Anxiety of Older Persons Living Alone in the Community

Prevalence and correlates of anxiety and depression among chronically ill older adults in Zunyi, China: a cross-sectional study

Background

Against the background of an aging population, the prevalence of mental health problems among elderly people with chronic diseases is steadily increasing. The prevalence of mental health problems is higher in less economically developed regions, but there are still limited reports on the mental health data of elderly people with chronic diseases in less developed western regions.

Objective

To find out the prevalence of anxiety and depression among chronically ill elderly people in Zunyi, China, and to analyze the risk factors for the prevalence of anxiety and depression.

Methods

A stratified randomized whole-cluster sampling method with face-to-face questionnaires was used to survey people aged 60 years and older with chronic diseases in Zunyi, China, from March 2022 to October 2023. Relevant demographic and clinical data were collected using structured questionnaire contents of sociodemographic characteristics, Self-Assessment Scale for Anxiety (SAS), Geriatric Depression Scale (GDS-15), Brief Miniature Nutritional Assessment Scale (MNA-SF), Pittsburgh Sleep Quality Index (PSQI), Barthel Index (BI), etc., and bivariate analyses were carried out to explore the anxiety according to the different characteristics of the subjects Bivariate analyses were conducted to explore the differences in anxiety and depression according to the different characteristics of the subjects, and multifactorial logistic regression analyses were conducted to test the factors affecting anxiety and depression.

Findings

A total of 9,998 subjects were enrolled in this study, and 9,821 valid questionnaires were obtained. The prevalence of anxiety was 26.83% (95% CI: 26.00-27.70), the prevalence of depression was 10.33% (95% CI: 9.70-10.90), and the prevalence of anxiety combined with depression was 6.88% (95% CI: 6.40-7.40). The chronic diseases included in this study encompass cardiovascular diseases, endocrine system diseases, cerebrovascular diseases, degenerative diseases, respiratory system diseases, digestive system diseases, kidney diseases, and cancer. Compared to patients with other chronic diseases, those suffering from cardiovascular diseases exhibit a higher prevalence of anxiety, depression, and the co-occurrence of both anxiety and depression. The results of multifactorial logistic regression analysis showed that advanced age, high literacy, high average monthly household income, regular physical exercise, adequate material and emotional support, and mild dependence in daily life were protective factors for depression among chronically ill older adults (P < 0.05). Living in rural areas, moderate ability to perform activities of daily living, heavy dependence, poor self-assessed health, presence of malnutrition, presence of debilitation and in the pre-debilitating stage, and presence of sleep disorders were independent risk factors for depression in chronically ill older adults (P < 0.05). High literacy, high average monthly family income, regular physical exercise, regular social activities, sufficient material and emotional support, living in a nursing facility, and mild dependence in daily life were protective factors for anxiety in chronically ill older adults (P < 0.05). Advanced age, childlessness, moderate ability to perform activities of daily living, heavy dependence, poor self-assessed health, the presence of malnutrition, the presence of infirmity and pre-infirmity, and the presence of sleep disorders were independent risk factors for anxiety in chronically ill older adults (P < 0.05).

Interpretation

The prevalence of anxiety among elderly individuals with chronic diseases in Zunyi City, China, is higher than the global average, whereas the prevalence of depression is lower than the global level. Patients with cardiovascular diseases exhibit a higher prevalence of anxiety, depression, and the co-occurrence of both anxiety and depression. Factors such as economic income, education level, lifestyle habits, and medical history influence the occurrence of anxiety and depression in elderly individuals with chronic diseases. This highlights the need to promote screening for anxiety and depression among the elderly with chronic conditions and to enhance community awareness of mental health issues in the elderly population.

