The impact of social networks on the relationship between functional impairment and depressive symptoms in older adults

Prospective trajectories of depression predict mortality in cancer patients

An ever-growing body of empirical evidence has demonstrated the relationship between depression and cancer. The objective of this study was to examine whether depression trajectories predict mortality risk above and beyond demographics and other general health-related factors. Participants (n = 2,345) were a part of the Health and Retirement Study. The sample consisted of patients who were assessed once before their cancer diagnosis and thrice after. Depressive symptoms and general health-related factors were based on self-reports. Mortality risk was determined based on whether the patient was alive or not at respective time points. Latent Growth Mixture Modeling was performed to map trajectories of depression, assess differences in trajectories based on demographics and general health-related factors, and predict mortality risk. Four trajectories of depression symptoms emerged: resilient (69.7%), emerging (13.5%), recovery (9.5%), and chronic (7.2%). Overall, females, fewer years of education, higher functional impairment at baseline, and high mortality risk characterized the emerging, recovery, and chronic trajectories. In comparison to the resilient trajectory, mortality risk was highest for the emerging trajectory and accounted for more than half of the deaths recorded for the participants in emerging trajectory. Mortality risk was also significantly elevated, although to a lesser degree, for the recovery and chronic trajectories. The data highlights clinically relevant information about the depression-cancer association that can have useful implications towards cancer treatment, recovery, and public health.

Comparing the role of social connectivity with friends and family in depression among older adults in China: evaluating the moderating effect of urban-rural status

Background

Social connectivity and support can reduce depressive symptoms. Few studies have examined urban-rural differences in the relationship between social support and depressive symptoms in the context of urbanization for Chinese older adults. The overall aim of this study is to examine urban-rural differences in the relationship between family support and social connectivity on depression among Chinese older adults.

Methods

This cross-sectional study used data from the 2010 Sample Survey on Aged Population in Urban/Rural China (SSAPUR). Depressive symptoms were measured using the Geriatric Depression Scale short-form (GDS-15). Family support was measured by structural, instrumental, and emotional support. Social connectivity was measured using the Lubben Social Network Scale-6 (LSNS-6). Descriptive analysis was conducted using chi-square and independent t-tests to examine urban-rural differences. Adjusted multiple linear regressions were conducted to examine the moderating effect of urban-rural status on the association between types of family support and social connectivity with depressive symptoms.

Results

In rural areas, respondents who felt their children exhibited filial piety (β = -1.512, p < 0.001) and had more social connectivity with family (β = -0.074, p < 0.001) were more likely to report fewer depression symptoms. In urban areas, respondents who received instrumental support from their children (β = -1.276, p < 0.01), who thought their children exhibited filial piety (β = -0.836, p < 0.01), and who had more social connectivity with friends (β = -0.040, p < 0.01) were more likely to report fewer depression symptoms. In the fully adjusted regression model, social connectivity with family was associated with decreased depressive symptoms, although to a lesser degree among urban-dwelling older adults (urban-rural interaction effect, β = 0.053, p < 0.05). Social connectivity with friends was similarly associated with decreased depressive symptoms, although this effect was greater among urban-dwelling older adults (urban-rural interaction effect, β = -0.053, p < 0.05).

Conclusion

The results of this study suggested that older adults both in rural and urban areas with family support and social connectivity were associated with fewer depression symptoms. Differences observed in the role of family and friend social connectivity by urban-rural status may provide practical information for developing targeted social support strategies for improving depressive symptoms among Chinese adults, and call for further mixed-methods research to disentangle mechanisms behind these differing associations.

The double-edged role of accessed status on health and well-being among middle- and older-age adults in rural South Africa: The HAALSI study

Background

Social capital theory conceptualizes accessed status (the socioeconomic status of social contacts) as interpersonal resources that generate positive health returns, while social cost theory suggests that accessed status can harm health due to the sociopsychological costs of generating and maintaining these relationships. Evidence for both hypotheses has been observed in higher-income countries, but not in more resource-constrained settings.

We therefore investigated whether the dual functions of accessed status on health may be patterned by its interaction with network structure and functions among an older population in rural South Africa.

Method

We used baseline survey data from the HAALSI study (“Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa”) among 4,379 adults aged 40 and older. We examined the direct effect of accessed status (measured as network members’ literacy), as well as its interaction with network size and instrumental support, on life satisfaction and self-rated health.

