The transition to living alone and psychological distress in later life

Death of a Family Member and Self-Perceptions of Aging Among Middle-Aged and Older Adults

The death of a family member is one of the life's most emotionally distressing experiences, yet its impact on self-perceptions of aging remains understudied. This study examines the relationship between the death of a family member and self-perceptions of aging among middle-aged and older adults using data from the 2014-2016 Health and Retirement Study (n = 11,416). Four types of family death (father death, mother death, spousal death, and child death) were analyzed. Linear regression models with Generalized Estimating Equations were estimated to examine the association between the death of a family member and self-perceptions of aging, as well as the moderation effect of gender. Results indicated that the death of a mother or a spouse is associated with less positive self-perceptions of aging compared to those not bereaved. No significant gender differences were observed in the association between the death of a family member and self-perceptions of aging. Interventions and support are necessary to help the bereaved navigate the bereavement process and maintain a positive outlook on aging in the face of loss.

Trajectory classes of depressive symptoms among middle-aged and older adults following the transition to living alone

This study identified the trajectory classes of depressive symptoms after transitioning to living alone and the factors affecting these trajectories. Data from the initial to the seventh waves of the Korean Longitudinal Study of Aging were analyzed, focusing on four consecutive waves. We selected 369 participants aged ≥45 who transitioned to living alone between consecutive waves (T1 and T2). They were followed up for six years (T1 to T4) while living alone from T2 to T4. Using latent class growth modeling, three trajectories emerged: low-lessening, moderate-lessening, and high-stable. The highly stable class was associated with older age, more chronic diseases, lower satisfaction with health and financial status, and less frequent social interactions at T1 than the low-lessening class. These findings underscore the importance of community-based interventions for middle-aged and older adults with risk factors as they face an increased risk of depression over time after transitioning to living alone.

Financial strain and social support as moderators of the relationship between living alone and depressive symptoms in older people

This study investigated the moderating effect of financial strain or social support on depressive symptoms among older people living alone in Taiwan. Data were collected from the "Taiwan Longitudinal Study on Aging (TLSA)," which included 1513 participants aged 65 and over, among them, 153 (10.1%) were living alone, while 1360 (89.9%) were living with others. Measurement tools included the Depression scale (CES-D), financial stress scale, social support scale, ADL scale, IADL scale, and stress scale, with Cronbach's α coefficients were 0.85, 0.78, 0.67, 0.91, 0.90, and 0.70 respectively. Hierarchical multiple regression was used to examine the moderator effect. The findings revealed that (1) Financial strain was found to moderate the relationship between living alone and depressive symptoms, acting as a promotive moderator among older men living alone. For older women, financial stress does not moderate the relationship between living alone and depressive symptoms. However, financial strain was also identified as a significant factor associated with depressive symptoms among older women living alone. (2) Social support does not moderate effect on the relationship between living alone and depressive symptoms in older men or older women. These results underscore the importance of considering financial stress in mental health policy development by government agencies. It is imperative to address the unique challenges faced by older individuals living alone, particularly in relation to financial strain, in order to promote their mental well-being.

Age-Dependent Differences in Frequent Mental Distress (FMD) of US Older Adults Living in Multigenerational Families versus Living Alone

Frequent mental distress (FMD) is prevalent among older Americans, but less is known about disparities in FMD of older adults living in multigenerational families versus living alone. We pooled cross-sectional data (unweighted, n = 126,144) from the Behavioral Risk Factor Surveillance System (BRFSS) between 2016 and 2020 and compared FMD (≥14 poor mental health days in the past 30 days = 1; 0 otherwise) of older adults (≥65 years) living in multigenerational families versus living alone in 36 states. After controlling for covariates, findings indicate 23% lower odds of FMD among older adults living in multigenerational households compared to counterparts living alone (adjusted odds ratio (AOR): 0.77; 95% confidence interval (CI): 0.60, 0.99). Findings also show that the reduction in the odds of FMD with each 5 year increase in age was larger among older adults living in multigenerational families by 18% (AOR: 0.56; 95% CI: 0.46, 0.70) compared to older adults living alone (AOR: 0.74; 95% CI: 0.71, 0.77), and this difference was significant at the 5% significance level. Multigenerational living may have a protective association with FMD among older adults. Further research is needed to identify multigenerational family and non-kin factors that translate into mental health advantages for older adults.