Analysis and Strategies to Improve Living Conditions of Elderly Living Alone in China: A Healthcare Context

Background: The shift toward nuclear family structures in China has resulted in a growing number of elderly individuals living alone, intensifying the imbalance between the supply and demand of elderly care services. Objectives: This study aims to systematically examine the care needs of elderly individuals living alone in China and propose practical strategies to enhance their quality of life. Methods: Using the Kano model and ERG theory, 22 care services were categorized into three types: essential (must-have), attractive, and future-focused (outlook) elements. Survey data were gathered from 230 elderly individuals living alone in Yan'an, Baoji, and Hanzhong, located in Shaanxi Province. To determine the factors influencing the intensity of demand for these services, multivariate ordinal logistic regression analysis was applied. Results: The findings show that demand intensity for care services is significantly shaped by factors such as gender, age, marital status, education level, income, self-rated health, loneliness, and family support. The highest demand was observed for medical and mental health services, followed by life support services. Conclusions: To address the gaps in elderly care services, this study suggests standardizing institutional frameworks, diversifying service options, utilizing familial support networks, and integrating intelligent technologies. These measures are especially critical for reducing service disparities in rural and less developed regions, contributing to a fairer and more effective elderly care system in China.

Disparities in anxiety and related factors among Chinese older adults across different aged-care models: a comparison of two cross-sectional studies

BACKGROUND

Anxiety disorders in older adults have become a prominent public health problem due to their concomitant chronic conditions, reduced quality of life and even death. However, fewer studies have been conducted on differences in anxiety among older individuals in different aged-care models, and the interactive relationship between the influencing factors on anxiety remains unclear. The study aimed to examine the disparities in the prevalence of anxiety between community-dwelling and institutionalized older adults and related influencing factors.

METHODS

Data were collected from the Anhui Healthy Longevity Survey (AHLS) and the Anhui Elderly Caring Social Organizations Survey (AECSOS). Data on demographic variables, lifestyle factors and health-related variables in 6968 older adults were used for analysis. Anxiety symptoms were evaluated using the Generalized Anxiety Disorder Assessment Scale (GAD-7). Binary logistic regression models and a Classification and Regression Tree model (CART) were utilized to examine the relationship between variables.

RESULTS

The prevalence of anxiety were 24.3% and 16.7% among community-dwelling older adults and institutionalized older adults, respectively. Several factors including age, gender, residence, education, income level, live alone, and number of chronic diseases showed a linkage with anxiety among community-dwelling older adults. For the institutionalized older adults, gender, residence, source of income, and number of chronic diseases exhibited a significant association with anxiety. We noted the interactive effect, suggesting that community-dwelling female older adults with an income level of less than 6500 RMB per year and reported chronic disease comorbidities had the highest likelihood of anxiety, and institutionalized female older adults with income sources such as pension, subsidy, family providing, and resident in rural areas have the greatest risk of experiencing anxiety.

CONCLUSIONS

This study has brought to light the higher risk of anxiety among community-dwelling older adults compared to institutionalized older adults. Targeted interventions are, therefore emphasized to address the negative impact of anxiety for populations at higher risk.

A network analysis of depression and anxiety symptoms among Chinese elderly living alone: based on the 2017-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS)

BACKGROUND

Elderly individuals living alone represent a vulnerable group with limited family support, making them more susceptible to mental health issues such as depression and anxiety. This study aims to construct a network model of depression and anxiety symptoms among older adults living alone, exploring the correlations and centrality of different symptoms. The goal is to identify core and bridging symptoms to inform clinical interventions.

METHODS

Using data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), this study constructed a network model of depression and anxiety symptoms among elderly individuals living alone. Depression and anxiety symptoms were assessed using the Center for Epidemiologic Studies Depression Scale-10 (CESD-10) and the Generalized Anxiety Disorder Scale-7 (GAD-7), respectively. A Gaussian Graphical Model (GGM) was employed to build the symptom network, and the Fruchterman-Reingold algorithm was used for visualization, with the thickness and color of the edges representing partial correlations between symptoms. To minimize spurious correlations, the Least Absolute Shrinkage and Selection Operator (LASSO) method was applied for regularization, and the optimal regularization parameters were selected using the Extended Bayesian Information Criterion (EBIC). We further calculated Expected Influence (EI) and Bridge Expected Influence (Bridge EI) to evaluate the importance of symptoms. Non-parametric bootstrap methods were used to assess the stability and accuracy of the network.

