Is Living Alone "Aging Alone"? Solitary Living, Network Types, and Well-Being

"Kinlessness," Social Connectedness, and Subjective Well-Being in Europe

OBJECTIVES

This study examines the association between family structure and subjective well-being by focusing on the moderating effects of social connectedness across genders and country contexts. We compare the well-being of older adults across 4 family types: those with both a partner and children, those with a partner but not children, those with children but no partner, and those without a partner and children ("kinless").

METHODS

We use data from 6 waves of the European Social Survey (2012-2024) and estimate ordered logistic regression models of happiness and life satisfaction among middle-aged and older Europeans aged 50-104 (62,687 men and 73,323 women). We include interactions in the analysis to test whether social connectedness mitigates the well-being differences between kinless adults and partnered parents.

RESULTS

The results show that middle-aged and older adults, especially men, without a partner exhibit lower levels of happiness and life satisfaction compared with their partnered counterparts, regardless of the absence of children. The subjective well-being gap between partnered and unpartnered men diminishes according to their level of social connectedness, a moderating effect primarily observed in Nordic and Western European countries.

DISCUSSION

Contrary to the notion that "kinlessness" leads to aging alone, middle-aged and older men in less family-centered countries are able to alleviate the detrimental impact of partnerlessness on subjective well-being through increased social connectedness. In contrast, in countries where family ties are more emphasized, particularly in Eastern Europe, un-partnered adults face greater well-being challenges that are harder to offset with social connectedness.

Older adults living with Alzheimer's Disease, dementia or mild cognitive impairment with no informal caregiver or care partner: IDEA Café, the first pilot randomized trial intervention for this underserved populations

OBJECTIVES

This study presents findings from IDEA Café, for older adults aged 50 and older living with early dementia, dementia, Alzheimer's Disease or cognitive impairment (ED/CI) with no informal caregiver or care partner. IDEA Café is a group adaptation of Innovations in Dementia Empowerment and Action (IDEA) (built upon the foundation of RDAD). It was tested with sexual and gender minority (SGM) older adults, as an underserved population.

METHOD

Employing a two-group randomized controlled pilot trial, thirty participants were randomly assigned to IDEA Café (n = 15) or routine medical care (RMC; n = 15). Feasibility and acceptability were assessed. We conducted pre- and post-treatment assessments of primary and secondary outcomes.

RESULTS

IDEA Café was feasible (attendance, participation), acceptable (helpfulness of the program), and met enrollment goals, with 85% of participants reporting treatment as helpful. The treatment group showed significant improvement in physical functioning (p = 0.04), depressive symptomology (p = 0.03), quality of life (p = 0.04), and a reduction in microaggressions (p = 0.05) and social exclusion (p = 0.03). The RMC showed no statistical change from pretest to posttest.

CONCLUSION

A future randomized controlled trial is needed to test the efficacy and sustainability of the intervention and to bring the intervention to scale.

Assessing the Incremental Health Care Utilization and Expenditures Associated With Serious Psychological Distress by Living Arrangements Among Older Adults

Older adults suffering from serious psychological distress (SPD) have higher health care utilization and expenditures. However, it is unknown whether living alone might further amplify differences in health care usage and costs among older adults with SPD. Using pooled data from 2007-2019 Medical Expenditure Panel Survey, we estimated the incremental care expenditures and utilization associated with SPD among older adults living alone and living with others. The results show that in both living arrangements, having SPD is associated with increases in emergency department visits, hospital admissions, and prescription fill-ups, which leads to higher total prescription expenditures. However, the incremental differences of SPD-related incremental usage and expenditures between older adults living alone and living with others were similar. Our findings call for targeted community programs for older adults that go beyond eliminating physical loneliness, and innovative care coordination strategies that prioritize mental health and preventative care among older adults.

Wellbeing and Retirement in Europe: A Systematic Review with Meta-Analysis

Background/Objectives: Given the observed increase in life expectancy within Europe, it is anticipated that there will be a growing number of retirees and a lengthening of the retirement phase for individuals. This has brought attention to the examination of how the disengagement from professional endeavors influences overall wellbeing. The objective of this investigation was to conduct a comprehensive literature review spanning the period from 1998 to 2024, focusing on the intersection of retirement and wellbeing. Methods: This review (PROSPERO reference: CRD42024621454) was based on scientific articles available in PsycInfo, PubMed, Scopus, SPORTDiscus, and Web of Science, resulting in the inclusion of 32 articles in the systematic review, of which 12 were eligible for meta-analysis. The quality of evidence was evaluated based on the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies checklist. Results: The meta-analysis results revealed that the observed effect size was d = 0.383, considered moderate. This value was statistically significant (Z = 3.197; p = 0.001) with a 95% CI [0.148, 0.617]. The publications were subjected to qualitative analysis, taking into account study type and thematic content. The discernible outcomes were categorized as follows: (1) expectations regarding retirement, (2) preparation for retirement, (3) family relations and grandparenting, (4) quality of life and satisfaction with retirement, and (5) health consequences of retirement. Conclusions: The prevalent approach predominantly comprised quantitative investigations, with a particular focus on exploring the nexus between retirement and health implications, particularly in the context of European participants. This emphasis on health consequences provides a deeper comprehension of this association.

"Successfully" Aging "Alone?": Unequal Global Opportunities and Rising Risks in Family-Based Models of Care Cross-Nationally

BACKGROUND AND OBJECTIVES

For the first time in human history, older adults will outnumber children and a substantial and growing proportion will live alone and lack one or more nuclear family ties. Such unprecedented shifts require a reevaluation of existing models of "successful aging," particularly in terms of long-term care policies.

RESEARCH DESIGN AND METHODS

This paper draws on country-level data from multiple publicly available sources (e.g., World Bank, Organization for Economic Cooperation and Development, Our World in Data, and the World Values Survey) to examine cross-national patterns of development, health, demography, resources and policies, and cultural values in low-, middle-, and high-income countries.

RESULTS

Although there exists substantial heterogeneity across countries, country-level patterns illustrate the economic privilege of living alone and the dominance of "successful aging" opportunities in high-income countries. Cultural values about family reflect standard patterns of economic development, yet friendship emerges as a particularly consistent global value. At the country-level, living alone and health are associated with higher-income countries with lower within-country inequality.

DISCUSSION AND IMPLICATIONS

Aging "alone" is a risk factor in some contexts, yet a marker of privilege in others. Models of "successful aging" are largely unobtainable in lower-income countries or high-inequality countries, and therefore require a thorough incorporation of global realities or final abandonment in favor of more nuanced structural perspectives. Long-term care policies that assume the presence of family will yield increasing risk over time across all global contexts and represent a key vulnerability in the future of healthy aging policy.

Network Types and Functional Health in Old Age: It is Not Just the Size of the Network That Matters

OBJECTIVES

Findings on the effect of network size and support on functional health are mixed. We examine whether network types, that simultaneously incorporate multiple network characteristics, are associated with functional health in late life.