Decreasing patterns of depression in living alone across middle-aged and older men and women using a longitudinal mixed-effects model

There is little evidence regarding the association between living arrangement and depression, and no studies have examined the age- and gender-specific differences in this association. The present study sought to examine the longitudinal changes in depression patterns between isolative living versus living in company among middle-aged and older men and women by obtaining data from waves 1-7 of the Korean Longitudinal Study of Aging (KloSA), which comprises a sample of persons at least 45 years of age in the Republic of Korea (2273 middle-aged and 1387 older men, 2805 middle aged and 1862 older women). Depression scores were based on the self-reported Center for Epidemiologic Studies Depression Scale (CES-D-10) short forms. Using mixed-effect linear regression models, we estimated depression patterns by living arrangement across age- and gender groups. Our findings from the mixed-effects model revealed that over a 14-year follow-up period, there were significant decreasing patterns of depression were among middle-aged men and women, and older men living alone compared to living with a spouse and living with others. However, living alone still had the highest depression compared to other living arrangement types. On the other hand, the depression of older women living alone changed to a level similar to those living with others during the follow-up period. In conclusion, these findings indicate that living alone significantly increases the risk of depression, but the risk decreases over time. Additionally, depression patterns by living arrangement proved to differ across age and gender groups.

Gender and Psychosocial Differences in Psychological Resilience among a Community of Older Adults during the COVID-19 Pandemic

The study aimed at exploring gender and additional sociodemographic differences in psychological resilience, as well as the association between resilience and psychological distress in older adults, during the first lockdown in Italy, due to the COVID-19 pandemic. Participants attended an online survey during the first lockdown in May 2020. Psychological distress was assessed through the Depression Anxiety Stress Scale-21, the Resilience Scale (RS) was administered to evaluate psychological resilience, and sociodemographic variables were also collected. The study involved 108 community older adults (mean age 70.02 ± 3.5 years). Comparisons revealed that women reported significantly lower total scores of RS (p = 0.027), as well as lower levels of resilience-related domains, namely Meaningfulness (p = 0.049), Self-Reliance (p = 0.011), Perseverance (p = 0.035), and Existential Aloneness (p = 0.014), compared to men. Significantly higher RS scores were found in older adults being involved in a relationship, compared to those not involved in relationships (p = 0.026), and in older adults with children (p = 0.015), compared to those without offspring, suggesting the importance for older adults of not dealing alone with such a dramatic and stressful event, such as the pandemic. Negative correlations were found between psychological resilience and stress, depression, and anxiety. Linear regressions revealed that lower RS total scores, as well as lower scores in the majority of the RS scales, were associated with greater levels of stress, greater levels of anxiety, and greater levels of depressive symptoms. This study suggested that older women might appear more vulnerable in facing the pandemic, compared to men; having not lived alone through the lockdown period might also be considered as a factor of resilience for older adults.

Social isolation transitions and psychological distress among older adults in rural China: A longitudinal study before and during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic could increase the number of older adults who are socially isolated including community-dwelling older adults, and result in the secondary damage of mental health. This study aimed to examine the longitudinal association between social isolation transitions and psychological distress among the community-dwelling older adults before and during the COVID-19 pandemic in rural China.

METHODS

A total of 2749 community-dwelling older adults aged 60 years and older in rural Shandong, China were included. We used the generalized estimating equations (GEE) model to estimate the impact of social isolation transitions on psychological distress before and during the COVID-19 pandemic.

RESULTS

The percentage of high and very high psychological distress (K10 ≥ 22) was 23.54% and 31.36% before and during the COVID-19 pandemic, respectively, indicating a 7.82% increase (P < 0.001). Compared with the group remaining nonisolated, "became socially isolated" and "remained isolated" groups were more likely to have a deterioration of psychological distress after experiencing the COVID-19 pandemic (became socially isolated: b = 0.92, P < 0.001; remained isolated: b = 0.98, P < 0.001).

LIMITATIONS

The main variables in this study were measured by self-report information, which might result in recall bias.