Results

In models without interactions, accessed status was positively associated with life satisfaction but not self-rated health. Higher accessed status was positively associated with both outcomes for those with fewer personal contacts. Interaction effects were further patterned by gender, being most health-protective for women with a smaller network and most health-damaging for men with a larger network.

Conclusions

Supporting social capital theory, we find that having higher accessed status is associated with better health and well-being for older adults in a setting with limited formal support resources. However, the explanatory power of both theories appears to depending on other key factors, such as gender and network size, highlighting the importance of contextualizing theories in practice.

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We investigated the double-edged role of accessed status on self-rated health and life satisfaction among older South Africans in a rural setting.

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Accessed status was overall positively associated with life satisfaction.

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Accessed status was positively associated with health and well-being for women, unemployed respondents, and people with fewer social contacts.

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We found an inverse association between accessed status and life satisfaction among men with a larger personal network.

Physical activity and gender buffer the association of retirement with functional impairment in Ghana

Females on average live longer but with higher rates of functional impairment and lower physical and economic activities than men. However, research linking retirement to functional impairment and the modifying role of gender and physical activity (PA) is limited especially in low- and middle-income countries. This paper examines the association between retirement and functional impairment in Ghana and evaluates the effect modification of the association by gender and PA. The sample included 1201 adults aged ≥ 50 years from a population-based study. Functional impairment was assessed with the activities of daily living scale. Ordinary least squares regression models adjusted for confounding variables and estimated gender-wise and PA heterogeneity effect of retirement on functional impairment. Regressions showed that retirement predicted an increase in functional impairment score in the full sample (β = .76, p < .001) and in men (β = 1.96, p < .001), but not in women. Interestingly, retirement significantly increased functional impairment in ≥ 65 age cohort (full sample: β = .71, p < .005; men: β = 1.86, p < .001) although not in women. However, the effect was significantly moderated by PA such that retirement × PA predicted a decrease in functional impairment in the full sample (β = −.81, p < .005) and the ≥ 65 age group (β = −.43, p < .005). Functional impairment risk of retirement is gender-specific, but PA buffers the relationship. Retirement is generally commonplace, but these findings imply that promoting PA may hold promise for addressing functional impairment in old age. Attending to the physical health needs of men during retirement should be a social policy priority.

Thwarted Belongingness Hindered Successful Aging in Chinese Older Adults: Roles of Positive Mental Health and Meaning in Life

Aging of population has brought great challenges to many regions throughout the world. It has been demonstrated that interpersonal relationship is closely related to the experiences of aging for older adults. However, it still remains unknown how and under what conditions thwarted belongingness links to successful aging. This study examined the relationship between thwarted belongingness and successful aging and tested the mediating role of positive mental health and the moderating role of meaning in life. Community-dwelling older adults (n = 339) aged 60-75 years recruited in Chongqing, China completed self-measures of thwarted belongingness, successful aging, meaning in life, and positive mental health. Correlation analyses showed that successful aging was associated with less thwarted belongingness, better positive mental health, and higher levels of meaning in life. Positive mental health was found to totally mediate the negative effect of thwarted belongingness on successful aging. Moderated mediation analyses further revealed that two components of meaning in life (present of meaning and search for meaning) attenuated the indirect effect of thwarted belongingness on successful aging via positive mental health. This study highlights the protective roles of positive mental health and meaning in life and addressed cultural aspects in the process of successful aging among Chinese older adults.

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.

Communication About Chronic Pain in Older Persons' Social Networks: Study Protocol of a Qualitative Approach

A lack of social relations appears to impact on health and life expectancy among the older persons. The quality and diversity of social relations are correlated with good health and well-being in later life. Chronic pain is a crucial issue in aging population. Effective communication between the older persons with chronic pain, their relatives and the actors of the healthcare system facilitates the management of this condition. Studies on communication in later life generally do not consider the older persons' social network as a whole, focusing only a specific segment (e.g., family or medical staff). This lack of scientific data prevents the actors of the healthcare system from offering solutions to bridge clinically relevant communication gaps. As a consequence, our study has three objectives: (1) to identify how the older persons perceive communication about chronic pain with their social network; (2) to identify their unmet communication needs; (3) to develop recommendations that improve communication about chronic pain in later life. The study will be divided into two phases. The first phase will meet objectives 1 and 2. It will involve individual interviews with about 50 people over 75 years old suffering from chronic pain and without major cognitive or auditory troubles. In this phase, we will apply a multi-layered analysis. We will map the older persons' personal network and identify their communication practices and needs, by combining content and discourse analysis with social network theories. The second phase of the study will aim at recommendations based on the results of the first phase (objective 3). It will require focus groups with different sets of stakeholders (older persons, relative caregivers, health professionals, decision-makers). In the second phase, we will use content analysis to pinpoint the concerns and suggestions for action. The results will be disseminated on three levels: (1) to the scientific world (specialists in the field of health and aging and health communication); (2) to health practitioners working with older persons; (3) to society at large, with a focus on institutions and groups directly concerned by the issue.

