An Overview of Social Participation in Older Adults: Concepts and Assessments

Future anxiety and belongingness in young and older adults: An empirical study

BACKGROUND

Human beings, by nature, have many expectations that create a feeling of anxiety about the future, but they are endured and long-ranged. They expect to have relationships with others and need to perceive an emotional interest, an interpersonal bond, and sustainment to continue living. Perceiving this link is required for feelings of belongingness, which decreases future anxiety.

AIM

To investigate the future anxiety and belongingness of young and older adults and determine their relationships.

METHODS

The study was conducted with 404 volunteer participants. Data were collected using the demographic characteristics from the “Dark Future Scale” and “General Belongingness Scale”.

RESULTS

The mean age of older adults was 66.76 ± 3.74, while that of younger adults was 36.72 ± 10.12. The average score for “future anxiety” was 18.81 ± 7.59, and for “general belongingness", it was 63.31 ± 1.40. Findings indicated a reverse correlation between future anxiety and belongingness. A significant difference in belonging scores was observed between young and older adults (P = 0.016, which is < 0.05), whereas no significant difference was found regarding future anxiety scores (P > 0.05).

CONCLUSION

Participants had a moderate level of “future anxiety” and higher “belongingness”. Lower belongingness scores correlated with increased future anxiety. Older adults reported a lower sense of belonging than younger individuals.

Association of Social Participation with Cardiovascular Risk Factors: A Systematic Review

AIM

Although social participation, defined as involvement in social activities, may be beneficial for cardiovascular health, evidence about the association remains limited. This systematic review summarized the relationship between social participation and cardiovascular risk factors.

METHODS

Original articles of longitudinal observational studies published in English before January 1, 2024, were searched via PubMed, Scopus, and Cochrane Library. Two investigators selected eligible literature for four health outcomes: hypertension, diabetes, dyslipidemia, and obesity.

RESULTS

Eight articles (including duplicates) covering cohort studies were included. The results indicated that social participation is associated with lower hypertension risk, but gender differences may exist in the association between social participation and hypertension. Two articles from a Japanese cohort study were found on diabetes, both of which reported significant preventive association with social participation. The only study on dyslipidemia showed a higher hyperlipidemia risk among women, but not men, with social participation. Two studies on the risk of obesity showed inconsistent results, with one reporting the association between social participation and maintenance of smaller waist circumference only among men, while the other found no association with body mass index.

CONCLUSIONS

There is some evidence of the association between social participation and better cardiovascular health outcomes. However, evidence on gender differences and validation of the methodology for measuring social participation was still lacking.

The impact of social activity on cardiovascular disease risk among middle-aged and older adults in China: a nationwide cohort study based on the CHARLS database

Objective

This study aims to examine the relationship between social activity and the risk of cardiovascular disease (CVD) in middle-aged and older adults in China.

Methods

We used data from the China Health and Retirement Longitudinal Study (CHARLS) collected between 2011 and 2020. The study followed 4,099 participants aged 45 and older, all free from cardiovascular disease at baseline (2011), over a 9-year period. CVD status was self-reported by participants. Kaplan-Meier survival curves were employed to illustrate the cumulative incidence of cardiovascular events across different levels of social activity. Cox proportional hazards regression models and restricted cubic spline (RCS) were used to evaluate the association between social activity and CVD risk. Subgroup analyses were conducted to explore potential interactions between social activity and CVD risk, stratified by age, gender, education level, smoking and drinking status, number of chronic conditions, depression, and body mass index (BMI).

Results

A total of 4,099 participants were included in the analysis. Over the 9-year follow-up period, 813 cardiovascular events occurred. After adjusting for age, gender, residence, education, marital status, smoking and drinking habits, chronic disease burden, depression, and BMI, each 0.1 decrease in social activity level was associated with a 7.4% increased risk of cardiovascular events (aHR, 1.074; 95% CI: 1.069-1.079).

Conclusion

Social activity is significantly linked to the risk of cardiovascular disease among middle-aged and older adults in China. These findings emphasize the importance of maintaining social engagement to support cardiovascular health in this population.

Development of evaluation index system for functional ability of older patients with stroke based on healthy aging: a modified Delphi study

Background

The prevalence of stroke in the older population is high and it is critical to promote and maintain the functional status of older patients post stroke. Health measures centered on functional ability can scientifically reflect the health status of older individuals. The aim of this study was to develop an evaluation index system for assessing the functional ability of older patients with stroke based on the World Health Organization Healthy Aging Model.

Methods

Key indicators were identified through literature analysis and semi-structured interviews with 10 older patients with stroke. A two-round expert consultation process was conducted to evaluate and revise the indicators. Subsequently, a hierarchical construction model was established using the analytic hierarchy process to determine the weight of each level indicator.