CONCLUSIONS

During the COVID-19 pandemic, psychological distress increased among the community-dwelling older adults in rural China. There was a significant risk of psychological distress among those who had transitioned from nonisolation before the pandemic to social isolation after experiencing the pandemic, thus intervention on social isolation process during the pandemic may be important to protect older adults' mental health.

Pre-pandemic Psychobiological Features Predict Impact of COVID-19 Confinement on Loneliness

The coronavirus disease 2019 (COVID-19) pandemic led to various government-imposed limitations on social interaction and strict home confinement. Such involuntary social-distancing policies can exacerbate feelings of loneliness and alter emotional well-being. Dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) axis is a potential mechanism for loneliness' deleterious health effects. In this study, we explored whether pre-pandemic diurnal cortisol output (AUC G ), a measure of HPA axis function, may predict the propensity to changes in loneliness during long-term COVID-19 home confinement and if extraversion would moderate this relationship. This association has been explored by analysing the impact of COVID-19 pandemic and strict home confinement on social and emotional loneliness in 45 Spanish young adults. Diurnal cortisol levels were measured from five saliva samples obtained across a day just before the pandemic, and data about participants' perceived loneliness, empathic state, extraversion, and prospective volunteering were obtained both before and during the confinement. Participants' social and family loneliness increased during long-term strict home confinement, while prospective volunteering tendencies and extraversion decreased. Importantly, after adjusting for relevant confounders, moderation analyses revealed that in young adults with high pre-pandemic extraversion, a higher AUC G predicted a larger increase in social loneliness during confinement, while in individuals with low extraversion, AUC G was negatively related to change in loneliness. Our findings highlight the utility of pre-pandemic diurnal cortisol output in predicting the social impact of COVID-19 home confinement, presenting this hormone as a potential biomarker for a priori identification of at-risk groups during public health crises.

Effect of Perceived Social Support on Self-care Agency and Loneliness Among Elderly Muslim People

This study was conducted to investigate the effect of perceived social support on self-care agency and loneliness among elderly Muslim people. This study used a cross-sectional design and included 965 elderly individuals who met the inclusion criteria. There was a positive correlation between perceived social support and self-care agency and a negative correlation between perceived social support and loneliness in elderly muslim individuals (p < 0.05). It is recommended that psychiatric nurses should activate the social support mechanisms of elderly individuals, and necessary follow-ups to increase self-care agencies must be conducted.

The health and well-being of older women living alone in the United Kingdom and beyond: a scoping review

In the United Kingdom (UK), women are more likely to live alone in later life. Social factors such as household composition have been shown to affect health and wellbeing as we age. The health and well-being of older women who live alone are of interest to researchers, care providers, health organizations, and policymakers. This article contributes to the literature by detailing a scoping review, establishing the current evidence in this field. The purpose and context of the review are given. The methodology and resulting data are described. Gaps in the literature and implications for practice and research are given.

The impact of mutual aid on mental health and perceived isolation among the single elderly: An examination of economic status

AIM

This study aimed to identify patterns in mutual aid relationships between older people living alone and their relatives and neighbors, and to examine the impact of mutual aid relationship patterns on mental health and perceived isolation through the mediating effect of subjective economic status.

METHODS

We conducted a survey with 5000 randomly selected adults aged 65 years or older, from the five official senior care service areas of city A in Saitama Prefecture, Japan. Valid responses were received from 3941 participants (78.8%), of whom 436 participants from single-person households constituted the study sample.

RESULTS

Latent class analysis revealed four types of mutual aid: family; family and intra-generational neighbors; no mutual aid; and family and multi-generational neighbors. Regression analysis showed that the interaction effect between family and neighbors' mutual aid and subjective economic status was a significant predictor of depressive symptoms. Simple slope analysis clarified that subjective economic status had a negative effect on depressive symptoms for the non-family/neighbors group, but not for the family/neighbors group. Furthermore, the interaction term between no mutual aid and subjective economic status was negatively associated with the fear of future isolation. Finally, the significantly negative effect observed was greater for the no mutual aid group than for the non-no mutual aid group.

CONCLUSIONS

Mutual aid relationships are effective in improving the mental health and decreasing the fear of future isolation of older adults living alone who experience low economic status. Geriatr Gerontol Int 2021; 21: 555-560.