A Qualitative Investigation on the Roles of Social Support on Physical Activity Behaviour among the Rural-Dwelling Older Women in Malaysia

Despite many health benefits of physical activities, both physically and mentally, the majority of the older women in the rural areas of Malaysia are showing a low prevalence of physical activities. Understanding the roles of social support to improve physical activities is imperative to promote active and healthy ageing among the rural-dwelling older women in Malaysia. Hence, this qualitative study adopted an inductive design using 17 in-depth interviews to understand the role of social support on physical activity behaviour among the rural community-dwelling older woman in Kuala Pilah District, Negeri Sembilan, Malaysia from December 2019 to January 2020. Three categories of themes were identified in this study. Firstly, adaptive social support in terms of informational, companionship and emotional supports reported enhancing physical activity levels among older women. Secondly, the absence of help and assistance from the social network asserts independence and triggers the older women to perform the activities by themselves, thus engage in physically active lifestyles. Thirdly, lacking social support demotivate older women to be engaged in physical activities. In particular, loss of companionship support, poor acceptance or appraisal support, logistic issues to attend exercise programmes and neighbourhood safety and security issues were among the main barriers of physical activities reported by the older women. The main findings of this study shed some light on the exigency of strengthening social support from the social network to engage the older women in physical activities. The roles of social media, effective patient-doctor communication and interventions targeting the spouses and family members must be strengthened to create a supportive atmosphere to enhance physical activity levels among older women.

Financial inclusion and physical health functioning among aging adults in the sub-Saharan African context: Exploring social networks and gender roles

BACKGROUND

It remains poorly understood how financial inclusion influences physical health functioning in later life in sub-Saharan African context and whether the association differs by gender and social relationships. We aim 1) to examine the associations of financial inclusion with functional impairment during older age in Ghana; and 2) to evaluate whether gender and social networks modify this association.

METHODS

The cross-sectional analyses are based on a sample (N = 1,201) of study participants aged 50 years and over (M = 66.5 years, SD = 11.9, 63.3% female) deriving from the 2016-2017 AgeHeaPsyWel-HeaSeeB Study. Ordinary least squares (OLS) regression analyses with interactions were performed to estimate the link between financial inclusion and functional health and how the association is modified by gender and older age social networks.

RESULTS

The mean financial inclusion score was 1.66 (SD = 1.74) in women and 2.33 (SD = 1.82) in men whilst mean activities of daily living (ADL) score was 13.03 (SD = 4.99) and 14.85 (SD = 5.06) in women and men respectively. We found that financial inclusion was associated with decreases in ADL (total sample: β = -.548, p < .001; women: β = -.582, p < .001; men: β = -1.082 p < .001) and instrumental ADL (IADL) (total sample: β = -.359, p = .034; women: β = -.445, p = .026 but not in men). Social networks significantly moderated the association of financial inclusion with ADL such that the financially included who were embedded in a stronger constellation of social networks were 6% less likely to report ADL impairment compared to those with weaker social networks (β = -.062, p = .025).

CONCLUSIONS

The study provides empirical evidence for a better understanding of the association between financial inclusion and physical health functioning in the context of later life social networks. Interventions for functional health through financial inclusion in sub-Saharan Africa should include improving interpersonal and social networks for older adult and also through gender lenses.

Depression, functional disability, and accessing health care among older Ghanaians and South Africans: a comparative study based on WHO study on global ageing and adult health (SAGE)

OBJECTIVES

The study explored the association and variabilities between mild depression, functional disability, and healthcare access among older Ghanaians and South Africans.

