Regional Differences in the Effects of Social Relations on Depression Among Korean Elderly and the Moderating Effect of Living Alone

Association between chronic diseases and depressive inclinations among rural middle-aged and older adults

This study investigates the association between chronic diseases and depressive inclinations among middle-aged and older adults in rural Northwest China, emphasizing the moderating role of social relationships. Data collected via face-to-face surveys in a cross-sectional design conducted in March 2021, encompassing 395 participants aged 45 and above, were analyzed using Ordinary Least Squares (OLS) regression. The results indicate that, excluding metabolic diseases (such as dyslipidemia and diabetes), other chronic diseases significantly increase depressive inclinations, particularly eye diseases, chronic lung diseases, heart disease, rheumatoid arthritis, and gastrointestinal diseases. Additionally, a greater number of chronic diseases show a positive association with depressive inclinations. Among social relationships, spousal trust and intergenerational relationship satisfaction were associated with a mitigation of the association between chronic diseases and depressive inclinations, whereas skipped generational caregiving exacerbated this association. Other social relationships, including kinship and friendship network size, neighbor relationships, and villager relationships, exhibited no significant moderating associations. These findings underscore the critical role of positive family relationships and robust social support systems in improving the mental health of rural middle-aged and older adults. They provide practical insights for designing targeted policies and interventions to promote healthy aging and mental well-being in resource-limited rural settings.

Social frailty in older adults: A concept analysis

BACKGROUND

Social frailty has been increasingly prevalent due to the aging populations. This concept is a relatively new topic in the gerontology. Older adults experiencing social isolation because of social frailty remain in a state of loneliness or depression. Many misconceptions exist regarding the association between social frailty and high levels of loneliness and depression in older adults, which may exacerbate their condition.

OBJECTIVE

To analyze the concept of social frailty on the basis of method introduced by Rodgers and Knafl.

DESIGN

Rodgers and Knafl' evolutionary concept analysis INFORMATION SOURCES: PubMed, Cochrane Library, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Embase were searched for the terms "Social frailty" and "Elderly" OR "Older adults" OR "Aged."

RESULTS

A total of 65 articles on social frailty were selected from 4 databases and subjected to concept analysis based on Rodgers and Knafl' evolutionary concept. Data extraction and analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The analysis yielded 4 domains (11 subdomains) of antecedents, 3 attributes, and 2 domains (28 subdomains) of consequences.

CONCLUSION

The study findings contribute to a comprehensive and structured understanding of social frailty for health-care workers and the general public. Emphasizing the concept of social frailty can increase the levels of awareness and vigilance among health-care workers regarding the risks associated with social frailty in older adults.

The Effectiveness of Digital Interactive Intervention on Reducing Older Adults' Depressive and Anxiety Symptoms: A Systematic Review and Meta-Analysis

INTRODUCTION

Anxiety and depression are prevalent among older adults, and digital interactive interventions have shown promise in promoting their mental well-being. However, limited research has explored the effects of different types of digital interactive interventions across various devices on anxiety and depression in older adults with different health conditions.

METHODS

A systematic literature review and meta-analysis were conducted using seven selected databases to identify relevant studies up to July 19, 2023. Two reviewers independently conducted study selection, data extraction, and quality appraisals. The risk of bias in the included studies was assessed using the Cochrane risk-of-bias tool. For the meta-analysis, the effect size was calculated as the standardized mean difference (SMD) using a random-effects model.

RESULTS

A total of 20 randomized control trails involving 1,309 older adults fulfilled inclusion criteria. The meta-analysis results demonstrates that the digital interactive intervention technologies had a significance on depression (SMD = -0.656 s, 95% confidence interval [CI] = -0.992 to -0.380, p < 0.001) and anxiety (SMD = -0.381 s, 95% CI = -0.517 to -0.245, p < 0.001). Physical interactive interventions demonstrated a significant effect on depression and anxiety (SMD = -0.711 s, 95% CI = -1.102 to -0.319, p < 0.001) and (SMD = -0.573 s, 95% CI = -0.910 to -0.236, p = 0.001). Similarly, immersive interactive interventions also showed a significant effect on depression and anxiety (SMD = -0.699 s, 95% CI = -1.026 to -0.373, p < 0.001) and (SMD = -0.343 s, 95% CI = -0.493 to -0.194, p < 0.001). Additionally, in the internal medicine group, significant intervention effects were observed for depression (SMD = -0.388, 95% CI = -0.630 to -0.145, p = 0.002) and anxiety (SMD = -0.325, 95% CI = -0.481 to -0.169, p < 0.001). Similarly, in the neurocognitive disorders group, significant intervention effects were found for depression (SMD = -0.702, 95% CI = -0.991 to -0.413, p < 0.001) and anxiety (SMD = -0.790, 95% CI = -1.237 to -0.342, p = 0.001).