RESULTS

The Network centrality analysis revealed that GAD2 (Uncontrollable worry) and GAD4 (Trouble relaxing) exhibited the highest strength centrality (1.128 and 1.102, respectively), indicating their significant direct associations with other symptoms and their roles as core nodes in the anxiety symptom network. Other highly central nodes, such as GAD1 (Nervousness or anxiety) and GAD3 (Generalized worry), further underscore the dominance of anxiety symptoms in the overall network. Betweenness centrality results highlighted GAD1 (Nervousness or anxiety) and GAD2 (Uncontrollable worry) as critical bridge nodes facilitating information flow between different symptoms, while CESD3 (Feeling depressed) demonstrated a bridging role across modules. Weighted analyses further confirmed the central importance of GAD2 (Uncontrollable worry) and GAD4 (Trouble relaxing). Additionally, the analysis showed gender differences in the depression-anxiety networks of elderly individuals living alone.

CONCLUSION

This study, through network analysis, uncovered the complex relationships between depression and anxiety symptoms among elderly individuals living alone, identifying GAD2 (Uncontrollable worry) and GAD4 (Trouble relaxing) as core symptoms. These findings provide essential insights for targeted interventions. Future research should explore intervention strategies for these symptoms to improve the mental health of elderly individuals living alone.

Assessing the prevalence of generalized anxiety disorder in a multicultural medical education setting in Saudi Arabia during the COVID-19 pandemic

Introduction

Mental health among medical students is an area that has been increasingly garnering world-wide attention. Yet, despite this increased attention, research related to anxiety disorders in Saudi Arabia remain limited. This study aims to address this gap by assessing the prevalence of generalized anxiety disorder (GAD) as well as explore its association with students' sociodemographic factors and academic performance among medical students in a Saudi Arabian institute that has a diverse, multicultural student body.

Methods

The study takes place in a unique educational environment: a privately funded institute in Riyadh, the capital of Saudi Arabia, with 32% of its student body comprising international students from over 40 countries, during the COVID-19 pandemic. The study deploys the use of a survey that was sent to the students at this institute via their institutional emails. A survey containing 33 items assessing demographics, GAD using GAD-7 questionnaire, stress-relief measures, online learning experience during the pandemic, mental disorders, anxiety associated with the pandemic, two open-ended questions, and one item assessing sleep difficulty.

Results

The results of the survey showed that a significant majority of the responders' scores in the GAD-7 assessment were in the range of moderate to severe anxiety. The results also suggest that low cGPA and the first academic years are significantly associated with higher GAD-7 scores. Students found severe time constraints, difficult educational content, and lack of psychological support to be major sources of stress. Furthermore, students suggested providing an in-house psychologist, personalized feedback, and guidance on study tactics as methods to reduce anxiety.

Conclusion

These findings, among others, suggest a need for further studies and research in this field to uncover broader patterns and inform targeted mental health support strategies.

Tobacco use and its associated factors among middle and old-aged women in India using LASI wave-1 data

BACKGROUND

Despite a global decline in tobacco use reported by the Global Adult Tobacco Survey (GATS), India stands out for its high number of tobacco users. While research in India often focuses on tobacco use among young adults, there's a notable lack of studies addressing tobacco use among middle and old-aged women. However, the national prevalence of tobacco use among middle and old-aged (45 years and above) women in India is 18.2%. Thus, this study seeks to identify the factors influencing tobacco consumption among middle and old-aged women in the country.

METHODS

The study has utilized secondary data from Longitudinal Aging Study in India (LASI) conducted in 2017-18. This study exclusively included a total of 38,180 middle and old-aged women who reported tobacco use. The analysis encompassed the utilization of Chi-square tests and Binary logistic regression to pinpoint the risk factors linked to tobacco use among middle and old-aged women.