METHOD

The data used in this study was based on the Cross-sectional wave 1 (2007-2010) data from WHO's Study on Global Ageing and Adult Health (SAGE). Using multiple binary logistic regression, responses from a sample of 4558 Ghanaians and 3076 South Africans were analyzed to investigate hypothesized patterns.

RESULTS

The proportion of mild depression (MD) is 6.0 % and 7.53% for older Ghanaians and older South Africans, respectively. At 95% Confidence Interval, increased severity (mild and high levels) of functional disability are associated with increased odds of MD in Ghanaian and South African older adults. Apart from South African older adults, older Ghanaians in the study who do not receive healthcare when needed have increased odds of MD than those who do. Sociodemographic and socioeconomic factors are also associated with MD.

DISCUSSION

An untreated, persistent MD may lead to worse conditions with fatal outcomes. Since mental health care is lacking in both countries, this study may inform policies directed towards support for formal and informal long-term care, and healthcare access to reduce the risks of depression.

The Role of a Health Protection Scheme in Health Services Utilization Among Community-Dwelling Older Persons in Ghana

OBJECTIVES

This study examines the relationships between National Health Insurance Scheme (NHIS) enrollment and the frequency and "timing" of health services utilization among community-dwelling older Ghanaians. It also investigates whether the NHIS policy has improved equity in access to health care in later life.

METHODS

Cross-sectional data were derived from an Ageing, Health, Psychological Wellbeing and Health-seeking Behavior Study collected between August 2016 and January 2017 (N = 1,200). Descriptive and bivariate analyses described the sample. Generalized Poisson and logit regression models, respectively estimated the predictors of frequency of health services utilization and time from onset of illness to health facility use and during last illness episode.

RESULTS

Older persons with active NHIS membership frequently used health facilities (β = 0.237, standard error [SE] = 0.0957, p ˂ .005), but the association was largely a function of health-related factors. The NHIS enrollees were more likely to attend health facility earlier (β = 1.347, SE = 0.3437, p ˂ .001) compared with nonenrollees, after adjusting for theoretically relevant covariates. Moreover, given the NHIS enrollment, the rich (eβ = 2.149, SE = 0.240, p ˂ .005), social support recipients (eβ = 1.366, SE = 0.162, p ˂ .05) and those living with relevant others (eβ = 2.699, SE = 0.175, p ˂ .001) were more likely to consume health services.

DISCUSSION

Ghana's NHIS policy generally increases health services utilization but at present lacks the capability to improve equitable access to health care, especially between poor and nonpoor older adults. This may hamper the progress toward universal health coverage (UHC), indicating the need for further refinements in the policy including ways to improve the health status of older persons.

Age and Gender Differences in Social Network Composition and Social Support Among Older Rural South Africans: Findings From the HAALSI Study

Objectives

Drawing on the “Health and Aging in Africa: A Longitudinal Study of an INDEPTH community in South Africa” (HAALSI) baseline survey, we present data on older adults’ social networks and receipt of social support in rural South Africa. We examine how age and gender differences in social network characteristics matched with patterns predicted by theories of choice- and constraint-based network contraction in older adults.

Method

We used regression analysis on data for 5,059 South African adults aged 40 and older.

Results

Older respondents reported fewer important social contacts and less frequent communication than their middle-aged peers, largely due to fewer nonkin connections. Network size difference between older and younger respondents was greater for women than for men. These gender and age differences were explicable by much higher levels of widowhood among older women compared to younger women and older men. There was no evidence for employment-related network contraction or selective retention of emotionally supportive ties.

Discussion

Marriage-related structural constraints impacted on older women’s social networks in rural South Africa, but did not explain choice-based network contraction. These findings suggest that many older women in rural Africa, a growing population, may have an unmet need for social support.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Vulnerability in health and social capital: a qualitative analysis by levels of marginalization in Mexico

Background

Social capital is employed as an asset when there is a lack of an efficient health-care system. However, this relationship is not homogeneous and can differ according to the characteristics of individuals and their context. In this paper, we aim to analyze the role of social capital in the solution of healthcare problems among individuals with different levels of marginalization and unequal access to health services.

Methods

This qualitative study examines the role of social capital in the demand for healthcare among Mexican individuals with different levels of marginalization. The research draws data from semi-structured interviews (N = 247) that were collected in four Mexican states with different social welfare benefits: Mexico City, Tamaulipas, the State of Mexico, and Oaxaca. The interviewees were selected using the snowball method and other eligibility criteria such as education, age, and gender.