METHODS

Data are from the National Social Life, Health, and Aging Project (N = 3005). We estimated the longitudinal effect of membership in five multidimensional network types on disability in six activities of daily living using negative binomial regression, and on mobility (assessed using a timed walk test) using a generalized linear mixed model.

RESULTS

Compared to those in the large without strain network, older adults in the small, restricted, high contact network had fewer disabilities but worse mobility, while those in the large network with strain also had worse mobility.

DISCUSSION

Care plans focusing on function and mobility should consider multiple aspects of older adults' social networks including network size, diversity, and relationship strain.

Association of the combination of social isolation and living alone with cognitive impairment in community-dwelling older adults: The IRIDE Cohort Study

BACKGROUND

Living alone has been associated with cognitive impairment; however, findings have been inconsistent. Social isolation among older adults who live alone may contribute to cognitive impairment. This study was carried out to examine the association of social isolation and living alone with cognitive impairment in community-dwelling older adults.

METHODS

In this cross-sectional study, data from the Integrated Research Initiative for Living Well with Dementia Cohort Study, which comprises pooled data from five community-based geriatric cohorts, was used. Social isolation was defined as infrequent interactions with others. Participants were categorized into four groups based on their social isolation and living alone statuses. Cognitive function was assessed using the Mini-Mental State Examination, with a score <24 indicating cognitive impairment. The association between social isolation combined with living alone and cognitive impairment was analyzed using logistic regression.

RESULTS

Of the 4362 participants included in the analysis (mean age 75.6 years, 44.3 % male), 11 % had cognitive impairment. Regardless of living alone, social isolation was associated with cognitive impairment (no social isolation x not living alone: reference, social isolation x not living alone; odds ratio (OR): 1.74, 95 % confidence interval (CI): 1.29-2.33, social isolation x living alone; OR: 2.10, 95 % CI: 1.46-3.01).

CONCLUSIONS

Social isolation is associated with cognitive impairment; however, living alone is not intrinsically associated with cognitive impairment in older adults. Healthcare providers must focus on social interactions to prevent cognitive impairment in older adults rather than simply focusing on living arrangements.

Livin' La Vida Sola: Network Diversity and Well-Being in Middle-Aged Adults Living Alone

BACKGROUND

For individuals living alone, having a diverse personal network is considered crucial for mitigating the risk of social isolation and enhancing well-being. Although a reciprocal dynamic between network diversity and well-being is likely, longitudinal evidence supporting reciprocal effects is limited. This study investigates dynamic transactions between network diversity and well-being (life satisfaction, loneliness, and depressiveness) in a community-based sample of middle-aged adults from Germany. It also explores moderations by the duration of living alone.

METHOD

Data were drawn from the three-wave RIKSCHA (Risks and Chances of Living Alone) project, which includes N = 389 middle-aged adults living alone.

RESULTS

Cross-lagged panel models revealed high rank-order stabilities and correlated changes in network diversity and well-being. Random-intercept cross-lagged panel models and dynamic panel models indicated that unobserved traits accounted for these high stabilities. Correlated changes disappeared when accounting for the trait-like stability of variables. Across all models, no evidence of reciprocal associations between network diversity and well-being was found. All results remained consistent regardless of the duration of living alone.

CONCLUSIONS

The study discusses trait factors accounting for the high stabilities observed in network diversity and well-being among middle-aged adults living alone. Future research should further explore the traits impacting successful adaptation to living alone within the context of personal networks.

The Effect of Long-Term (Im)balance of Giving Versus Receiving Support With Nonrelatives on Subjective Well-Being Among Home-Dwelling Older People

OBJECTIVES

Although many studies have explored the benefits of support giving or receiving for older people, little is known about how the balance between giving and receiving instrumental support in nonrelative relationships affects home-dwelling older people. This study examines the relationship between long-term support balance and subjective well-being in relationships with nonrelatives among older people across 11 European countries.

METHODS

A total of 4,650 participants aged 60 years and older from 3 waves of the Survey of Health and Retirement in Europe were included. Support balance was calculated as the intensity difference between support received and support given across 3 waves. Multiple autoregressive analyses were conducted to test the relationship between support balance and subjective well-being, as indicated by quality of life, depression, and life satisfaction.

RESULTS

The impact of balanced versus imbalanced support on all subjective well-being measurements was not significantly different. Compared to balanced support, imbalanced receiving was negatively related to subjective well-being and imbalanced giving was not related to better subjective well-being. Compared to imbalanced receiving, imbalanced giving showed to be the more beneficial for all subjective well-being measures.

DISCUSSION

Our results highlight the beneficial role of imbalanced giving and balanced support for older people compared to imbalanced receiving. Policies and practices should prioritize creating an age-friendly environment that promotes active participation and mutual support among older people, as this may be effective to enhance their well-being.

The impact of the COVID-19 pandemic on frail older people ageing in place alone in two Italian cities: Functional limitations, care arrangements and available services

The study aimed to explore and compare effects of lockdown, due to the COVID-19 pandemic in 2020, on frail older people living alone at home in Brescia and Ancona, two urban cities located respectively in Northern and Central Italy. This country was the Western epicenter of the first wave of the pandemic (February-May 2020), which affected the two cities differently as for infections, with a more severe impact on the former. A follow-up study of the IN-AGE research project (2019) was carried out in July-September 2020, by means of telephone interviews, involving 41 respondents. Semi-structured questions focused on the effects of the first wave of the pandemic on their mobility and functional limitations, available care arrangements, and access to health services. The lockdown and social distancing measures overall negatively impacted on frail older people living alone, to a different extent in Ancona and Brescia, with a better resilience of home care services in Brescia, and a greater support from the family in Ancona, where however major problems in accessing health services also emerged. Even though the study was exploratory only, with a small sample that cannot be considered as representative of the population, and despite differences between the two cities, findings overall suggested that enhancing home care services, and supporting older people in accessing health services, could allow ageing in place, especially in emergency times.

The social readjustment rating scale: Updated and modernised

The Social Readjustment Rating Scale, originally devised in 1967 by Holmes and Rahe, measures the impact of life events stress. At the time, the SRRS advanced its field of research by standardising the impact of stress with a set of independently derived weights called 'life change units' (LCUs) for 43 life events found to predict illness onset. The scale has been criticised for being outdated, e.g. "Mortgage over $10,000" and biased, e.g. "Wife begin or stop work". The aim of this cross-sectional survey study is to update and improve the SRRS whilst allowing backwards compatibility. We successfully updated the SRRS norms/LCUs using the ratings of 540 predominantly UK adults aged 18 to 84. Moreover, we also updated wording of 12 SRRS items and evaluated the impact of demographics, personal experience and loneliness. Using non-parametric frequentist and Bayesian statistics we found that the updated weights were higher but broadly consistent with those of the original study. Furthermore, changes to item wording did not affect raters' evaluations relative to the original thereby ensuring cross-comparability with the original SRRS. The raters were not unduly influenced by their personal experiences of events nor loneliness. The target sample was UK rather than US-based and was proportionately representative regarding age, sex and ethnicity. Moreover, the age range was broader than the original SRRS. In addition, we modernised item wording, added one optional extra item to the end of the scale to evaluate the readjustment to living alone and identified 3 potential new items proposed by raters. Backwards-compatibility is maintained.

