changing lifestyles, health care, growing age, and life expectancy have contributed to the occurrence of old age in communities. The elderly population are rising who are aged 60 or older in the present scenario. They are more prone to psychosocial problems such as stress, loneliness, low self-esteem, and anxiety. These problems impact their psychological health.

MATERIALS AND METHODS

This cross-sectional study was conducted at selected communities of Amritsar, Punjab. A total of 200 older adults were involved using the purposive sampling technique. Data were collected using a predesigned sociodemographic pro forma and a five-point Likert scale to assess psychosocial problems among the elderly. The data collection method employed was interviewed. In the psychosocial problems assessment tool, a total of 35 items were included, which were further categorized as follows: no psychosocial problem (0-35), mild psychosocial problem (36-70), moderate psychosocial problem (71-105), and severe psychosocial problem (106-140).

RESULTS

The average age of the older adults was 69.31 ± 6.63 years, 65.5% were males and 34.5% were females. Regarding psychosocial problems, 69% had moderate, 16% had mild, 10.5% severe, and 4.5% had no problems. The median score was 90 (18). The median score was 17.50 (7) for stress, 38 (17.75) for loneliness, 18 (7.75) for anxiety, and 14 (7) for self-esteem. All the four domains, stress, loneliness, anxiety, and self-esteem, had a statistically significant relationship (P < 0.01). A statistically significant association was found between self-esteem, type of family, and anxiety with educational level.

CONCLUSION

The study concluded that older adults in communities have significant psychosocial problems such as stress, loneliness, self-esteem, and anxiety. Collaboratively, health professionals, local community leaders, and social workers can formulate and execute a health awareness campaign to avoid these issues that cause the aged much anguish.

Wisdom and aging

How is wisdom related to aging? While many people associate wisdom with advanced age, becoming wise clearly requires more than "just" growing old - accumulated life experience is an important foundation for wisdom, but not all highly wise individuals are old and many old individuals are not particularly wise. This article first reviews how wisdom is defined in psychological research, with an emphasis on models of how wisdom develops. Then, recent research is reviewed that looks into (a) the relationship between wisdom and chronological age and (b) wisdom as a resource for coping with age-related challenges. Finally, some general conclusions are drawn and important research gaps are highlighted.

Canadian Workers' Well-Being During the Beginning of the COVID-19 Pandemic: A Latent Profile Analysis

To explore workers' well-being during COVID-19, researchers have primarily utilized variable-centered approaches (e.g., regression) focusing on describing workers' general level of well-being. Given the diversity of factors that may have impacted workers' well-being during the pandemic, focusing on such well-being trends do not provide sufficient insight into the different lived well-being experiences during the pandemic. Moreover, positive well-being in workers' general lives and work has been understudied in such complex public health crises. To address these issues, we use latent profile analysis, a person-centered analysis, to explore the diverse well-being realities Canadian workers (employed before COVID-19 or working at the time of the survey) experienced at the beginning of COVID-19. Canadian workers (N = 510) were surveyed between May 20-27th, 2020, on positive (meaning in life, flourishing, thriving at work) and negative (distress, stress, impaired productivity, troublesome symptoms at work) well-being indicators, as well as on factors that may be associated with experiencing different well-being profiles. Five well-being profiles emerged: moderately prospering, prospering, moderately suffering, suffering, and mixed. Factors at the self- (gender, age, disability status, trait resilience), social- (marital status, family functioning, having children at home), workplace- (some employment statuses and work industries, financial strain, job security), and pandemic-related (perceived vulnerability to COVID-19, social distancing) ecological levels predicted profile membership. Recommendations for employers, policymakers, and mental health organizations are discussed.

An 18-month meditation training selectively improves psychological well-being in older adults: A secondary analysis of a randomised controlled trial

OBJECTIVES

As the world population is ageing, it is vital to understand how older adults can maintain and deepen their psychological well-being as they are confronted with the unique challenges of ageing in a complex world. Theoretical work has highlighted the promising role of intentional mental training such as meditation practice for enhancing human flourishing. However, meditation-based randomised controlled trials in older adults are lacking. We aimed to investigate the effects of meditation training on psychological well-being in older adults.