Long-Term Impact of Social Isolation and Molecular Underpinnings

Prolonged periods of social isolation can have detrimental effects on the physiology and behavior of exposed individuals in humans and animal models. This involves complex molecular mechanisms across tissues in the body which remain partly identified. This review discusses the biology of social isolation and describes the acute and lasting effects of prolonged periods of social isolation with a focus on the molecular events leading to behavioral alterations. We highlight the role of epigenetic mechanisms and non-coding RNA in the control of gene expression as a response to social isolation, and the consequences for behavior. Considering the use of strict quarantine during epidemics, like currently with COVID-19, we provide a cautionary tale on the indiscriminate implementation of such form of social isolation and its potential damaging and lasting effects in mental health.

How do lifestyle choices affect the link between living alone and psychological distress in older age? Results from the AgeHeaPsyWel-HeaSeeB study

BACKGROUND

Social isolation is widespread and strongly associated with worsening health-related outcomes across the life-course. Despite this broad base of knowledge, there is a paucity of research on the interactive effect of lifestyle choices and living arrangements on later life psychological state particularly in low- and middle-income settings. The aim of this study is to examine the influence of living alone on psychological distress in older people and to explore the protective roles of social participation and physical activity participation.

METHODS

We used cross-sectional data from the 2016-17 Aging, Health, Psychological Well-being and Health-seeking Behavior Study (AgeHeaPsyWel-HeaSeeB) involving a representative sample of 1200 adults aged 50+ years in Ghana. The study focused on a latent measure of Kessler Psychological Distress Scale (K10) and on the General Practice Physical Activity Questionnaire (GPPAQ). Ordinary Least Squares (OLS) regression models evaluated the interactive effects of living arrangements and lifestyle choices on the K10 score.

RESULTS

Living alone was independent predictor of psychological distress in the overall sample, among females, urban dwellers and all age groups. However, lifestyle choices of physical activity and social participation significantly moderated these associations. Moreover, in the stratified analysis, physical activity moderated the association for males, rural-dwellers and those 65+ years whilst social participation moderated the association for females, urban-dwellers and those 50-64 years.

CONCLUSIONS

Lifestyle choices i.e. social participation and physical activity, and demographic factors i.e. age, gender, and residential status strongly attenuate the positive association of living alone with the risk of psychological distress in older age. These findings may inform intervention initiatives targeted at improving mental health of chronically detached and isolated older people.

Association between Food Label Unawareness and Loss of Renal Function in Diabetes: A Cross-Sectional Study in South Korea

Objectives: To examine sex differences in the association between food label unawareness and loss of renal function among South Korean diabetic patients aged ≥30 year and determine whether reading food labels when choosing which food products to consume plays a potential role in slowing the progression of renal disease. Methods: Data from the 2016–2017 Korea National Health and Nutrition Examination Survey were used for the analysis. Renal function was determined by the Modification of Diet in Renal Disease estimated glomerular filtration rate, and food label unawareness was defined as being unaware of the food label when choosing a food product for consumption. Multiple regression analysis was used to investigate the association between food label unawareness and loss of renal function among South Korean diabetic patients. Results: Four hundred and eighty-seven diabetic patients (men: 274; women: 213) were enrolled. Loss of renal function was associated with food label unawareness in only male diabetic patients (men: β = –10.01, standard error (SE) = 5.08, p = 0.0506; women: β = –0.30, SE = 5.14, p = 0.9528). A strong association was found between loss of renal function and food label unawareness among socially isolated male diabetic patients who lived in a one-generational household, did not have a spouse, and ate alone. Conclusion: Cultivating habits of reading food labels and inducing social facilitation may play a potential role in managing loss of renal function among male diabetic patients.