The Sensitive Care of the Elder Orphan in Critical Care Environments

All patients within critical care units are vulnerable and many of them are unable to communicate their wishes and needs to the caregivers treating their acute critical illness. This inability to communicate is why interdisciplinary intensive care teams across the country heavily rely on spouses, children, siblings, parents, other next of kin, or other designated medical durable power of attorneys to advocate for those who cannot advocate for themselves. Unfortunately, there is a growing population of elder orphans who lack this support system when they need it the most.

Patterns of Social Isolation and Low Social Support and Frailty Trajectories Among Chinese Older Adults

Objectives: This study aims to identify patterns of social isolation and low social support, and discover their associations with frailty trajectories among Chinese older adults. Methods: The paper used five waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS, 2005-2018). The latent class analysis, multi-trajectory modeling, and the multinomial logistic regression approaches were used to perform the analysis. Results: The paper identified five types of social isolation and low social support, and three typical frailty trajectories. Patterns of social isolation and low social support were associated with frailty trajectories among older adults. Conclusions: Distinct patterns of social isolation and low social support were significantly correlated with frailty trajectories. To improve frailty trajectories among older adults, interventions such as Healthy China 2030 should prioritize addressing the interplay between social isolation and low social support.

The Care Gap in Later Life Across European Countries

OBJECTIVES

Do adults without kin experience a care gap where they need help with activities of daily living but get no help from any source? We examine the prevalence of the care gap across Europe, and test whether those without partners or children substitute for their lack of close kin with help from broader networks, or whether they disproportionately experience care gaps.

METHODS

Using data from the Survey on Health, Ageing and Retirement in Europe, we estimate the care gap in 28 European countries and Israel, how it varies, and who provides help for respondents with different family structures.

RESULTS

The care gap is substantial, with 6.1% of all respondents ages 50 and above reporting a gap. It is highest in Western and Eastern Europe and lowest in Southern Europe and Israel. Respondents without partners or children are significantly more likely to have care gaps than those with close kin. However, respondents without close kin draw more often on more diverse networks of friends and relatives and use nursing home care.

DISCUSSION

Our study introduces the concept of the care gap and shows that although it is most common among unpartnered adults without children it is also quite common for those with immediate family. A broader network partially but not completely substitutes for care gaps among those without immediate family. Our results offer new insights into the demand for public care services in countries with diverse welfare states.

[Older people living alone: the importance of informal non-kin care : Scoping review]

BACKGROUND

The number of older people living alone is constantly increasing. This group faces special challenges regarding remaining at home when their care needs increase, especially in later life. When no family is available, friends and neighbors, so called non-kin carers, are important sources of support.

OBJECTIVE

A literature review was conducted to evaluate existing research on the relevance of non-kin support for older people living alone, from initial limitations to the end of their lives, particularly when they wished to remain at home.

METHOD

The literature search followed the criteria of a scoping review and was conducted in relevant databases and manually. A total of 22 studies were included in the analysis.

RESULTS

Older people living alone are often embedded in complex support networks. Living alone at an advanced age creates tensions between the desire for independence and the need for help. Non-kin carers primarily provide instrumental, emotional, and informational support. Challenges arise due to difficult interpersonal dynamics and the overburdening of non-kin carers, especially when those they support are at the end of their lives.

CONCLUSION

It is important to understand care networks as a complex interplay of different actors. Future research should focus on the specific burdens on non-kin carers as well as on the dynamics of relationships in these care networks.

Factors related to subjective well-being among community-dwelling older adults living alone: A stratified analysis by sex and marital status from the JAGES

BACKGROUND

Previous cross-sectional studies suggest that negative health outcomes such as mortality, social isolation, loneliness, and depression among older adults living alone vary by sex and marital status, with men often worse off than women and unmarried people worse off than married people. However, limited evidence exists from longitudinal studies regarding whether positive health outcomes such as subjective well-being (SWB) also vary by sex and marital status. The focus by sex and marital status on the positive health outcomes and diverse profiles of older adults living alone is important for public health in the near future. Therefore, the purpose of this study was to identify changes in SWB over time and its associated factors by sex and marital status among older adults living alone in the community using a longitudinal study in a representative population.

METHODS

This was a longitudinal study using data from the Japan Gerontological Evaluation Study. This study is the first to reveal differences in SWB and related factors over 3 years among older adults living alone in the community (n = 8,579) who were stratified by sex and marital status (married men, non-married men, married women, and non-married women).

RESULTS

Women moved to higher levels of SWB than did men, and married individuals moved to higher levels of SWB than did unmarried individuals. Independent functioning factors and interpersonal factors were significantly associated with SWB for married men and married women, but for unmarried women, the association by interpersonal factors was more pronounced, and for unmarried men, only limited emotional support and health promotion activities were significant among the interpersonal factors.

CONCLUSIONS

This study revealed that among older adults living alone, changes in SWB over time and the independent functioning factors and interpersonal factors associated with this change varied by sex and marital status among older people living alone. These findings are useful for policy-making and guiding intervention activities to promote SWB in a society in which the environment for older adults living alone is changing dramatically.

Marital-history differences in increased loneliness during the COVID-19 pandemic: A European study among older adults living alone

The COVID-19 pandemic and related physical distancing measures have disproportionally affected older adults living alone due to their greater social isolation. Unlike previous studies on the subject, the current research recognizes the diversity amongst older adults living alone by considering the impact of marital history. Combining information from Wave 8 of the Survey of Health Ageing and Retirement (SHARE), with data of SHARELIFE and the SHARE Corona survey, we investigated the differential impact of the COVID-19 pandemic on loneliness in older men (N = 1504) and women (N = 4822) living alone. Logistic multilevel analyses were performed on data from 26 European countries and Israel. For men, we found that the short-term widowed were more likely to report increased loneliness than the medium- and long-term widowed and those living apart together (LAT). For women, the results indicated that the short- and medium-term widowed and the divorced were at greater risk for increased loneliness than those in a LAT relationship. Also, medium-term widowed women were more likely to report increased loneliness than their long-term widowed counterparts. The three hypothesized underlying mechanisms - i.e., (i) the opportunity mechanism, (ii) the expectation mechanism, and (iii) the vulnerability mechanism - only played a small role in explaining the observed differences. In sum, our study highlights the importance of recognizing the diversity within the group of older adults living alone when investigating the effects of the pandemic on loneliness, yet the mechanisms behind the stratifying role of marital history are not fully understood.