METHODS

This study presents a secondary analysis of the Age-Well trial (ClinicalTrials.gov: NCT02977819), which randomised 137 healthy older adults (age range: 65 to 84 years) to an 18-month meditation training, an active comparator (English language training), or a passive control. Well-being was measured at baseline, mid-intervention, and 18-month post-randomisation using the Psychological Well-being Scale (PWBS), the World Health Organisation's Quality of Life (QoL) Assessment psychological subscale, and composite scores reflecting the meditation-based well-being dimensions of awareness, connection, insight, and a global score comprising the average of these meditation-based dimensions.

RESULTS

The 18-month meditation training was superior to English training on changes in the global score (0.54 [95% CI: 0.26, 0.82], p = 0.0002) and the subscales of awareness, connection, insight, and superior to no-intervention only on changes in the global score (0.54 [95% CI: 0.26, 0.82], p = 0.0002) and awareness. Between-group differences in psychological QoL in favour of meditation did not remain significant after adjusting for multiple comparisons. There were no between-group differences in PWBS total score. Within the meditation group, psychological QoL, awareness, insight, and the global score increased significantly from baseline to 18-month post-randomisation.

CONCLUSION

The longest randomised meditation training conducted to date enhanced a global composite score reflecting the meditation-based well-being dimensions of awareness, connection, and insight in older adults. Future research is needed to delineate the cognitive, affective, and behavioural factors that predict responsiveness to meditation and thus help refine the development of tailored meditation training.

Can Resilience Buffer the Effects of Loneliness on Mental Distress Among Working-Age Adults in the United States During the COVID-19 Pandemic? A Latent Moderated Structural Modeling Analysis

BACKGROUND

The profound health consequences of loneliness are well-established. However, less is known about the protective factors which may alleviate the effects of loneliness on mental health especially among working-age adults amidst the COVID-19 pandemic. We draw on the social ecology of resilience and examine whether resilience factors can buffer the effects of loneliness on mental distress.

METHODS

Data came from the National Well-being Survey-a national study of a demographically representative sample of U.S. working-age adults (N = 4014). We used (a) structural equation models with latent variables to examine the main effects of loneliness, psychological resilience, and perceived social support on mental distress, and (b) latent moderated structural equations to estimate the latent interaction effects.

RESULTS

Results revealed that (a) loneliness was positively associated with mental distress and psychological resilience was negatively related to mental distress, and (b) psychological resilience and perceived social support moderated the strength of the relationship between loneliness and mental distress.

CONCLUSIONS

Our study highlights the importance of psychological resilience and perceived social support as two protective factors in the relationship between loneliness and mental distress. Given that loneliness significantly predicts worse mental and physical health and higher mortality, identifying protective factors that might disrupt these connections is vital. As such, public health efforts to strengthen and expand familial and community social support networks and foster psychological resilience are urgently needed to support mental health among working-age adults during additional waves of the pandemic or future similar stressors.

Geospatial vaccine misinformation risk on social media: Online insights from an English/Spanish natural language processing (NLP) analysis of vaccine-related tweets

BACKGROUND

Misinformation is known to affect norms, attitudes, and intentions to engage with healthy behaviors. Evidence strongly supports that Spanish speakers may be particularly affected by misinformation and its outcomes, yet current insights into the scope and scale of misinformation is primarily ethnocentric, with greater emphasis on English-language design.

OBJECTIVE

This study applies Natural Language Processing (NLP) to analyze a corpus of English/Spanish tweets about vaccines, broadly defined, for misinformation indicators.

METHODS

We analyzed NEnglish = 247,140 and NSpanish = 104,445 tweets using Latent Dirichlet Allocation (LDA) topic models with Coherence score calculation (model fit) with a Mallet adjustment (topic optimization). We used informal coding to name computer-identified topics and compare misinformation scope and scale between languages.

RESULTS

The LDA analysis yielded a 12-topic solution for English and a 14-topic solution for Spanish. Both corpora contained overlapping misinformation, including uncertainty of research guiding policy recommendations or standing in support of antivax movements. However, the Spanish data were positioned in a global context, where misinformation was directed at government equity and disparate vaccine distribution.

CONCLUSION

Our findings support that misinformation is a global issue. However, misinformation may vary depending on culture and language. As such, tailored strategies to combat misinformation in digital planes are strongly encouraged.