Results

The evaluation index system comprised three first-level, 13 s-level, and 53 third-level indicators. The weights ranged from 0.143-0.429 for first-level indicators, 0.052-0.349 for second-level indicators, and 0.040-0.667 for third-level indicators.

Conclusion

The developed evaluation index system demonstrates reliability for assessing the functional ability of older stroke patients and provides a standardized framework for nursing staff to conduct functional assessment of older stroke patients.

Themes of togetherness. Examining space sharing sociality among older people

Extensive research demonstrates a positive relationship between social participation and health and well-being in older adults. Yet, knowledge is scarce regarding the diverse practices older individuals employ when engaging with others in everyday life settings. For the purpose, we elaborate on the concept of togetherness to encapsulate the full spectrum of co-located activities. Togetherness embodies a spatiotemporal understanding of sociality, involving "being with" others in shared spaces, times, and projects. We empirically investigate how various forms of togetherness manifest in everyday life and explore the motivation behind immediate and more overarching projects and goals. Drawing on time-space diaries that inform in-depth interviews with 22 older adults (aged 68-85) in Gothenburg, Sweden, our findings reveal that practising everyday togetherness seldom is a standalone project with the explicit purpose of socializing. More often, sociality is integrated into projects with other primary, sometimes overlapping, goals such as maintaining everyday routines, providing structure and rhythm to daily life, breaking away from routines, thriving and feeling safe in a place, and seeking inspiration and creativity in life.

Social Participation Patterns Among Community-Dwelling Older Adults Before and During the COVID-19 Pandemic: Roles of Community Social Cohesion and Health

The objectives of this study were to investigate groupwide variations in social participation among older adults before and during the COVID-19 pandemic and how such variations were associated with their community social cohesion and health. Data were from the National Health and Aging Trends Study (2019-2020; n = 2,597 adults aged 65 or older). Latent class analysis was used to identify groupwide variations in social participation. These variations were then incorporated into adjusted regressions to test relationships with social cohesion and health. Four participation patterns emerged: active, selective independent, occasional, and selective religious participants. Selective independent and occasional participants were likely to live in less socially cohesive communities. During the pandemic, active participants were likely to report better self-rated health and lower risks of depressive and anxiety symptoms and dementia. Findings highlight directions for policy and intervention design that can enhance social participation and support healthy aging.

The association between employment and cognitive function in older adults: A systematic review

The number of working older adults has been increasing in the past decade. Past studies have shown that working has a beneficiary effect on the health of older adults. One of the functions that older adults want to maintain is cognitive function, as this function is essential for an independent and high quality of life. Meanwhile, the association between employment >60 years and cognitive function has not yet been organized. In this study, a systematic review was conducted to clarify the longitudinal association between working older adults and cognitive function. A computerized search was performed using PubMed, CINHAL, and PsycINFO for prospective studies published until July 2023. Of the 76 174 studies identified, six were included in the systematic review based on the inclusion and exclusion criteria. Four studies were from Asian countries (one from Taiwan and three from Japan), and two from the USA. Of the six studies, five reported an association between employment later in life and a lower risk of cognitive decline. Three studies examined the association by performing gender-specific analyses, reporting varied results. Overall, the results of this review suggest that the employment of older adults was positively associated with cognitive function over time. Geriatr Gerontol Int 2024; 24: 1283-1291.

Heterogeneous effects of socio-economic status on social engagement level among Chinese older adults: evidence from CHARLS 2020

Introduction

Older adults benefit from social connections as it aids in their adjustment to the physical and psychological changes that come with aging, thereby improving their health, well-being, and overall quality of life.

Methods

This study utilizes data from the 2020 China Health and Retirement Longitudinal Study (CHARLS) to investigate the influence of Socio-economic Status (SES) on the social activity levels of older persons and the disparities observed among demographic groups, employing the Heckman two-stage analysis and heterogeneity analysis.

Results

The results indicate that SES has a significant positive impact on the social engagement of older adults, and this effect varies across different older groups, with women, married individuals living with a spouse, urban residents, those aged 70-79, and individuals with average health conditions.

Discussion

To effectively address the social needs of older adults, it is essential to prioritize integrating cohesive structural methods that improve social connections. Establishing solid and sustainable social support mechanisms and meeting the social needs of older adults across various SES and demographic groups are crucial in promoting active and healthy aging.

Role of Meaningful Social Participation and Technology Use in Mitigating Loneliness and Cognitive Decline Among Older Adults

IMPORTANCE

Community social participation aids dementia prevention and alleviates loneliness among older adults. Incorporating occupational therapy using information and communications technology (ICT) could potentially delay dementia onset and reduce loneliness.

OBJECTIVE

To quantify how meaningful social participation, participation frequency, ICT use, and expanded social networks influence cognitive function and loneliness among socially active older Japanese adults.