The Association between Social Support Sources and Cognitive Function among Community-Dwelling Older Adults: A One-Year Prospective Study

There is evidence that social relationships may modify cognitive decline in older people. We examined the prospective association between social support and cognitive function among community-dwelling older people. Japanese adults recruited at health checkups in suburban towns were surveyed at baseline and one-year follow-up. Cognitive function was assessed using the Montreal Cognitive Assessment, Japanese version (MoCA-J). Social support from coresiding family, non-coresiding family, and neighbors/friends was assessed using self-administered questionnaires. Multivariable linear regression analysis was conducted to examine the effects of social support on MoCA-J scores at follow-up. Data were analyzed from 121 older people (mean age (standard deviation): 73.86 (4.95) years). There was a positive association between social support exchanges with neighbors and friends and MoCA-J scores at follow-up after covariate adjustment (unstandardized β = 1.23, p = 0.006). Social support exchanges with coresiding family and non-coresiding family and relatives were not associated with MoCA-J scores at follow-up (coresiding family: Unstandardized β = 0.28, p = 0.813, non-coresiding family and relatives: Unstandardized β = 0.51, p = 0.238). The provision of emotional support to neighbors and friends had the largest effect on MoCA-J scores. Our findings suggest that social support exchanges with neighbors and friends are protective against cognitive decline.

Accumulated lifecourse adversities and depressive symptoms in later life among older men and women in England: a longitudinal study

This paper investigates the association between accumulated major lifecourse adversities and later-life depressive symptoms among older people in England, both at a single point in time (prevalence) and the onset over time during later life (incidence), using data from the English Longitudinal Study of Ageing. Using retrospective data on the experience of major life adversities from childhood onwards, five latent classes were identified: no/few lifecourse adversities (58.6%), lost relationship (27.0%), chained adversities (2.4%), childhood adversities (6.3%) and war-related adversities (5.7%). Older people who had experienced ‘chained adversities’, ‘childhood adversities’ and ‘a lost relationship’ had higher odds of presenting current depressive symptoms in 2006, even after controlling for socio-demographic characteristics, health-risk behaviours and social resources. Longitudinal analysis indicated that amongst respondents who were clear of depression in 2006, those older people who had experienced childhood adversities, a lost relationship and war-related adversities experienced a higher risk of having a new case of depressive symptoms. Results further indicate that women's mental health in later life is more sensitive to earlier life adversities than men's. The study shows that intervention earlier in the lifecourse may have benefits for the individual both contemporaneously and over the longer term.

Coresidence with a child and happiness among older widows in Europe: Does gender of the child matter?

Both coresidence patterns and the reported well-being of older people vary widely across Europe for a variety of economic, cultural, and historical factors. We investigate how far 2 indicators of well-being, happiness and life satisfaction, vary according to whether or not older women live with their children and, in particular, with son(s) or daughter(s). We compare outcomes for women who are unpartnered widows, the great majority of whom will have had children, so those with and without coresident children may be compared. We use data for 34 countries in Europe by combining 7 waves of the European Social Survey for the period 2002-2014 (N = 18,500). We control for a range of other variables known to be associated with well-being including health status, socioeconomic position, and social support. Results show that widows living with a child were happier than those living without a child (generally alone) but that in Eastern and Southern Europe it was only living with a daughter that had this positive effect. Older age was associated with higher levels of happiness and life satisfaction. Other associations, and regional differences, were as expected with lower levels of happiness in Eastern Europe and for those with poorer health and fewer social resources. These findings indicate the important influence of contextual factors on associations between living arrangements and the well-being of older people and a need for further work on possible negative impacts of living alone on the well-being of older Europeans.

Living Alone or With Others and Depressive Symptoms, and Effect Modification by Residential Social Cohesion Among Older Adults in Japan: The JAGES Longitudinal Study

Background

There is little longitudinal evidence on the impact of specific living arrangements (ie, who individuals live with) on mental health among older adults, and no studies have examined the modifying effect of residential social cohesion level on this association. We aimed to examine the association between living arrangements and depressive symptoms and whether this association varies with residential neighborhood social cohesion level among 19,656 men and 22,513 women aged 65 years and older in Japan.

Methods

We analyzed the association between baseline living arrangements in 2010 and depressive symptoms in 2013. We calculated gender-specific odds ratios (ORs) of living arrangements for depressive symptoms using a logistic regression and conducted subgroup analyses by neighborhood social cohesion level.

Results

Among men (but not women), living alone (OR 1.43; 95% confidence intervals [CI], 1.18–1.73) and living with spouse and parent (OR 1.47, 95% CI, 1.09–1.98) were associated with increased odds of depressive symptoms compared with living with a spouse only. Living with spouse and child was a risk for men in the young age group but a protective factor for women. We also identified that the negative impact of living arrangements on depressive symptoms was attenuated in neighborhoods with higher levels of social cohesion.