Chronic stressors, coping strategies, and depressive symptoms: A comparison across older age groups

Late-life depression is a prevalent mental health problem among older adults. Variations may exist in the intensity of chronic stressors experienced by people in different older age groups and their effects on depressive symptoms. To examine differences among older adults by age group in the experienced intensity of chronic stressors in relation to coping strategies and depressive symptoms. Participants were 114 older adults. The sample was divided into three age groups: 65-72, 73-81, and 82-91. The participants completed questionnaires on coping strategies, depressive symptoms, and chronic stressors. Moderation analyses were conducted. The lowest levels of depressive symptoms were in the young-old age group and the highest levels were in the oldest-old age group. The young-old age group used more engaged and less disengaged coping strategies than the two other groups. The association between intensity of chronic stressors and depressive symptoms was stronger in the two older age groups compared to the youngest (moderating effect of age groups). Differences exist in the relationships among chronic stressors, coping strategies, and depressive symptoms by age groups in the older adult population. Professionals should be aware of the possible differences between age groups in depressive symptoms and the impact of stressors on depressive symptoms in different older adult age groups.

The positive and negative emotion functions related to loneliness: a systematic review of behavioural and neuroimaging studies

Loneliness is associated with high prevalences of major psychiatric illnesses such as major depression. However, the underlying emotional mechanisms of loneliness remained unclear. We hypothesized that loneliness originates from both decreases in positive emotional processing and increases in negative emotion processing. To test this, we conducted a systematic review of 29 previous studies (total participants n = 19 560, mean age = 37.16 years, female proportion = 59.7%), including 18 studies that included questionnaire measures of emotions only, and 11 studies that examined the brain correlates of emotions. The main findings were that loneliness was negatively correlated with general positive emotions and positively correlated with general negative emotions. Furthermore, limited evidence indicates loneliness exhibited negative and positive correlations with the brain positive (e.g. the striatum) and negative (e.g. insula) emotion systems, respectively, but the sign of correlation was not entirely consistent. Additionally, loneliness was associated with the structure and function of the brain emotion regulation systems, particularly the prefrontal cortex, but the direction of this relationship remained ambiguous. We concluded that the existing evidence supported a bivalence model of loneliness, but several critical gaps existed that could be addressed by future studies that include adolescent and middle-aged samples, use both questionnaire and task measures of emotions, distinguish between general emotion and social emotion as well as between positive and negative emotion regulation, and adopt a longitudinal design that allows us to ascertain the causal relationships between loneliness and emotion dysfunction. Our findings provide new insights into the underlying emotion mechanisms of loneliness that can inform interventions for lonely individuals.

Understanding factors associated with the trajectory of subjective cognitive complaints in groups with similar objective cognitive trajectories

BACKGROUND

Cognitive complaints are often regarded as an early sign of Alzheimer's disease (AD) but may also occur in several other conditions and contexts. This study examines the correlates of cognitive complaint trajectories over a 5-year period in individuals who shared similar objective cognitive trajectories.

METHODS

We analyzed a subsample (n = 1748) of the MEMENTO cohort, consisting of individuals with subjective cognitive decline or mild cognitive impairment at baseline. Participants were stratified based on their latent MMSE trajectory over a 5-year period: "high and increasing," "subtle decline," and "steep decline." Within each of the three strata, we used a latent-class longitudinal approach to identify distinct trajectories of cognitive complaints. We then used multiple logistic regressions to examine the association between these complaint trajectories and several factors, including AD biomarkers (blood pTau/Aβ42 ratio, cortical thickness, APOE genotype), anxiety, depression, social relationships, a comorbidity-polypharmacy score, and demographic characteristics.

RESULTS

Among participants with high and increasing MMSE scores, greater baseline comorbidity-polypharmacy scores (odds ratio (OR) = 1.30, adjusted p = 0.03) were associated with higher odds of moderate and increasing cognitive complaints (as opposed to mild and decreasing complaints). Baseline depression and social relationships also showed significant associations with the complaint pattern but did not survive correction for multiple comparisons. Among participants with subtle decline in MMSE scores, greater baseline depression (OR = 1.76, adjusted p = 0.02) was associated with higher odds of moderate and increasing cognitive complaints (versus mild and decreasing). Similarly, baseline comorbidity-polypharmacy scores and pTau/Aβ42 ratio exhibited significant associations, but they did not survive correction. Among participants with a steep decline in MMSE scores, greater baseline comorbidity-polypharmacy scores increased the odds of moderate complaints (versus mild, OR = 1.38, unadjusted p = 0.03, adjusted p = 0.32), but this effect did not survive correction for multiple comparisons.