DESIGN

Cross-sectional exploratory study using structural equation modeling.

SETTING

Meetings organized by older adults at seven community gathering places in Osaka Prefecture, Japan.

PARTICIPANTS

One hundred thirteen healthy older adult cohort members.

MEASURES

Cognitive function assessed via Mini-Cog; loneliness assessed via the condensed UCLA Loneliness Scale.

RESULTS

The final model demonstrated excellent fit, χ2(23) = 28.291, p = .205 (root mean square error of approximation = .045, 90% confidence interval [.000, .094]; confirmatory factor index = .995; Tucker-Lewis Index = .993). ICT use directly affected social networks (β = 0.472), which directly influenced participation frequency (β = 0.324) and meaningful social participation (β = 0.381). The indirect effect of meaningful participation significantly improved cognitive function (β = 0.237). The only indirect effect of meaningful interpersonal participation was a reduction in loneliness (β = -0.235).

CONCLUSIONS AND RELEVANCE

ICT use contributes to the expansion of social networks among elderly people. Furthermore, the frequency of social participation and the meaningfulness of such participation are related to reduction in loneliness and maintenance of cognitive function. Although the frequency of social participation was not directly related to these outcomes, the results suggest that meaningful social participation may play an important role in reducing loneliness and maintaining cognitive function. Plain-Language Summary: The promotion of social participation among older people is a global phenomenon, driven by the recognition of its positive relationship with cognitive function and the alleviation of loneliness. Nevertheless, older people's social participation is constrained by a combination of physical and social factors. To address this issue, there has been a push to promote social participation based on information and communications technology (ICT). However, no specific study has been conducted on occupational therapists' perspective in capturing social participation and the use of ICT. The findings of this study show that using ICT has the potential to enhance opportunities for social interaction for older adults, thereby improving the quality and quantity of social participation. The quality of social participation was identified as the sole factor that had a positive impact on cognitive function and loneliness. This study suggests the need for occupational therapists to consider means of facilitating the use of ICTs among older adults as well as interventions that use occupational therapy theory to enhance the meaningfulness of existing social participation opportunities.

Social participation of women with breast cancer compared to the general population 5 years after primary surgery-what role do medical data and cancer-related complaints play?

PURPOSE

This study analyzes levels of social participation in patients with breast cancer on average 5 years following primary surgery as compared to women in the general population. In addition, the role of breast cancer-related complaints and medical data as possible influencing factors on levels of patients' social participation is investigated.

METHODS

A total of n = 454 patients after primary surgery (t0) were recruited for a third follow-up study, and n = 372 completed this survey (t3), corresponding to a response rate of 82.2%. For measuring breast cancer-related complaints, participants completed a written questionnaire. Social participation was measured by a questionnaire on different leisure activities that was taken from the Socio-Economic Panel Study. Medical information was extracted from medical reports at t0. A principal component analysis was carried out to identify different dimensions of social participation. Chi2-tests and logistic regression analyses were applied to analyze social participation as compared to the general population and the role of possible medical and diagnosis-related influencing factors thereby.

RESULTS

Compared to the general population, patients show lower levels of social participation in the domains "socio-cultural participation" and "participation in institutions," while no significant differences for "social participation in the private sphere" and "social participation via social media" were found. Psychological symptoms, pain, and a history of mastectomy were most strongly associated with restrictions in social participation.

CONCLUSIONS

Our study suggests that social withdrawal may happen due to disease-related symptoms, preventing some breast cancer patients from participating fully in society. Cancer-related follow-ups should address this issue and support patients' reintegration into society through appropriate therapeutic interventions.

The impact of social participation on Subjective Wellbeing in the older adult: the mediating role of anxiety and the moderating role of education

Introduction

The study aims to examine the mediating role of anxiety in the relationship between social participation and Subjective Wellbeing among Chinese older adults. Additionally, it investigates the moderating ed of education in this relationship.

Methods

The data came from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) published by peking University, with a sample size of 10,626 individuals aged 60 years and above. SPSS 21.0 was used for the statistical analysis of the data, and Mplus 8.0 was used for the statistical processing of the mediating and moderating effects analysis.

Results

(1) The social participation significantly and positively predicated Subjective Wellbeing; (2) Anxiety partially mediated the eect between social participation and Subjective Wellbeing. The mediating eect value was 0.103; (3) Education plays a moderating role in the impact of social participation on subjective Wellbeing.

Discussion

In summary, social participation can reduce the anxiety and enhance their Subjective Wellbeing. Meanwhile, the eet of social participation on Subjective Wellbeing was the greatest for the older adult with high education. The findings suggest that community-led activities can be initiated to improve social participation in the older adult. Furthermore, educational courses could be to support the healthy aging of older adults in China.