RESULTS

Our study reveals a heightened likelihood of tobacco use among middle and old-aged women residing in the northeastern region of India. The study underscores the imperative to direct targeted efforts toward middle and old-aged women who fall into specific categories, including those who are widowed, separated, or unmarried, individuals who consume alcohol, those with lower socioeconomic and educational standings, residents of rural areas, those living in solitude, individuals experiencing depressive symptoms, and those who self-report poor health.

CONCLUSION

Given the heightened susceptibility of these demographic groups to tobacco use, it is crucial to prioritize tobacco prevention and cessation initiatives specifically tailored to their needs and circumstances.

Everyday life experiences of Chinese community-dwelling oldest old who live alone at home

PURPOSE

Older adults aged ≥ 80 years living alone at home are more likely to experience challenges. Daily life experiences regarding living alone are still limited in the Asian context. This study explored the everyday life experiences of older Chinese residents living alone at home. Research questions included: (1) How do Chinese community-dwelling old people describe everyday life experiences related to living alone? (2) What kind of difficulties and needs do Chinese community-dwelling older people living alone face in everyday lives? (3) How do Chinese community-dwelling older people cope with challenges faced in their everyday lives related to living alone?

METHODS

This was qualitative descriptive research. Purposive sampling was adopted to recruit 13 participants aged 80-92 years of age from communities and one hospital. Semi-structured interviews were conducted to collect data which was analysed by conventional content analysis.

RESULTS

Three themes were identified: theme 1-difficulty in finding a sense of belonging, theme 2-striving to maintain independence, theme 3-hard to gain a sense of control.

CONCLUSIONS

This study provided novel insights into understanding the difficulties and needs of Chinese older people living alone at home. Three key challenges and associated strategies they used to cope with in daily lives were presented.

Do living arrangements and health behaviors associate with anxiety symptoms among Chinese older people? Differences between urban and rural areas

Living arrangements and health behaviors are considered to be associated with mental health, but their relationship has been less investigated by national survey data in China. The purpose of this study is to explore the relationship of living arrangements and health behaviors with anxiety among Chinese older people and to compare the results between urban and rural areas. The study was based on the Chinese Longitudinal Healthy Longevity Survey conducted in 2018, and a total of 12 726 old-aged respondents were included. Ordinal logistic regression was used to analyze the associations between living arrangements, health behaviors and anxiety. This study found that people living in nursing institutions are likely to be more anxious than their dwelling counterparts. Although we found no significant relationships of health behaviors such as smoking, drinking alcohol and exercise with anxiety, older adults with greater dietary diversity were less likely to experience anxiety. Furthermore, different trends between living arrangements and anxiety, smoking and anxiety were also found among urban versus rural respondents. The findings of this study help to better understand anxiety among Chinese older people and shed light on health policy on older people protection and services.

The relationship between living alone or not and depressive symptoms in older adults: a parallel mediation effect of sleep quality and anxiety

BACKGROUND

With modernization and ageing in China, the population of older adults living alone is increasing. Living alone may be a potential risk factor for depressive symptoms. However, no parallel mediation model analysis has investigated the mediating factors for living alone or not (living arrangements) and depressive symptoms.

METHODS

This cross-sectional study included a total number of 10,980 participants from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), 1699 of whom lived alone and 9281 of whom did not live alone. Binary logistic regression and parallel mediation effect model were used to explore the relationship between living alone or not and depressive symptoms and possible mediation effects. Bootstrap analysis was used to examine the mediation effect of living alone or not on depressive symptoms.

RESULTS

Compared to the participants who were not living alone, the living alone group had a higher rate of depressive symptoms. The binary logistic regression showed that after adjusting for other covariates, the risk of depressive symptoms was approximately 0.21 times higher for living alone compared to not living alone (OR = 1.21, 95% CI: 1.06, 1.37). Further, the results of the bootstrap analysis supported the partial mediating role of sleep quality and anxiety. Mediation analysis revealed that sleep quality and anxiety partially mediate the relationship between living alone and depressive symptoms (β = 0.008, 95% CI [0.003, 0.014]; β = 0.015, 95% CI [0.008, 0.024], respectively).