CONCLUSIONS

Despite similar objective cognitive trajectory, there is heterogeneity in the subjective perception of these cognitive changes. This perception was explained by both AD-related and, more robustly, non-AD-related factors. These findings deepen our understanding of the multifaceted nature of subjective cognitive complaints in individuals at risk for dementia and underscore the importance of considering a range of factors when interpreting cognitive complaints.

The effects of psychosocial and behavioral interventions on depressive and anxiety symptoms during the COVID-19 pandemic: a systematic review and meta-analysis

Psychosocial and behavioral interventions have been shown to significantly reduce depressive and anxiety symptoms in different populations. Recent evidence suggests that the mental health of the general population has deteriorated significantly since the start of Coronavirus Disease 2019 (COVID-19) pandemic. We conducted a systematic review and meta-analysis of studies on the therapeutic effects of psychosocial and behavioral interventions on depression and anxiety during the COVID-19 pandemic. We systematically searched six electronic databases between December 2019 and February 2022 including PubMed, PsycINFO, Scopus, Web of Science, CNKI, and Wanfang Data. We included randomized clinical trials of psychosocial and behavioral interventions in individuals with depressive or anxiety symptoms during the COVID-19 outbreak compared to various control conditions. A total of 35 eligible studies with 5457 participants were included. The meta-analysis results showed that psychosocial and behavioral interventions had statistically significant moderate effects on depression [SMD =  - 0.73, 95% CI (- 1.01, - 0.45), I2 = 90%] and large effects on anxiety [SMD =  - 0.90, 95% CI (- 1.19, - 0.60), I2 = 92%], especially in the general population and COVID-19 survivors. Exercise and cognitive behavioral therapy were found to be the most effective treatments with moderate-to-large effect size for depression and anxiety during the outbreak of COVID-19. We also found the internet-based approach could also achieve almost equally significant effects on depression and anxiety compared with face-to-face traditional approach. Our findings suggest that cognitive behavioral therapy and physical exercise intervention are significantly effective for depression and anxiety related to the COVID-19 pandemic regardless of the delivery modes, and gender differences should be taken into consideration for better implementation of interventions in clinical and community practice.

Combined effects of loneliness and inflammation on depression in people with HIV

OBJECTIVE

Loneliness is prevalent in people with HIV (PWH) and associated with adverse health-related consequences, including depression. Chronic inflammation has been linked to depression in PWH, though its association with loneliness is less well established. Simultaneous examination of inflammation, loneliness and depression is needed to clarify these relationships. This study investigated the relationship between loneliness and inflammation, and the effects of loneliness and inflammation on depression in PWH.

METHODS

82 PWH who were on suppressive ART (mean age [SD] = 53.2 [9.0]) completed the UCLA Loneliness Scale-Version 3 and the Center for Epidemiologic Studies Depression Scale as part of a comprehensive evaluation. Biomarkers of systemic inflammation (CRP, IL-6, CCL2/MCP-1, sCD14) and coagulation (D-dimer) were measured in blood using commercial immunoassays.

RESULTS

Multivariable linear regression analyses revealed that higher D-dimer, CCL2/MCP-1, and sCD14 were significant predictors of loneliness (ps < .05) while accounting for relevant covariates. Stepwise multiple linear regression models that included loneliness, biomarkers, and their interactions as predictors of depressive symptoms revealed significant main effects of loneliness and CCL2/MCP-1 levels (ps < .05), and a significant loneliness by D-dimer interaction (p < .05) whereby higher D-dimer was associated with increased depressive symptoms only at higher levels of loneliness.

CONCLUSIONS

Increased coagulation activity is associated with loneliness, and in the context of loneliness, may increase risk for depression. Increased inflammation was associated with depression suggesting potentially dissociable underlying biological processes. To the extent that these processes are modifiable, such findings could have important implications in the treatment of loneliness and depression in PWH.

Quality of life and well-being during the COVID-19 pandemic: associations with loneliness and social isolation in a cross-sectional, online survey of 2,207 community-dwelling older Canadians

BACKGROUND

The far-reaching health and social sequelae of the COVID-19 pandemic among older adults have the potential to negatively impact both quality of life (QoL) and well-being, in part because of increased risks of loneliness and social isolation. The aim of this study was to examine predictors of QoL and well-being among Canadian older adults within the context of the pandemic, including loneliness and social isolation.

METHODS

This cross-sectional, online survey recruited older adult participants through community organizations and research participant panels. Measures included the: Older People's Quality of Life Scale-B, WHO-5, DeJong Gierveld Loneliness Scale, Lubben Social Network Scale and five COVID-19 specific items assessing impact on loneliness and social isolation. Multiple linear regression models were used to adjust for potential confounders.