Conclusions

Living arrangements are associated with risk of depressive symptoms among men and women; these associations differ by gender and neighborhood social cohesion level. Our results suggest the need to pay more attention to whether individuals live alone, as well as who individuals live with, to prevent depressive symptoms among older adults.

Who Lives Alone During Old Age? Trends in the Social and Functional Disadvantages of Sweden's Solitary Living Older Adults

This study identifies specific social and functional disadvantages associated with living alone during old age in Sweden and assesses whether these associations have changed during recent decades. Data came from repeated cross-sectional surveys of Swedish adults aged 77+ during 1992-2014. Findings indicate that several types of disadvantage are consistently associated with the probability of living alone including financial insecurity and having never married for women and having never married and mobility impairment for men. Also for older men, low education has become an increasing strong determinant of living alone. These findings suggest that older adults who live alone are a subgroup that is particularly, and in some cases increasingly, vulnerable with respect to social and functional status. This has important policy implications related to addressing the needs of this growing subgroup as well as methodological implications for studies on the health effects of living alone.

Elder abuse as a risk factor for psychological distress among older adults in India: a cross-sectional study

OBJECTIVES

This study examines the association between elder abuse and psychological distress among older adults in India and explores whether this association varies by the level of psychosocial and material resources.

DESIGN

The study uses a cross-sectional survey design.

SETTING

The data are drawn from a representative sample of 9589 adults aged 60 and above in seven Indian states-Himachal Pradesh, Punjab, West Bengal, Odisha, Maharashtra, Kerala and Tamil Nadu-in 2011.

STATISTICAL ANALYSES

Secondary analysis, using bivariate and multivariate logistic regression models, is conducted using the United Nations Population Fund project Building Knowledge Base on Ageing in India survey. Elder abuse (physical and/or emotional) emanating from family members in the previous month before the survey is examined. Multivariate models are run on the total analytical sample and for men and women separately.

RESULTS

The overall prevalence of psychological distress among persons aged 60 and over living in the seven Indian States is 40.6%. Among those older persons who experienced some form of physical or emotional abuse or violence in the last month, the prevalence of psychological distress is much higher than that in the general older population, at 61.6% (p<0.001). The results show that the experience of abuse is negatively associated with the mental health of older adults, and this relationship persists even after controlling for demographic and socioeconomic factors (OR=1.60, 95% CI 1.22 to 2.09). The findings also suggest that household wealth has an inverse relationship with mental health, with the association between experiencing elder abuse and reporting poor mental health being strongest among older people in wealthy households.

CONCLUSIONS

Elder abuse in India is currently a neglected phenomenon, and greater recognition of the link between abuse and mental health is critical to improve the well-being of vulnerable older adults, some of whom may be 'hidden' within well-off households.

Impact of Living Alone on Depressive Symptoms in Older Korean Widows

We examined the relationship between living alone and the prevalence of depressive symptoms in older Korean widows and assessed the individual contributions of health, social ties, and socioeconomic factors to the development of depressive symptoms. The study was a secondary analysis using data from widows, 65 years of age and older, who participated in the Living Profiles of Older People Survey (LPOPS). A logistic regression analysis was used to evaluate the contributions of health, social ties, and socioeconomic factors to the development of depressive symptoms. Working status and equivalent household income were significantly associated with depressive symptoms in both those living with others and those living alone. Adjustment for health status and social ties did not change the impact of living alone on the prevalence of depressive symptoms. However, adjustment for equivalent household income eliminated the negative association between living alone and depressive symptoms. Our findings indicate that economic resources are more important than health and social ties for alleviating the negative impact of living alone on the development of depressive symptoms in older widows.

Survival analysis of increases in care needs associated with dementia and living alone among older long-term care service users in Japan

BACKGROUND

Japan is known for its long life expectancy and rapidly aging society that there are various demands of older adults need to be fulfilled with, and one of them is long-term care needs. Therefore, Japan implemented the Long-Term Care Insurance in year 2000 for citizens who are above 65-year old and citizens who are above 40-year old in needs of long-term care services. This study was undertaken to longitudinally examine the influence of dementia and living alone on care needs increases among older long-term care insurance service users in Japan.