CONCLUSION

The results indicated that various digital interactive devices, including physical and immersive interactive devices, have a positive impact on depression and anxiety among older adults. However, mobile games were not effective in addressing depression. Digital interactive technologies did not significantly influence anxiety intervention, except for elderly individuals undergoing surgical procedures. Nevertheless, these interventions effectively addressed depression and anxiety in older individuals with neurocognitive disorders, internal medical issues, and those without health issues.

Association between area deprivation index and concerns to COVID-19: A multi-level analysis of individual and area factors

Background

The coronavirus disease 2019 (COVID-19) pandemic has been one of the most serious global threats to public health recently. The present study examined whether area deprivation is associated with concerns related to COVID-19 using large nationwide data across South Korea.

Methods

We used nationwide 2020 Korea Community Health Survey and official government database. Of the 225,680 included participants, 123,324 (54.6%) were women, and the mean age was 54.9 [17.8] years old. We classified the Area deprivation index (ADI) into Quartile 1 (Least deprived); Quartile 2; Quartile 3; and Quartile 4 (Most deprived). Our primary outcome was the concerns related to COVID-19 (0-16 scores). Multilevel regression analysis was conducted.

Results

The mean score of concerns related to COVID-19 was 11.3 [3.2] in the total population. 13.5% of the variability in the scores of concerns related to COVID-19 was accounted for by district areas. Area with Q4 of ADI were associated with an increased score of concerns related to COVID-19 (Q1: reference; Q2: β = 0.218, SE = 0.119, FDR adj.p-value = 0.085; Q3: β = 0.235, SE = 0.133, FDR adj.p-value = 0.094; Q4: β = 0.252, SE = 0.109, FDR adj.p-value = 0.029). 19-49 groups in area with Q4 of ADI were associated with an increase in scores of concerns related to COVID-19 than other age groups in area with Q4 of ADI. Area with Q4 of ADI were associated with a score of concern of being criticized if getting infected compared to area with Q1 of ADI.

Conclusion

We found that the highest quartile ADI was associated with greater concerns related to COVID-19. By identifying vulnerable population to concerns related to COVID-19, health systems may consider preventive intervention to mitigate mental health issues.

Nutritional Risk, Depression, and Physical Function in Older People Living Alone

This study investigated depression and physical function as factors associated with nutritional risk in older adults living alone. The study included 2896 people 65 years or older who lived alone. Data were collected in South Korea between September and November 2020. Descriptive statistics, a chi-squared test, independent samples t-test, weighted multiple regression analysis, and binary logistic regression analysis were performed using IBM SPSS for Windows ver. 23.0. In this study, 44.8% of participants were in the nutritional risk group. Furthermore, 60.9% of those at risk for depression, 75.1% of those with instrumental activities of daily living (IADLs) dependency, and 59.1% of those with chewing limitations were at nutritional risk. The factors that increased nutritional risk in the weighted multiple regression analysis were depression (β = 0.27, p < 0.001), chewing limitations (β = 0.12, p < 0.001), IADL dependency (β = 0.09, p < 0.001), and basic physical movement (β = 0.04, p = 0.020). Binary logistic regression analysis showed that those with IADL dependency had a 2.59 times higher nutritional risk than those with IADL non-dependency (p < 0.001). The nutritional risk group had a higher risk of depression (2.01 times higher [p < 0.001]), chewing limitations (1.76 times higher [p < 0.001]), and basic physical movement limitations (1.35 times higher [p = 0.009]) than the good nutritional group. Therefore, nutritional screening is required of older individuals living alone. To mitigate nutritional risks, it is necessary to assess depression and physical function, including IADL dependency.

Living alone and the risk of depressive symptoms: a cross-sectional and cohort analysis based on the China Health and Retirement Longitudinal Study

BACKGROUND

There were a few studies that examined the longitudinal association between living alone and depressive symptoms, and the vast majority of them were conducted in patients with certain diseases, such as heart failure, cancer, and glaucoma. This study aimed to examine the association between living alone and depressive symptoms in a large representative older Chinese population.

METHODS

The China Health and Retirement Longitudinal Study (CHARLS) data from 2015 to 2018 were used. Living alone was defined as participants who did not live with others ever or more than 11 months in the past year at baseline. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression Scale (CES-D10). The multivariate logistic regression was used to estimate the relationship between living alone and depressive symptoms.

RESULTS

There were 5,311 and 2,696 participants ≥ 60 years old included in the cross-sectional and cohort analysis, respectively. The risk of depressive symptoms in participants who lived alone was significantly higher than those who lived with others in both cross-sectional (OR:1.33; 95%CI:1.14,1.54) and cohort analysis (OR:1.23; 95%CI:0.97,1.55). There was a significant interaction between financial support and living alone (Pinteraction = 0.008) on the risk of depressive symptoms. Stratified analyses showed that, compared to those who lived with others, the risk of depressive symptoms in participants who lived alone increased by 83% (OR:1.83; 95%CI:1.26,2.65) in participants receiving lower financial support. However, we did not find statistically significant associations in participants with medium (OR:1.10; 95%CI: 0.74,1.63) and higher financial support (OR: 0.87; 95%CI: 0.53,1.41).