RESULTS

A total of 2,207 older Canadians (55.7% female, with a mean age of 69.4 years) responded to the survey. Over one-third strongly disagreed that the pandemic had had a significant effect on either their mental (35.0%) or physical health (37.6%). Different patterns of predictors were apparent for QoL and well-being. After adjusting for all variables in the models, the ability of income to meet needs emerged as the strongest predictor of higher QoL, but was not associated with well-being, except for those who chose not to disclose their income adequacy. Age was not associated with either QoL or well-being. Females were more likely to experience lower well-being (β=-2.0, 95% C.I. =-4.0,-0.03), but not QoL. Reporting three or more chronic health conditions and that the COVID-19 pandemic had a negative impact on mental health was associated with lower QoL and well-being. Loneliness was a predictor of reduced QoL (β=-1.4, 95% C.I. =--1.6, -1.2) and poor well-being (β=-3.7, 95% C.I. =-4.3,-3.0). A weak association was noted between QoL and social isolation.

CONCLUSIONS

The COVID-19 pandemic is associated with differential effects among older adults. In particular, those with limited financial resources and those with multiple chronic conditions may be at more risk to suffer adverse QoL and well-being consequences. Loneliness may be a modifiable risk factor for decreased QoL and well-being amenable to targeted interventions.

The impacts of social restrictions during the COVID-19 pandemic on the physical activity levels of over 50-year olds: The CHARIOT COVID-19 Rapid Response (CCRR) cohort study

OBJECTIVES

To quantify the associations between shielding status and loneliness at the start of the COVID-19 pandemic, and physical activity (PA) levels throughout the pandemic.

METHODS

Demographic, health and lifestyle characteristics of 7748 cognitively healthy adults aged >50, and living in London, were surveyed from April 2020 to March 2021. The International Physical Activity Questionnaire (IPAQ) short-form assessed PA before COVID-19 restrictions, and up to 6 times over 11 months. Linear mixed models investigated associations between shielding status and loneliness at the onset of the pandemic, with PA over time.

RESULTS

Participants who felt 'often lonely' at the outset of the pandemic completed an average of 522 and 547 fewer Metabolic Equivalent of Task (MET) minutes/week during the pandemic (95% CI: -809, -236, p<0.001) (95% CI: -818, -275, p<0.001) than those who felt 'never lonely' in univariable and multivariable models adjusted for demographic factors respectively. Those who felt 'sometimes lonely' completed 112 fewer MET minutes/week (95% CI: -219, -5, p = 0.041) than those who felt 'never lonely' following adjustment for demographic factors. Participants who were shielding at the outset of the pandemic completed an average of 352 fewer MET minutes/week during the pandemic than those who were not (95% CI: -432, -273; p<0.001) in univariable models and 228 fewer MET minutes/week (95% CI: -307, -150, p<0.001) following adjustment for demographic factors. No significant associations were found after further adjustment for health and lifestyle factors.

CONCLUSIONS

Those shielding or lonely at pandemic onset were likely to have completed low levels of PA during the pandemic. These associations are influenced by co-morbidities and health status.

Sex-related differences in the associations between diurnal cortisol pattern and social and emotional loneliness in older adults

Introduction

Loneliness is a distressful feeling that can affect mental and physical health, particularly among older adults. Cortisol, the primary hormone of the Hypothalamic-Pituitary-Adrenal axis (HPA-axis), may act as a biological transducer through which loneliness affects health. While most previous studies have evaluated the association between loneliness, as a unidimensional construct, and diurnal cortisol pattern, no research has examined this relationship discriminating between social and emotional loneliness in older adults. As sex differences in the negative mental health outcomes of loneliness have been reported, we also investigated whether diurnal cortisol indices and loneliness associations occur in a sex-specific manner.

Methods

We analyzed the diurnal cortisol- pattern in 142 community-dwelling, non-depressed, Caucasian older adults (55,6% female) aged 60-90. Social and emotional (family and romantic) loneliness scores were assessed using the Spanish version of the Social and Emotional Loneliness Scale for Adults (SELSA). Five salivary cortisol samples were used to capture key features of the diurnal cortisol pattern, including: awakening and bedtime cortisol levels, awakening response (CAR), post-awakening cortisol output (post-awakening cortisol [i.e., the area under the curve with reference to the ground: AUCG]), total diurnal cortisol release (AUCG), and diurnal cortisol slope (DCS).