The Risk for Loneliness and Major Depression among Solo Agers

Solo agers may be vulnerable to social isolation and mental health sequelae, particularly if they lack close family or friendship ties. This study examined associations among indicators of solo aging, frequency of loneliness, and Major Depressive Disorder among adults aged 60+. Depressed participants were diagnosed by a geriatric psychiatrist and control participants were not depressed. We hypothesized that older adults with more indicators of solo aging (i.e., living alone, being unmarried, not having family or friends nearby) would be more often lonely and more likely to be depressed. In multivariate analyses controlling for health comorbidities and financial difficulty, each additional solo aging indicator significantly increased the likelihood of frequent loneliness, 95% CI OR [1.50, 2.80], and having a depression diagnosis 95% CI OR [1.04, 2.07]. Solo agers may be vulnerable to loneliness and depression, reinforcing the need for assessment and intervention for social isolation among older adults.

Isolation or Replenishment? The Case of Partner Network Exclusivity and Partner Loss in Later Life

OBJECTIVES

People's partners and spouses often provide a wide range of essential emotional and practical support. As crucial as they may be, a nontrivial segment of the older population appears to limit close discussions to their partner alone, a phenomenon we term "partner network exclusivity." This network structure could leave people vulnerable to partner losses and subsequent social isolation. The present research has 3 aims: (a) examine the prevalence of partner-exclusive networks among European older adults; (b) consider who is most likely to inhabit such networks; and (c) investigate whether and how individuals in such precarious networks rebalance them in case of partner losses.

METHODS

The analysis uses Wave 4 (2011) and Wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) to perform logistic regression on one's possession of partner-exclusive networks and the addition of core ties.

RESULTS

More than a quarter of partnered respondents (28.1%) are in partner-exclusive core networks. Men, childless individuals, and those with financial difficulties are most likely to occupy such networks. Individuals in partner exclusivity are especially likely to enlist additional ties upon partner loss. Nevertheless, men and individuals at early old age are relatively unlikely to rebalance their core networks in case of partner death.

DISCUSSION

This study provides new evidence that network replenishment following relationship disruptions is plausible even for those from precarious network settings. Nevertheless, widowhood produces patterns of vulnerability for a subset of older adults in partner-exclusive core networks.

Solo but Not Alone: An Examination of Social and Help Networks among Community-Dwelling Older Adults without Close Family

This study evaluates help sources for personal and health tasks of adults living in the community without a spouse or nearby children. Using data from the National Health and Aging Trends Study (NHATS), a nationally representative sample of Medicare beneficiaries ages 65 and over, we conducted a population-based study of 2998 community-dwelling adults who received assistance with personal, household, or medical tasks in the past month. Using ANOVA, we compared adults aging solo to those with spouses at home and/or children in the same state. Adults aging solo were significantly more likely to identify non-child/spouse family, friends, neighbors and paid aides as part of their social networks. Their sources of unpaid help included siblings (33%), friends (32%), and non-family (e.g., neighbors (23%)). Adults aging solo were more likely to use paid caregivers, despite having lower incomes than married peers. Interventions to support adults aging solo should incorporate diverse social/help networks.

Profiles of socially isolated community-dwelling older adults during the COVID-19 pandemic: A latent class analysis

OBJECTIVE

To identify different profiles of socially isolated older adults during the first wave of COVID-19 in Quebec, Canada.

STUDY DESIGN

Cross-sectional data were obtained through a telehealth socio-geriatric risk assessment tool, ESOGER, administered to adults aged 70 years or more between April and July 2020 in Montreal, Canada.

MEASURES

Those living alone with no social contacts in the last few days were considered socially isolated. Latent class analysis was performed to identify profiles of socially isolated older adults based on: age, sex, polypharmacy, use of home care, use of a walking aid, recall of current year/month, anxiety level (scale 0-10), and need for follow-up from a healthcare provider.

RESULTS

Three-hundred and eighty (380) older adults identified as socially isolated were analyzed, of whom 75.5 % were female and 56.6 % were over 85. Three classes were identified: Class 1 ("physically frail older females") had the highest proportion of polypharmacy, walking aid, and home care use. Class 2 ("anxious, relatively younger males") were predominantly males who used the least home care but had the highest anxiety levels. Class 3 ("seemingly well older females") had the highest proportion of females, lowest proportion of polypharmacy, lowest anxiety level, and none used a walking aid. Recall of current year/month was similar across the three classes.

CONCLUSIONS

This study found heterogeneity among socially isolated older adults during the first wave of the COVID-19 pandemic with varying levels of physical and mental health. Our findings may contribute to the development of targeted interventions to support this vulnerable population during and after the pandemic.

Volunteering and political participation are differentially associated with eudaimonic and social well-being across age groups and European countries

Voluntary participation is thought to promote the well-being of engaged individuals, especially in old age, but prior evidence on this link is mixed. In the present studies, we used the cross-sectional data from Round 6 (2012) of the European Social Survey (ESS) to investigate the variation in the associations between voluntary participation and eudaimonic (e.g., sense of direction) and social (e.g., perceived social support) well-being across types of participation (nonpolitical volunteering vs. political participation), age groups, and European countries. Study 1 addressed individual-level associations and age differences therein (preregistered at https://osf.io/2p9sz and https://osf.io/6twqe). Two-level multiple regression with an extensive set of control variables showed that at the within-country level, the associations between voluntary participation and well-being indicators were small on average. Nonpolitical volunteering had significantly more positive effects than did political participation, whereas few significant age differences emerged. Study 2 focused on the country-level variables that might explain the substantial cross-national variation in the main effects of voluntary participation (preregistered at https://osf.io/mq3dx). Only GDP per capita was a significant moderator at the country level: The associations of nonpolitical volunteering with eudaimonic well-being were more positive in the European countries with lower GDP. Other country-level variables (Gini coefficient, social welfare spending, and democracy indices) yielded no consistent moderation effects. Study 3 considered potential country-level explanations for the substantial cross-national variation in whether younger or older adults appeared to benefit more (preregistered at https://osf.io/7ks45). None of the country-level variables considered (effective retirement age in men, life expectancy at 65, average age of members of the national parliament and cabinet, and youth unemployment rate) could account for this variation. We conclude that, given the large cross-national variation in the effects of voluntary participation on well-being and in age differences therein, more attention to national specifics is warranted.

How solitude relates to well-being in old age: A review of inter-individual differences

Older adults are more likely to live alone and engage in solitary activities than young adults, leading to decrement in their well-being. However, researchers have discovered beneficial implications of solitude, and some of them even have established that the negative and positive effects of solitude coexist. The study's purposes are to investigate the relationship between solitude and well-being among older adults and to further examine the inter-individual differences in this relationship. In the database of Google Scholar, the systematic review methods are used and 17 articles meet the inclusion criteria. The study concludes that older adults experience solitude both negatively and positively; the complex relationship between solitude and well-being can be better understood and explained by inter-individual differences based on intrapersonal, interpersonal, and cultural factors. This systematic review adopts a perspective that spans individual and social/cultural levels and helps grasp the link between solitude and well-being in older adults. Based on this review, the researcher can develop appropriate interventions to help older people maximize the benefits of solitude while minimizing the drawbacks to further achieve a higher quality of life.