Intrinsic capacity trajectories, predictors and associations with care dependence in community-dwelling older adults: A social determinant of health perspective

AIMS

To identify intrinsic capacity trajectories, predictors of intrinsic capacity trajectories and associations between intrinsic capacity trajectories and care dependence in community-dwelling older adults in China.

METHODS

A retrospective longitudinal study was conducted, and the data were obtained from a five-year national longitudinal cohort study of older adults in China between 2011 and 2015. The social determinants of health framework informed the data analysis and interpretation.

RESULTS

A total of 3893 older adults met the selection criteria and were included in the study. Three intrinsic capacity trajectories were identified: high trajectory (15.7 %), stable trajectory (52.7 %) and declining trajectory (31.6 %). Social determinants contribute to intrinsic capacity decline in older adults. Decreased cognitive function, psychological status, and locomotion at baseline were associated with care dependence.

CONCLUSION

Approximately thirty percent of the older adults in this cohort study experienced a decline in intrinsic capacity within a 5-year period. Social determinants contributed to this decline in older adults.

The Mediating Role of Social Participation in Motoric Cognitive Risk and its Relation to Depression and Loneliness in Older Adults

BACKGROUND

Motoric cognitive risk syndrome (MCR) reduces the quality of life, independence, and social interaction in older adults. Social participation is a potentially modifiable factor that benefits cognitive and mental health. This study explored the mediating roles of social participation between MCR and depression and between MCR and loneliness.

METHODS

We performed a secondary analysis of data from the 2015-2016 National Social Life, Health, and Aging Project. Slow gait speed and cognitive decline were used to assess MCR. Mediation analysis was applied to two models, both of which used MCR as an exposure and social participation as a mediator. The outcomes were depression and loneliness for each model, respectively.

RESULTS

Among 1,697 older adults, 196 (11.6%) had MCR. The mediating role of social participation was statistically significant in both models. The indirect effect (β=0.267, p=0.001) of MCR on depression through social participation comprised 11.97% of the total effect (β=2.231, p&lt;0.001). The indirect effect (β=0.098, p=0.001) of MCR on loneliness through social participation was 19.48% of the total effect (β=0.503, p&lt;0.001).

CONCLUSION

Interventions to increase social participation may reduce depression and loneliness of older adults with MCR.

The Importance of Place Attachment in the Understanding of Ageing in Place: "The Stones Know Me"

As academic literature has shown, there is a preference among older adults to experience old age independently, in their own homes, giving shape to what has been called ageing in place. This phenomenon links residence, life cycle, and the experience of old age. Although it depends on many factors (housing characteristics, the elderly's economy, or their social support, among others) it is based on place attachment as a key aspect, which comprises two different but interwoven dimensions: the home (private space) and the neighbourhood (social space), understood as an extended sphere of the home. Despite its importance, and beyond the consensus that the time spent in a place increases attachment to it, the processes whereby place attachment is constructed by the elderly and the role of the experience of neighbourhood are little known. This article intended to delve into the meaning of place attachment, its importance, and how it is built by the elderly population in urban areas. For this purpose, a qualitative study was conducted in Spain, selecting Madrid (the biggest city in the country) as a case study of how place attachment is shaped in an urban setting. To obtain in-depth information, data were collected through ethnographic interviews with 37 people aged 65-95 and 1 focus group among elderly aged 65-71. The most relevant finding of the qualitative analysis is the emotional significance of attachment to the local space as an element that enables continuity-as opposed to the rupture to which we associate old age- in the experience of the life cycle of the elderly. It should be noted that some of the results are conditioned by the specificities of Spanish society, particularly with regard to family ties. Potential extrapolations to other realities should take this point into account.

Differences According to Sex in the Relationship between Social Participation and Well-Being: A Network Analysis

This study aimed to explore the effects of different types of social participation on the components of well-being, as well as the differences according to sex in the relationship between social participation and well-being. This was a cross-sectional community study. Well-being was measured using the positive emotion, engagement, relationships, meaning, and accomplishment (PERMA) profile. Social participation included activities of daily life, sports and entertainment activities, and social service activities. The independent association between each type of social participation and the components of well-being was examined by using a network analysis in both males and females. Of all 1276 participants surveyed, 60% were females. The results of the network analysis showed that positive emotion-housework (0.263), positive emotion-games (0.102), engagement-housework (0.107), engagement-work (0.054), and meaning-socializing (0.085) had unique connections in males; the average predictability in the network was 0.417. For females, positive emotion-physical activity (0.102), engagement-associations or societies (0.071), relationships-physical (0.090), relationships-socializing (0.092), and relationships-volunteering activities (0.133) had significant connections; the average predictability in the network was 0.358. Different types of social participation may have different effects on the components of well-being. Furthermore, differences according to sex in the relationship between social participation and well-being should be considered when formulating interventions to improve well-being.