METHODS

Long-term care insurance claims data were used to identify enrollees who applied for long-term care services between October 2010 and September 2011, and subjects were tracked until March 2015. A Kaplan-Meier survival analysis was conducted to examine increases in care needs over time in months. Cox regression models were used to examine the effects of dementia and living alone on care needs increases.

RESULTS

The cumulative survival rates before care needs increased over the 4.5-year observation period were 17.6% in the dementia group and 31.9% in the non-dementia group. After adjusting for age, sex, care needs level, and status of living alone, the risk of care needs increases was found to be 1.5 times higher in the dementia group. Living alone was not a significant risk factor of care needs increases, but people with dementia who lived alone had a higher risk of care needs increases than those without dementia.

CONCLUSION

Dementia, older age, the female sex, and lower care needs levels were associated with a higher risk of care needs increases over the study period. Among these variables, dementia had the strongest impact on care needs increases, especially in persons who lived alone.

Life resources and personal goals in old age

It has been theorized that life resources influence goal engagement. The aim of the present study was to examine whether personal characteristics, and socio-economic, social and health resources are associated with personal goal content in old age. The participants were 824 community-dwelling people aged 75-90 from the Life-Space Mobility in Old Age project. Personal goals were elicited using a revised version of the Personal Project Analysis in a structured interview. Cross-sectional bi- and multivariate analyses using logistic regression modelling were conducted. The results showed that the most commonly reported goals were health maintenance related. People with better health resources were more likely to report goals related to leisure-time, social and physical activities and less likely to report goals related to recovery of health. Those with poor social resources were at risk for having no personal goals in their lives. The results are in line with theorizing on the influence of life resources on goal setting in old age. Further longitudinal studies are needed on whether resource loss precedes goal modification, and how goal setting strategies influence both mental and physical well-being in old age.

Factors Influencing the Prevalence of Mental Health Problems among Malay Elderly Residing in a Rural Community: A Cross-Sectional Study

Background and Purpose

Mental health problems are common in old age, but frequently remain undetected and untreated. Mental health problems in the elderly are the result of a complex interaction of social, psychological and biological factors. The aim of this study is to determine the prevalence of mental health problems (depression, anxiety, and emotional stress) and their associated factors among the Malay elderly in a rural community of Perak, Malaysia.

Methods

It was a cross-sectional study. The Malay elderly aged 60 years and above were selected through convenient sampling to give a total of 230 respondents. The Depression, Anxiety, and Stress Scale (DASS-21) was used to assess the symptoms of depression, anxiety, and stress. Bivariate analyses were performed using chi-square tests and multiple logistic regression analyses were conducted to determine the association between the factors and each of the mental health statuses assessed.

Results

The results showed that the prevalence of depression, anxiety, and stress among the elderly respondents was 27.8%, 22.6%, and 8.7%, respectively. The significant factors for depression were single elderly (Adjusted OR = 3.27, 95%CI 1.66, 6.44), living with family (Adjusted OR = 4.98, 95%CI 2.05, 12.10), and poor general health status (Adjusted OR = 2.28, 95%CI 1.20, 4.36). Living with family was the only significant factor for anxiety (Adjusted OR = 2.68, 95%CI 1.09, 6.57). There was no significant factor for stress.

Conclusions

Depression and anxiety among the Malay elderly in the rural community were very worrying. More equity in health should be created or strengthened in order to intensify the opportunity to identify, diagnose, and treat those with mental health problems. Living arrangement in the rural community was an important factor that had influenced depression and anxiety. Therefore, further research is recommended for more comprehensive information, as a result of which appropriate intervention can be made.

Marital Disruption and Allostatic Load in Late Life

OBJECTIVE

This study examines the link between marital disruption and biological risk, and asks whether the association of this precarious life event with health is contingent on marital loss duration and history.

METHOD

Data are drawn from the National Social Life, Health, and Aging Project ( N = 1,414), and Poisson regressions are presented for allostatic load and logistic regressions for individual biomarkers.

RESULTS

The currently unmarried with more distant marital disruptions exhibit higher levels of allostatic load than the currently married, which is primarily driven by dysregulation of cardiovascular and metabolic indicators. Results also reveal the differing ways marital disruption "gets under the skin" with widowhood associated with compromised inflammatory, metabolic, and cardiovascular functioning, and divorce with cardiovascular and neuroendocrine markers.