“Even though we are elders living alone”: has social support reshaped the care of older adults during the COVID-19 pandemic?

Purpose

This study aims to explore how social support has reshaped the care of older adults living alone in northeast Thailand during the COVID-19 pandemic.

Design/methodology/approach

This study used a qualitative method using a narrative gerontological perspective with a descriptive design. Purposive sampling was conducted from 20 in-depth narrative interviews between November 2021 and February 2022 in Maha Sarakham province, northeast Thailand. Data transcriptions were performed using a narrative analytical process.

Findings

The in-depth narrative interviews indicated that older adults living alone during the coronavirus pandemic valued a comfortable life, a sense of place, favourable living arrangements, self-reliance, life goals and meaningful life. The gerontological analysis showed that social support for older adults living alone included a social safety net, networking, supporting needs, physical care and mental health responses to the COVID-19 pandemic.

Originality/value

To the best of the authors’ knowledge, this is the first qualitative narrative gerontological study to explore how social support reshaped the care of older adults living alone during the COVID-19 pandemic in northeast Thailand.

Reconfiguring Social Disconnectedness and Its Link to Psychological Well-Being among Older Adults in Rural China

Using data from 2015 to 2018 waves of the Longitudinal Study of Older Adults in Anhui Province, China, this study investigated associations between different forms of social disconnectedness (social isolation, loneliness, living alone) and psychological well-being of older adults longitudinally. The results showed that social isolation and loneliness were independently associated with psychological well-being, whereas living alone was not. Different forms of social disconnectedness had additive and interactive effects on psychological well-being of older adults. Those who were exposed to all three forms of social disconnectedness suffered from the lowest level of psychological well-being. Moreover, the adverse effects of social disconnectedness on psychological well-being were found to be stronger for older women than for older men. The results underscore the necessity to consider multiple forms of social disconnectedness as well as their different combinations in explaining psychological well-being in later life.

The role of social networks in the self-management support for young women recently diagnosed with breast cancer

It is widely acknowledged that social network support plays an important role in the quality of life and illness management of breast cancer survivors. However, the factors and processes that enable and sustain such support are less well understood. This paper reports baseline findings from a prospective UK national cohort of 1,202 women with breast cancer (aged <50 years at diagnosis), recruited before starting treatment, conducted in 2016-2019. Descriptive, univariate and multivariate regression analyses explored associations between the individual, and network member characteristics, and the type of support provided. Social network members provided a substantial level of illness-related, practical and emotional support. Highest contribution was provided by friends, followed by close family members. The social network members of women who did not have a partner provided a higher level of support than those in networks with a partner. Women without higher education were more reliant on close family members than those with higher education, and this was more so for women without a partner. Women with higher education without a partner were more reliant on friends and were overall best supported. Women without higher education who did not have a partner were overall least well supported. They had much smaller networks, were highly reliant on close family members, and on high level contributions from all network members. There is a need to develop network-based interventions to support people with a cancer diagnosis, prioritising support for the groups identified as most at risk. Interventions that support engagement with existing network members during treatment, and those that help extend such networks after treatment, are likely to be of benefit. A network perspective can help to develop tailored support and interventions by recognising the interactions between network and individual level processes.

Living Alone and Depressive Symptoms among Older Adults in the COVID-19 Pandemic: Role of Non-Face-to-Face Social Interactions

OBJECTIVE

This study examined the association of living alone with changes in depressive symptom status and the moderating effect of non-face-to-face social interactions among older adults during the coronavirus disease (COVID-19) pandemic.

DESIGN

A longitudinal study.

SETTING AND PARTICIPANTS

This study recruited individuals aged ≥ 65 years without long-term care in one semi-urban city in Japan, who completed mailed questionnaires in March (baseline) and October 2020 (follow-up).

METHODS

Based on depressive symptoms assessed by the Two-Question Screening at baseline and follow-up, participants were classified as: "non-case," "onset," "remission," and "persistence." Non-face-to-face social interactions during the pandemic, including phone calls or emails with separated families or friends, were dichotomized as "less than weekly interactions" and "weekly interactions." A multinomial logistic regression analysis was conducted to examine the association of living arrangement (living alone or together) with changes in depressive symptoms status.

RESULTS

Data of 1001 participants were analyzed (mean age = 79.9 years). Of them, 13.8% lived alone. Overall, 40.6% participants were grouped as "non-case," 11.7% as "onset," 11.0% as "remission," and 27.1% as "persistence." Living alone was significantly associated with depressive symptom onset (odds ratio: 1.92; 95% CI: 1.03-3.56; P = .039), and a negative interaction (protective effect) was found between living alone and weekly non-face-to-face social interactions for depressive symptom onset.

CONCLUSION AND IMPLICATIONS

During the pandemic, older adults living alone had a higher depressive symptom risk, but non-face-to-face social interactions may have buffered this risk. Our findings suggest the importance of supporting older adults living alone in times of social restrictions such as the pandemic, and furthermore, maintaining social connections, including non-face-to-face relationships, is necessary to protect their mental health.

Loneliness before and during the COVID-19 pandemic-are unpartnered and childless older adults at higher risk?

COVID-19 mitigation efforts had the potential to exacerbate loneliness among older adults, particularly for the unpartnered or childless, yet specific studies on loneliness among these groups during the COVID-19 pandemic are lacking. Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) collected before (October 2019-March 2020) and during the pandemic (June-August 2020), we examine two loneliness outcomes: (1) "have you felt lonely recently?" (both datasets) and (2) "have you felt lonelier than before the pandemic?" (2020), and examine differences by partnership and parenthood status. Before COVID-19, those who lacked one tie but had the other (unpartnered parents or partnered childless) were at highest loneliness risk. During COVID-19, unpartnered and childless-especially unpartnered-remain at higher risk for loneliness, entering loneliness, and not "exiting" loneliness. We discuss these findings in light of family norms and needs in pandemic and non-pandemic times and provide recommendations for future research.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10433-022-00718-x.

Relationship of social isolation with mental distress among older Korean Americans: The moderating role of social cohesion

Social isolation has been associated with poor mental health outcomes, particularly for older immigrants who do not have a protective social environment. The purpose of this study was to investigate the relationship of social isolation (living alone, marginal family ties and marginal friend ties) with mental distress and to examine the moderating role of social cohesion (family cohesion and community cohesion). We hypothesised that social isolation and social cohesion would be directly associated with mental distress and that social cohesion would buffer the influence of social isolation on mental distress. Data were drawn from the Study of Older Korean Americans (SOKA), which included 2150 older Korean Americans aged 60 or over in multiple areas, collected during 2017-2018. A series of hierarchical regression models of mental distress examined the direct and interactive role of social isolation and social cohesion. Approximately one-third of the sample lived alone, 20% had marginal family ties and 27% had marginal friend ties. All three indicators of social isolation had a significant direct effect on mental health; however, living alone lost its statistical significance with the inclusion of social cohesion variables. Both indicators of family and community cohesion were significantly associated with lower levels of mental distress. In addition, family cohesion buffered the negative effects of marginal ties to family and friends on mental distress. The significant role of a positive social environment must be considered when addressing the needs of older immigrants who are socially isolated.