CONCLUSIONS

Sleep quality and anxiety were identified as partially parallel mediators between living alone or not and depressive symptoms. Older adults living alone with poorer sleep quality and more pronounced anxiety were positively associated with higher levels of depressive symptoms. Older adults living alone should be encouraged to engage in social activities that may improve sleep quality, relieve anxiety, and improve feelings of loneliness caused by living alone. Meanwhile, older adults living alone should receive attention and support to alleviate their depressive symptoms.

Latent profile analysis of depression among older adults living alone in China

BACKGROUND

The number of older adults living alone has increased significantly. Depression is one of the significant mental health problems they face; classifying depressive conditions into homogeneous subgroups can help discover hidden information.

METHODS

The data comes from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Latent profile analysis (LPA) was used to identify depression subgroups among elderly living alone, Chi-square tests and Kruskal-Wallis tests were used to univariate analysis, multinomial logistic regression was used to analyze the related factors.

RESULTS

1831 older adults living alone were identified and classified as low-level (30.4 %), moderate-level (55.3 %) and high-level (14.4 %). All variables, except age, were significant in the univariate analysis. Multinomial logistic regression showed that not participating in exercise, sometimes interacting with friends, anxiety symptoms, and impaired IADL were associated with the moderate- and high-level of depression in older adults living alone; good or fair self-rated health and life satisfaction were associated with the low-level of depression in older adults living alone. Anxiety symptoms were associated with high-level of depression in older adults living alone compared to moderate-level; good or fair self-rated health and life satisfaction were associated with moderate-level of depression in older adults living alone.

LIMITATIONS

The CES-D-10 cannot fully determine the presence of depression in elderly people living alone at high-level.

CONCLUSIONS

In future primary health care, it would be more meaningful to provide targeted interventions for different subgroups of depression in older adults living alone.

Living alone is associated with a higher prevalence of psychiatric morbidity in a population-based cross-sectional study

Background

Living alone has been linked to poor mental health, however large-scale epidemiological studies on the association between living alone and psychiatric morbidity including depression and anxiety are lacking. The aim of this study was to investigate this issue in a large Taiwanese cohort.

Methods

In this cross-sectional study, we enrolled 121,601 volunteers from 29 community recruitment stations in Taiwan and divided them into two groups based on whether or not they lived alone. Psychiatric morbidity was defined as a Generalized Anxiety Disorder 2-item score ≥ 3, Patient Health Questionnaire 2-item score ≥ 3, or self-reported depression. Logistic regression was used to explore the associations between living alone and psychiatric morbidity.

Results

The participants who lived alone had a higher prevalence of psychiatric morbidity [odds ratio (OR) = 1.608, 95% confidence interval (CI) = 1.473 to 1.755] after adjusting for potential confounders. In a subgroup analysis, married subjects who lived alone and divorce/separation (OR = 2.013, 95% CI = 1.763 to 2.299) or widowing (OR = 1.750, 95% CI = 1.373 to 2.229) were more likely to have psychiatric morbidity than those who were married and not living alone.

Conclusions

Our findings suggest that living alone is a risk factor for psychiatric morbidity, especially for married subjects who live alone in concordance with divorce, separation, or the death of a spouse.