Results

After controlling for sociodemographic variables, the hierarchical linear multiple regression analyses revealed that in male older adults, higher scores on social and family loneliness were associated with elevated awakening cortisol levels, total diurnal cortisol output, and a steeper diurnal cortisol slope (DCS). However, these associations were not observed in female older adults. In addition, feelings of romantic loneliness were positively associated with bedtime cortisol levels and AUCG in older males. Multilevel growth curve modeling showed that experiencing more social and emotional loneliness predicted higher diurnal cortisol output throughout the day in older male adults.

Discussion

The presence of sex differences in the relationship between cortisol indices and loneliness among older adults holds particular significance for diagnostic and screening procedures. Combining loneliness scales as screening tools with diurnal cortisol measures has the potential to be an effective and cost-efficient approach in identifying higher-risk individuals at early stages.

Engage coaching for caregivers: a pilot trial to reduce loneliness in dementia caregivers

OBJECTIVES

There are no evidence-based interventions for reducing loneliness in family caregivers of people with dementia (ADRD caregivers), despite heightened risk. We examined feasibility, acceptability, and potential efficacy of a brief behavioral intervention, Engage Coaching for Caregivers, to reduce loneliness and increase social connection for older ADRD caregivers experiencing stress and loneliness.

METHODS

A single-arm clinical trial of 8 individual sessions of Engage Coaching delivered remotely. Outcomes assessed 3-months post-intervention included loneliness and relationship satisfaction (co-primary) and perceived social isolation (secondary).

RESULTS

Engage Coaching was feasible to deliver, with n = 25 of 30 enrolled completing at least 80% of sessions. 83% indicated the program met expectations and 100% reported the program was suitable and convenient. Improvements were observed in loneliness (standardized response mean [SRM] = 0.63), relationship satisfaction (SRM = 0.56), and perceived social isolation (SRM = 0.70).

CONCLUSION

Engage Coaching is a promising behavioral intervention to enhance social connection for older ADRD caregivers.

Older adults' experiences of social isolation and loneliness: Can virtual touring increase social connectedness? A pilot study

The present pilot study explored the research aim of understanding how independent-living older adults experience social isolation and loneliness and whether virtual tour digital technology can increase social connectedness (N = 10). Through triangulation of interviews, experiences, and feedback, this study contributes to the knowledge base on the well-being of our ageing populations and how digital technologies, specifically virtual tourism, can aid in this process. The key findings reveal that the participants in our study were moderately lonely but were open to embracing more digital technology, sharing how it is instrumental in facilitating social connection and life administration. Participating in virtual tour experiences was well accepted as participants expressed enjoyment, nostalgia, and interest in future use. However, its contribution to increasing social connections needs to be clarified and requires further investigation. Several future research and education directions are provided.

Latent subgroups with distinct patterns of factors associated with self-rated successful aging among 1,510 community-dwelling Americans: potential role of wisdom as an implicit promoter

OBJECTIVES

To investigate whether latent subgroups with distinct patterns of factors associated with self-rated successful aging can be identified in community-dwelling adults, and how such patterns obtained from analysis of quantitative data are associated with lay perspectives on successful aging obtained from qualitative responses.

METHODS

Cross-sectional data were collected from 1,510 community-dwelling Americans aged 21-99 years. Latent class regression was used to identify subgroups that explained the associations of self-rated successful aging with measures of physical, cognitive, and mental health as well as psychological measures related to resilience and wisdom. Natural language processing was used to extract important themes from qualitative responses to open-ended questions, including the participants' definitions of successful aging.

RESULTS

Two latent subgroups were identified, and their main difference was that the wisdom scale was positively associated with self-rated successful aging in only one subgroup. This subgroup had significantly lower self-rated successful aging and worse scores for all health and psychological measures. In the subgroup's qualitative responses, the theme of wisdom was only mentioned by 10.6%; this proportion was not statistically different from the other subgroup, for which the wisdom scale was not statistically associated with the self-rated successful aging.

CONCLUSION

Our results showed heterogeneous patterns in the factors underpinning successful aging even in community-dwelling adults. We found the existence of a latent subgroup with lower self-rated successful aging as well as worse health and psychological scores, and we suggest a potential role of wisdom in promoting successful aging for this subgroup, even though individuals may not explicitly recognize wisdom as important for successful aging.