Community-Dwelling Older Adults' Intended Use of Different Types of Long-Term Care in China and Its Associated Factors Based on the Andersen Behavioral Model

In light of the increased demand for long-term care services in China, there is an ongoing discussion on what factors contribute to older adults' intended use of long-term care services. This study empirically recruited 239 community-dwelling older adults aged ≥60 years in China and explored factors influencing their intended use of four types of long-term care (basic life care, basic medical care, rehabilitation care, and psychological care) based on the Andersen behavioral model (i.e., predisposing characteristics, enabling resources, and need factors). The results showed that older adults were most likely to use psychological care. Age (as the predisposing characteristic) was the significant predictor of the intended use of four types of care. Regarding the intended use of basic life care, the enabling resources of marital status, household composition, income, as well as need factors of preference for the care setting, were influential. Moreover, income and need factors of self-rated physical health status were only two variables associated with the intended use of basic medical care. Concerning the intended use of rehabilitation care, household composition, income, self-rated physical health status, and preference for the care setting were significant predictors. The intended use of psychological care was influenced by enabling resources of marital status, household composition, and need factors of self-rated physical health status, preference for the care setting, and preference for the caregiver. These results can promote the sensitivity of policymakers and caregivers to the community-dwelling older adults' intended use of long-term care and contribute to the delivery of appropriate care services by public policy.

The partner in the plate: the association between changes in partnership status and protein consumption among older people in Europe

Experiencing a change in partnership status at older ages might have detrimental effects on an individual's habits, including eating behaviours. Prior studies presented evidence that widowhood is related to altered diets with a decrease in the amount of protein consumed, which is considered to be an important risk factor of frailty among older people. Using data from Waves 4–8 of the Survey of Health, Ageing and Retirement in Europe (N = 134,313), we investigate the association between stability and changes in partnership status and changes in the frequency of protein consumption at older ages. We also explore the potential moderating role played by changes in economic resources. Having never been married, being divorced and being widowed were significantly associated with a lower frequency of protein consumption among both men and women. The transition to widowhood was significantly associated with a reduction in the frequency of protein consumption, while this same association was not found in the transition to divorce. Subjective evaluation of economic resources did not moderate the relationship between changes in partnership status and frequency of protein consumption. In short, changes in eating behaviours after having experienced the loss of a partner due to widowhood might contribute to accounting for health differentials between those ageing alone and those with a partner.

Competing Risk Analysis of Time to Communal Residence for Elder Orphans

Elder Orphans, socially/physically isolated older adults without caregiving support, are of interest in an aging population. Lack of caregivers for Elder Orphans may influence relocation to residential care facilities, including skilled nursing or assisted living facilities, compared to aging in place. Using the National Health and Aging Trends Study (NHATS), Competing Risk Survival Analyses were performed to determine if Elder Orphans or those At Risk for becoming elder orphans had increased risk for residential care relocation over nine NHATS waves (2011-2019). Elder Orphans had significantly higher risk for moving to residential care facilities in unadjusted (SHR = 1.780; p = 0.001) and adjusted (SHR = 1.571; p = 0.043) models. Those At Risk for becoming an elder orphan had significantly decreased risk for residential care residence in unadjusted (SHR = 0.517; p < 0.001) and adjusted (SHR = 0.726; p = 0.037) models. As aging in place becomes prioritized in the US healthcare system, understanding caregiving needs of older adults is vital to their health outcomes.

Relationship Status and Well-Being in the Context of the COVID-19 Pandemic

The purpose of this study was to examine well-being, loneliness, and hope among single and partnered adults in the context of the COVID-19 pandemic. A total of 560 adults in the U.S. (50.2% female, 48.9% male, 28.7% single, 71.3% partnered) completed an online survey regarding their experiences amid the global health crisis. Results indicated that single and partnered individuals reported similar experiences of loneliness, hope, and well-being. Furthermore, hope served as a significant positive predictor of psychological well-being for both single and partnered individuals. Single and partnered individuals also engaged in a similar number of social interactions during the pandemic. The nature of these interactions (i.e., in-person vs. digital), however, uniquely predicted well-being across relationship status. Among single individuals, connecting with others in person significantly predicted well-being, whereas digital connections did not. The inverse was found for partnered individuals, where digital connections predicted well-being, but in-person interactions did not.

Older adults' experiences of loneliness over the lifecourse: An exploratory study using the BBC loneliness experiment

PURPOSE

To explore older adults' experiences of loneliness across the lifecourse and the relationship with current loneliness.

METHODS

Our sample is 6,708 people aged 65 years and older, resident in the UK, who participated in the BBC Loneliness Experiment in spring 2018. Loneliness was assessed using the 3 item UCLA Loneliness Scale, using a threshold score of 6+ to define loneliness. Participants were asked if they had experienced loneliness in 5 life-stages ranging from childhood to old age and, if so, at which stage had they experienced loneliness most intensely. Multivariate logistic regression analysis was used to estimate the odds ratios of experiencing loneliness in relation to previous experiences of loneliness and key covariates.

FINDINGS

41% of participants reported current feelings of loneliness and were more likely than those who did not to spend time alone, have poorer self-rated health, be unmarried, have fewer financial resources, and lower levels of neighbourhood trust. 71% reported they had experienced loneliness at some previous stage in their life, with 26% experiencing it in childhood (5-15 years and 39% as a young adult (16-24 years). Having had three or more prior life stage experiences of loneliness was an independent risk factor for current loneliness.

CONCLUSION

We highlight the potential importance of examining older adults' experience of loneliness within a lifecourse perspective. We suggest a research agenda that examines the importance of the number and timing of previous loneliness experiences and investigates the strategies used to cope with loneliness across the lifecourse as a pathway to developing more effective and personalised loneliness interventions.

Social Network and Environment as Determinants of Disability and Quality of Life in Aging: Results From an Italian Study

Background

The increase in life expectancy is leading to a worldwide increase in chronic diseases and disability, with significant concern about their management and long-term care. Investigating the aging process using a bio-psychosocial perspective is essential to understanding how to reduce disability and improve the quality of life of aging people. This study aims to explore the role of social networks and built environment as predictors of disability and quality of life in the Italian population aged over 50 years.

Materials and Methods

The research protocol is composed of several tools: World Health Organization Disability Assessment Scale 2.0 (WHODAS 2.0), World Health Organization Quality of Life Assessment in Aging (WHOQOL-AGE), Social Network Index (SNI), the Courage Built Environment Self-Reported Questionnaire (CBE-SR), and collection of sociodemographic information and information on health system coverage.