A Solution for Loneliness in Rural Populations: The Effects of Osekkai Conferences during the COVID-19 Pandemic

Social prescribing is an essential solution to the lack of social connection and interaction and provides a key approach to problems faced by communities during the COVID-19 pandemic. One social prescription used in Japan is the Osekkai conference, which has the potential to increase social participation in rural communities. The revitalization of Osekkai can improve social interactions among people involved in the conference, thereby reducing loneliness. This interventional study was conducted with people who participated in the Osekkai conference. The primary outcomes of the degree of loneliness were compared between 2021 and 2022 using the Japanese version of the three-item UCLA Loneliness Scale. The demographic data and process outcomes of participants were measured using a questionnaire. The participants’ roles in the Osekkai conference increased between the two periods. Loneliness scores tended to decrease during the study period (4.25 to 4.05, p = 0.099). In the questionnaire on loneliness, the scores for item 2 decreased significantly during the study period (1.36 to 1.25, p = 0.038). In conclusion, this study shows that the continual provision of Osekkai conferences as a social prescription may reduce the degree of loneliness among participants with improved social participation in rural communities. Future studies should investigate comparative interventions to show the effectiveness of social prescription on loneliness in communities.

Older Adults' Risk Perception during the COVID-19 Pandemic in Lombardy Region of Italy: A Cross-sectional Survey

During COVID-19 pandemic, older adults are the segment of the population at higher health risk. Given the important role the risk perception has in influencing both the behaviors and psychological well-being, it appears useful exploring this factor in this segment of the population. Despite different studies already described the factors influencing the risk perception, few focused on older adults. For this reason, we investigated risk perception in 514 people over 60 years during the lockdown. We administered a structured interview collecting socio-demographic information, sources of information used, actions undertaken to avoid contagion, and risk perception. Risk perception related to COVID-19 was significantly lower than the perceived risk associated with other threats, and it was correlated to the number of sources of information used but not to the actions undertaken. Furthermore, we found higher risk perception in who knew infected persons, and a negative correlation between the risk perception and age, with the over 75 perceiving a lower risk of getting infected compared to the younger participants. Our results should be taken as informative for future studies. Indeed, further studies on the older adults and the risk perception during emergencies are needed to better orient both communication and supporting strategies.

Rural Social Participation through Osekkai during the COVID-19 Pandemic

We investigated the effects of enabling Osekkai, the traditional Japanese behavior of creating a helping culture, on social participation among rural people in rebuilding social connections that can be vital during the coronavirus diseases 2019 (COVID-19) pandemic. The subjects of this cross-sectional study were people interested in the Osekkai conference (control group) and those actively involved in Osekkai activities (exposure group). The primary outcome of social participation was measured as the frequency of meeting and the number of friends or acquaintances. The demographic data of the participants and process outcomes were measured using a questionnaire provided to all 287 registered participants. The effective response rate was 64.5% (185 responses). The involvement in Osekkai conferences was statistically associated with a high frequency and number of meetings with friends or acquaintances (p < 0.001 and 0.048, respectively). A health check was significantly associated with the number of friends or acquaintances met in the previous month, while high social support was significantly associated with loneliness. Thus, we confirm that Osekkai contributes to high social participation, although we see no relationship with loneliness. Future studies should investigate this cause-and-effect relationship and promote culturally sensitive activities to improve social and health outcomes in rural Japan.

Verification of the Mediating Effect of Social Support on Physical Activity and Aging Anxiety of Korean Pre-Older Adults

There is a lack of research on Korean prospective elderly persons. In particular, there is little research regarding whether social support has a mediating effect on the relationship between physical activity and aging anxiety. Accordingly, this study investigated how social support affected physical activity and aging anxiety in 778 prospective senior citizens (55 to 65 years old) out of a total of 1447 senior citizens who participated in the Embrain Panel Power and Panel Marketing Interactive. Participants completed the IPAQ (International Physical Activity Questionnaires), Social Support Scale, and Aging Anxiety Scale. Physical activity in these Korean pre-older adults affected aging anxiety (p < 0.001), with a fixed effect of physical activity on social support (p < 0.001). Further, social support affected aging anxiety (p < 0.001). Social support was also an important parameter in the relationship between physical activity and aging anxiety. In conclusion, high physical activity of pre-older Korean persons lowered their anxiety regarding aging. Social support acted as a mediator that lowered anxiety regarding aging in the most active pre-older persons.