DISCUSSION

Findings lend support for both the crisis and chronic strain models, and likely reflect normative expectations of the timing of life events, decrements in marital resources, and selection processes.

Changes in life satisfaction when losing one's spouse: individual differences in anticipation, reaction, adaptation and longevity in the German Socio-economic Panel Study (SOEP)

Losing a spouse is among the most devastating events that may occur in people's lives. We use longitudinal data from 1,224 participants in the German Socio-economic Panel Study (SOEP) to examine (a) how life satisfaction changes with the experience of spousal loss; (b) whether socio-demographic factors and social and health resources moderate spousal loss-related changes in life satisfaction; and (c) whether extent of anticipation, reaction and adaptation to spousal loss are associated with mortality. Results reveal that life satisfaction shows anticipatory declines about two and a half years prior to (anticipation), steep declines in the months surrounding (reaction) and lower levels after spousal loss (adaptation). Older age was associated with steeper anticipatory declines, but less steep reactive declines. Additionally, younger age, better health, social participation and poorer partner health were associated with better adaptation. Higher pre-loss life satisfaction, less steep reactive declines and better adaptation were associated with longevity. The discussion focuses on the utility of examining the interrelatedness among anticipation, reaction and adaptation to further our understanding of change in life satisfaction in the context of major life events.

Living situations associated with poor dietary intake among healthy Japanese elderly: the Ohasama Study

BACKGROUND

Rapid increases in life expectancy have led to concurrent increases in the number of elderly people living alone or those forced to change living situations. Previous studies have found that poor dietary intake was common in elderly people living alone. However, there have been few studies about the dietary intake in elderly people living in other situations, particularly those living with family other than a spouse (nonspouse family), which is common in Japan.

OBJECTIVE

To examine the differences in dietary intake by different living situations in elderly Japanese people. We analyzed the data of 1542 healthy residents in the town of Ohasama aged 60 years and over who had completed self-administered questionnaires.

METHODS

The dietary intake was measured using a validated 141-item food frequency questionnaire. Multiple regression models with robust (White-corrected) standard errors were individually fitted for nutrients and foods by living situation.

RESULTS

In men, although the presence of other family was correlated with significantly lower intake of protein-related foods, e.g., legumes, fish and shellfish, and dairy products, these declines were more serious in men living with nonspouse family. Conversely, in men living alone the intake of fruits and vegetables was significantly lower. In women, lower intakes of fruit and protein-related foods were significantly more common in participants living with nonspouse family than those living with only a spouse.

CONCLUSION

These findings revealed that elderly people living alone as well as those living with family other than a spouse had poor dietary intake, suggesting that strategies to improve food choices and skills for food preparation could promote of healthy eating in elderly Japanese people.

Living alone and psychological well-being in mid-life: does partnership history matter?

BACKGROUND

Previous studies have found that the duration since a union dissolution and the number of union dissolutions are associated with psychological well-being. However, these two aspects of partnership history have rarely been considered jointly in models of mental health. This study aims to investigate how the time since the most recent union dissolution and the number of union dissolutions are related to two indicators of psychological well-being-life satisfaction and the General Health Questionnaire-among middle-aged solo-living British men and women.

METHODS

Data from the United Kingdom Household Longitudinal Study from 2009 to 2010 are analysed for 1201 50-64 year olds who were living alone and have ever been in a co-resident union (472 men and 729 women). Logistic regression analysis is used to investigate how life satisfaction and General Health Questionnaire 12 (GHQ-12) caseness are associated with partnership characteristics.

RESULTS

GHQ-12 caseness is significantly and positively associated with the number of union dissolutions and negatively with the duration since the most recent union dissolution. This is the case among both genders, in models in which these partnership characteristics are entered separately and jointly, and in models controlling for parenthood status, socioeconomic status and physical health.

CONCLUSIONS

The results suggest that there is a short-term deterioration in mental health after a partnership break-up and that experiencing multiple union dissolutions is detrimental for psychological well-being. The association between partnership characteristics and the two measures of psychological well-being differs, which is in line with previous research showing that negative affect and life satisfaction are two separate constructs.