Results

A total of 431 people were administered the protocol, and among them, 209 were males and 222 were females, with a mean age of 70 years. The majority of the sample reported earning a middle or high school diploma, and 60.6% of the sample declared to have a good health status. The results showed that people with a good social support network have higher levels of functioning and quality of life. However, the built environment did not significantly predict either disability or quality of life.

Conclusions

These results could provide elements for dialogue with institutions and policymakers. This is fundamental to develop active policies aimed at the implementation of services and systems to promote healthy aging process.

Multidimensional Social Network Types and Their Correlates in Older Americans

Background and Objectives

Social support networks of older adults have been linked to their health and well-being; however, findings regarding the effects of specific network characteristics have been mixed. Additionally, due to demographic shifts increasing numbers of older adults live outside of traditional family structures. Previous studies have not systematically examined the resulting complexity and heterogeneity of older adults’ social networks. Our objectives were to examine this complexity and heterogeneity by developing a multidimensional typology of social networks that simultaneously considers multiple structural and functional network characteristics, and to examine differences in network type membership by sociodemographic characteristics, health characteristics, and birth cohort.

Research Design and Methods

Participants included 5,192 adults aged 57–85 years in the National Social Life, Health, and Aging Project at rounds 1 (2005–2006) and 3 (2015–2016). Data were collected on social relationships including network size, diversity, frequency of contact, and perceived support and strain in relationships. We used latent class analysis to derive the network typology and multinomial logistic regression to examine differences in network type membership by sociodemographic characteristics, health characteristics, and birth cohort.

Results

Older adults were classified into 5 distinct social network types: (i) large, with strain; (ii) large, without strain; (iii) small, diverse, low contact; (iv) small, restricted, high contact; and (v) medium size and support. Membership in these network types varied by age, gender, marital status, race/ethnicity, education, mental health, and birth cohort.

Discussion and Implications

Network typologies can elucidate the varied interpersonal environments of older adults and identify individuals who lack social connectedness on multiple network dimensions and are therefore at a higher risk of social isolation.

Close ties, near and far away: patterns and predictors of geographic network range among older Europeans

A growing number of older adults maintain connections in their core discussion networks at variant distances, raising concerns about the lack of discussants in proximity and the consequences on their social life. This study examines the typical geographic layouts for aging Europeans' core discussion networks and their implications for network function and quality. With a sample of community-dwelling respondents aged 50 and above from the Survey of Health, Aging, and Retirement in Europe, the present research identifies seven geographic layouts that extend previously identified family and diverse network types by adding spatial nuance. Individuals in mid-range and distant-family networks typically lack a discussant nearby but sustain high emotional closeness with family discussants at a distance and express high overall satisfaction with their network. Proximate-diverse networks with a strong representation of non-kin members nearby turn out to be less advantageous than prior research might suggest, providing relatively frequent contact but the lowest level of network satisfaction. Results also identify how individual characteristics link to the geographic layouts and describe their prevalence across European regions. Overall, relatively dispersed layouts are common for older adults across multiple countries and do not necessarily indicate lower emotional closeness and network satisfaction. The present study highlights the importance of looking beyond the mere presence of proximate connections in older adults' core networks.

A Mixed-Methods Analysis of Care Arrangements of Older People with Limited Physical Abilities Living Alone in Italy

Older people with limited physical abilities, who live alone without cohabiting family members, need support ageing in place and to perform daily living activities. In this respect, both the available informal and formal care seem crucial. The present study aimed to explore the current role of the care arrangements of older people, especially if they have functional limitations. Qualitative interviews were carried out in 2019 within the “Inclusive ageing in place” (IN-AGE) research project, involving 120 older people who lived at home, alone, or with a private personal care assistant (PCA) in three Italian regions (Lombardy, Marche, and Calabria). A mixed-methods analysis was conducted. Results showed that support networks are still mainly made up of family members, but also of domestic home help (DHH) and PCAs, friends/neighbours, and public services, albeit the latter provide support in a residual way, while the former is not as intensive as it was in the past. Frequency and geographical/living proximity of help play a role, emerging also as a territorial differentiation. The paucity or absence of support, especially from the family, risks compromising the ability of ageing in place. It seems, thus, necessary to innovate and improve, in particular, home services, also through real formal and informal care integration.

The Physical, Mental, and Social Health of Middle-Aged and Older Adults without Close Kin in Canada

OBJECTIVES

We examine whether adults 45+ lacking a partner and children are disadvantaged in terms of physical, mental, and social aspects of health. Then we test whether the importance of family structure for these outcomes varies by age, gender, and educational attainment.

METHODS

We examine aging and social network modules from the Canadian General Social Survey to estimate associations between family structure and physical, mental, and social health, with the last measured as communication with relatives and friends, civic participation, and loneliness.

RESULTS

Results show that middle-aged and older adults without partners have lower levels of physical and mental health and higher levels of loneliness than those with partners. Those without partners and children (the "kinless") interact less with relatives than those who have children but not partners, but more with friends, showing some substitution. In terms of civic participation, kinless middle-aged and older adults have significantly lower odds of this type of engagement than peers with close kin. Our interaction models find some differences by age, gender, and education, which vary by the outcome.

DISCUSSION

Our results highlight some concerns about the well-being of kinless adults in Canada, especially as related to physical and mental health and two aspects of social health, loneliness, and civic participation. We find some substitution occurring, whereby middle-aged and older adults without family are interacting more with friends than comparable peers, but such substitution is marginal.

Compensatory Connections? Living Alone, Loneliness, and the Buffering Role of Social Connection among older American and European Adults

OBJECTIVE

The growth of solo living has important implications for the rising "loneliness epidemic" among older adults. This study considered whether two forms of social connectedness-extra-household core discussion networks and social participation-buffer the loneliness associated with living alone.

METHOD

Our study used data from two surveys (National Social Life, Health, and Aging Project; Survey of Health, Ageing and Retirement in Europe) encompassing 20 developed Western countries in 2009/2010 and 2015/2016 (n = 110,817). Harmonizing measures across data sets, we estimated survey-specific and pooled longitudinal regression models with interaction terms.

RESULTS

High levels of social connectedness only moderately buffered the loneliness associated with living alone in later life. Findings were largely consistent across regions of Europe and the United States, though the buffering patterns were most robustly identified for widowed solo dwellers.

DISCUSSION

Extra-household connections are partial compensators, but do not seem to fully replace the ready companionship afforded by residential co-presence in later life. Future research is needed to understand whether the efficacy of compensatory connections differs by gender, race/ethnicity, and across more diverse global regions.