CONCLUSION

Living alone was associated with a higher risk of depressive symptoms in the Chinese older population, and this association was moderated by the receipt of financial support. Living alone may be an effective and easy predictor for early identification of high-risk populations of depression in the older population.

Global rural health disparities in Alzheimer's disease and related dementias: State of the science

INTRODUCTION

Individuals living in rural communities are at heightened risk for Alzheimer's disease and related dementias (ADRD), which parallels other persistent place-based health disparities. Identifying multiple potentially modifiable risk factors specific to rural areas that contribute to ADRD is an essential first step in understanding the complex interplay between various barriers and facilitators.

METHODS

An interdisciplinary, international group of ADRD researchers convened to address the overarching question of: "What can be done to begin minimizing the rural health disparities that contribute uniquely to ADRD?" In this state of the science appraisal, we explore what is known about the biological, behavioral, sociocultural, and environmental influences on ADRD disparities in rural settings.

RESULTS

A range of individual, interpersonal, and community factors were identified, including strengths of rural residents in facilitating healthy aging lifestyle interventions.

DISCUSSION

A location dynamics model and ADRD-focused future directions are offered for guiding rural practitioners, researchers, and policymakers in mitigating rural disparities.

HIGHLIGHTS

Rural residents face heightened Alzheimer's disease and related dementia (ADRD) risks and burdens due to health disparities. Defining the unique rural barriers and facilitators to cognitive health yields insight. The strengths and resilience of rural residents can mitigate ADRD-related challenges. A novel "location dynamics" model guides assessment of rural-specific ADRD issues.

Effects of Serious Games on Depression in Older Adults: Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND

Depression is a severe psychological concern that negatively affects health in older adults. Serious games applied in various fields are considered appropriate interventions, especially in mental health care. However, there is a lack of evidence regarding the effects of serious games on depression in older adults.

OBJECTIVE

This study aimed to investigate the characteristics and effectiveness of serious games for depression in older adults.

METHODS

A systematic review and meta-analysis of randomized controlled trials were conducted. In total, 5 electronic databases (PubMed, CINAHL, Embase, PsycINFO, and Cochrane Library) were searched to identify relevant studies published until July 6, 2021. A total of 2 reviewers independently conducted study selection, data extraction, and quality appraisals. The risk of bias in the included studies was assessed using the JBI Critical Appraisal Checklist. For the meta-analysis, the effect size was calculated as the standardized mean difference (SMD) by using a random effects model.

RESULTS

A total of 17 studies with 1280 older adults were included in the systematic review, and 15 studies were included in the meta-analysis. Serious game interventions were classified into 3 types: physical activity (PA), cognitive function, and both PA and cognitive function. The meta-analysis demonstrated that serious games reduced depression in older adults (SMD -0.54, 95% CI -0.79 to -0.29; P<.001). Serious games had a more significant effect size in community or home settings (SMD -0.61, 95% CI -0.95 to -0.26; P<.001) than in hospital settings (SMD -0.46, 95% CI -0.85 to -0.08; P=.02); however, the difference between groups was not significant. Among the types of games, games for PA (SMD -0.60, 95% CI -0.95 to -0.25; P<.001) and games for both (SMD -0.73, 95% CI -1.29 to -0.17; P=.01) had a significant effect on reducing depression in older adults. However, no significant correlations were observed between the duration or number of serious games and depression.

CONCLUSIONS

Serious games were beneficial in reducing depression in older adults. Regardless of the study setting, serious games appeared to reduce depression. Particularly, serious games including PA had a significant impact on reducing depression. Furthermore, high-quality randomized controlled trials are needed to establish substantial evidence for the effectiveness of serious games on depression in older adults.

TRIAL REGISTRATION

PROSPERO CRD42021242573; https://tinyurl.com/26xf7ym5.

Assessment of the relationship between living alone and the risk of depression based on longitudinal studies: A systematic review and meta-analysis

BACKGROUND

Living alone is one of the most common psychosocial factors that may have an impact on lifestyle management and health status. Although many previous cross-sectional studies have found that living alone increases the risk of depression. However, this risk has rarely been assessed on the basis of longitudinal studies. Therefore, we will explore this relationship on the basis of longitudinal studies.

METHODS

We systematically searched Pubmed, Embase, and Cochrane databases up to May 2022. Adjusted odds ratios (ORs), and 95% confidence intervals (CIs) were pooled by a random-effects model using an inverse variance method.

RESULTS

Seven studies (six cohort studies and one case-control study) were included in our study. A total of 123,859 without a history of psychosis individuals were included, and the proportion of females was 65.3%. We applied a random-effects model to minimize the heterogeneity. Overall, the pooled data suggest that people living alone are associated with an increased risk of depression compared to those who do not live alone (OR 1.42, 95%CI 1.19-1.70).

CONCLUSION

Compared to people who live with others, living alone increases the risk of depression. Only cross-sectional studies and a few longitudinal studies currently support this association; more high-quality studies will be required in the future to confirm this causal association.