Gender differences in years of remaining life by living arrangement among older Singaporeans

Living arrangements of older adults have often been studied as a measure of the support available to them. Given the rapidly ageing and low fertility context of Singapore where the prevalence of older adults living alone and without children is expected to increase, we construct multistate life tables to estimate the number of years that older persons can expect to live in different living arrangements at a population level (population-based) as well as based on their initial living arrangement (status-based). We focus particularly on whether there are gender differences in the expected years of life in different living arrangement states. We use the Panel on Health and Ageing of Singaporean Elderly, a 2009 nationally representative survey of 4990 Singaporeans aged 60 years and older, with follow-up surveys in 2011 and 2015. In calculating the probabilities of transition between different states, we control for number of children, housing type, and time-varying ADL limitations. We find that at age 60, women can expect to spend more than twice the proportion (18%) of their remaining lives living alone compared to men (7%). Status-based estimates indicate that the proportion of remaining years living with a child is higher for women initially living alone, with a spouse only or already with a child, compared to males. Our results indicate that while older women are more likely to live alone compared to their male counterparts, older women living alone are also more likely to transition to living with children. Our research sheds light on the importance of expanding research on life expectancy beyond health, to consider analysis using other forms of social stratification, particularly gender differences in states of living arrangement.

Supplementary Information

The online version of this article contains supplementary material available at 10.1007/s10433-020-00594-3.

Decoupling of Elderly Healthcare Demand and Expenditure in China

This study examined the changing trajectory and factors that influenced the health and medical expenditure of the Chinese elderly population over the past two decades. Based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018, inferential and multiple linear regression models were constructed. The key finding is that China has experienced a decoupling of healthcare demand (HCD) and healthcare expenditure (HCE) since around 2014, when HCE began to decline despite the fact that HCD continued to rise. This is a promising sign, suggesting that the government's health insurance policy is working. Furthermore, participating in health insurance schemes can significantly reduce the elderly's HCD and HCE, demonstrating that health insurance can effectively affect the elderly's decision to seek medical treatment and improve their health condition. We also found that age, region, basic old-age insurance, and care by the government and institutions were significant factors that influenced the healthcare demand and expenditure of the elderly population.

Maintenance of high quality of life as an indicator of resilience during COVID-19 social distancing among community-dwelling older adults in Finland

PURPOSE

Social distancing during the COVID-19 pandemic reduced possibilities for activities of choice potentially threatening quality of life (QoL). We defined QoL resilience as maintaining high quality of life and studied whether walking speed, absence of loneliness, living arrangement, and stress-coping ability predict QoL resilience among older people.

METHODS

Community-dwelling 75-, 80-, and 85-year-old persons (n = 685) were interviewed and examined in 2017-2018 and were followed up during COVID-19 social distancing in 2020. We assessed QoL using the OPQOL-brief scale and set a cut-off for 'constant high' based on staying in the highest baseline quartile over the follow-up and categorized all others as having 'low/moderate'. Perceived restrictiveness of the social distancing recommendations was examined with one item and was categorized as 'yes' or 'no' restrictiveness.

RESULTS

Better stress-coping ability (OR 1.21, 95% CI 1.14-1.28) and not being lonely (OR 2.67, 95% CI 1.48-4.63) increased the odds for constant high QoL from before to amid social distancing, and the odds did not differ according to the perceived restrictiveness of the social distancing recommendations. Higher walking speed predicted constant high QoL only among those perceiving restrictiveness (OR 1.16, 95% CI 1.07-1.27). Living arrangement did not predict constant high QoL.

CONCLUSION

During social distancing, psychosocial resources helped to maintain good QoL regardless how restrictive the social distancing recommendations were perceived to be. Better physical capacity was important for constant high QoL only among those perceiving restrictiveness presumably because it enabled replacing blocked activities with open outdoor physical activities.

The structural equation modeling of personal aspects, environmental aspects, and happiness among older adults living alone: a cross-sectional study

Background

The happiness of older adults living alone warrants attention because they are more vulnerable to unhappiness than those living with families. The present study aimed to construct and test a structural equation model to elucidate the relationship among participation in social activities, satisfaction with the neighborhood environment, subjective health status, and happiness in older adults living alone in South Korea.

Methods

Secondary data of 2768 older adults (605 males and 2163 females) living on their own were extracted from the 2017 Korean Community Health Survey and used in this cross-sectional study. Data were collected via self-reported questionnaires and analyzed using SPSS version 20.0 and AMOS version 20.0.

Results

The hypothetical model exhibited a good fit: χ² = 342.06 (df = 58, p < .001), goodness-of-fit index = .98, adjected goodness-of-fit index = .97, root mean square error of approximation = .04, and nonstandard fit index = .92. Participation in social activities had a significant effect on participants’ subjective health status (path coefficient = .45, p = .001) and happiness (path coefficient = .20, p = .003).

Conclusions

Interventions to improve the health and happiness of older adults living alone should aim to enhance their social and physical environmental dimensions based on the participants’ various social activities and their neighborhoods’ characteristics.

Development of an Anomaly Alert System Triggered by Unusual Behaviors at Home

In many countries, the number of elderly people has grown due to the increase in the life expectancy of the population, many of whom currently live alone and are prone to having accidents that they cannot report, especially if they are immobilized. For this reason, we have developed a non-intrusive IoT device, which, through multiple integrated sensors, collects information on habitual user behavior patterns and uses it to generate unusual behavior rules. These rules are used by our SecurHome system to send alert messages to the dependent person’s family members or caregivers if their behavior changes abruptly over the course of their daily life. This document describes in detail the design and development of the SecurHome system.

A national profile of kinlessness at the end of life among older adults: Findings from the Health and Retirement Study

BACKGROUND/OBJECTIVES

The majority of end-of-life (EOL) caregiving is provided by unpaid family members. An increasing number of older adults are kinless (without close family/partnerships) and may have insufficient caregiver support to remain at home at the EOL. We therefore determined what proportion of older adults are kinless at the EOL and assessed the association of kinlessness with EOL care.

DESIGN

Retrospective analysis of Health and Retirement Study decedents, 2002-2015.

SETTING

US population-based sample.

PARTICIPANTS

Decedents age 51+ who died within 1 year of interview (n = 3844) and subset who are community-dwelling at last interview.

MEASUREMENTS

Kinlessness was defined as lacking a spouse/partner and children. Primary outcome measure was location of death. Secondary outcome measures included contextual EOL measures such as symptom burden and caregiver support.

RESULTS

A total of 7.4% of decedents were kinless at the EOL. Kinless decedents were more likely to be female, nonwhite, enrolled in Medicaid, living alone, or living in a nursing home prior to death. Although community-dwelling kinless decedents received fewer hours of caregiving per week at the EOL (34.7 vs. 56.2, p < 0.05) and were more likely to die in nursing homes (18.1% vs. 10.3%, p < 0.05) than those with kin, they did not have higher EOL symptom burden or treatment intensity (e.g., intensive care unit use). In multinomial logistic analysis controlling for demographic and illness characteristics, kinless decedents living in the community before death had a twofold increased risk of dying in the nursing home (odds ratio [OR] = 2.02 [95% confidence interval (CI) = 1.09-3.72]) and a trend toward increased risk of hospital death (OR = 1.60 [95% CI = 0.96-2.69]) versus home setting.

CONCLUSIONS

Kinless individuals are more likely to die in nursing homes, even if they are living in the community in their last year of life. Expanded long-term care services and policies are needed to enable all older adults regardless of their family support systems to receive high-quality EOL care.