Results

Findings suggest that social capital is a relevant factor in solving healthcare problems, depending on the level of marginalization. The role of social capital can be explained by the precariousness of medical service delivery, the poor health infrastructure, and the difficult access to health care in Mexico. Networks are the main resource to deal with health related issues, food, medicine, and out-of-the-pocket medical expenses in contexts of high levels of marginalization. In the middle level of marginalization, networks also help in raising funds for more-specialized medical services and higher quality hospitals. In the least-marginalized levels, social capital is used as companionship for sick individuals, while support networks act as emotional relief. At this level, most individuals have private health insurance, and many of them have major medical healthcare coverage.

Conclusions

Participants reported low levels of trust in the health care system because of the poor infrastructure and quality of medical service delivery. Although the main criticism is focused on public healthcare institutions, there is a lack of trust in private medical services as well. These facts are related to the access and quality of medical service delivery and turn social capital into a significant asset. Despite that social bonds or links are valuable resources that individuals can use to solve healthcare related issues, the use of social capital is not homogenous. Indeed, it can be influenced by several factors that were represented in this study through the municipal marginalization index.

Personal networks and associations with psychological distress among young and older adults

OBJECTIVE

The aim of the study was to provide new tests of the argument that aspects of personal networks affect psychological distress and moderate the effects of negative life events, leveraging new, rich data on two different cohorts.

METHOD

The UCNets project measured psychological distress, life events, and various dimensions of personal networks for 673 50- to 70-year old adults and 485 21- to 30-year old adults. The project used stratified random address based sampling for all the older adults. Such sampling, supplemented with Facebook advertisement and referral sampling, yielded the young adult sample. Networks were measured using several name-eliciting questions and several name descriptors.

RESULTS

The findings differed for younger versus older adults. Among young adults, personal network characteristics were not directly associated with, nor did they moderate the effect of negative life events on psychological distress. Unlike younger adults, the presence of supportive network ties, including social companions and emergency helpers, were directly associated with lower distress among older adults, while difficult and demanding ties as well as advisors were directly associated with higher distress. There was limited evidence of buffering among older adults, albeit through the presence of difficult and demanding ties.

CONCLUSIONS

In the current sample, network exchange roles (i.e., specific types of network support and burden) were associated with psychological distress among older adults while other characteristics of the network, including size, multiplexity, and social participation were not. Further, network support may be best positioned to have direct, as opposed to buffering, effects on psychological well-being.

Neighborhood, social isolation and mental health outcome among older people in Ghana

OBJECTIVE

Loneliness and living alone have been strongly related to mental health but limited empirical evidence of these relationships exists among older people in Ghana. We examine the pathways of independent and interactive impacts of loneliness and living alone on psychological distress (PD) risk among older people in Ghana and to investigate whether the associations are moderated by neighborhood characteristics.

METHODS

Data were analyzed for 1200 community-dwelling adults aged ≥50 years from a 2016/2017 Aging, Health, Psychological Wellbeing and Health-seeking Behavior Study. Mental health and loneliness were respectively assessed using the Kessler Psychological Distress Scale (KPDS-10) and the Three-Item Loneliness Scale of the University of California, Los Angeles. OLS models estimated the associations and interactions.

RESULTS

Participants were mostly women (63.3% [95%CI: 60.5-66.0%]) with a mean age of 66.2 ± 11.9. Mean scores for PD and loneliness were 15.9 ± 4.7 and 5.3 ± 3.9 respectively whilst the prevalence of living alone was 38.2% (95%CI: 35.4-41.0%). After full adjustment, the OLS regressions showed that loneliness (β = 1.474, SE = 0.151, p < 0.001), living alone (β = 0.381, SE = 0.162, p < 0.05) and the interaction between them (β = 0.917, SE = 0.308, p < 0.05) significantly increased the PD risk. However, engagement in regular physical activity, family contacts and social participation decreased PD outcomes among the socially isolated.

LIMITATION

The cross-sectional nature of the data may prohibit any causal and directional inferences.

CONCLUSIONS

Social connectedness and neighborhood engagements strongly buffer against the risk of later life mental disorders in the context of loneliness, and living alone. Moderate-to-rigorous physical activity and social cohesion should be effectively and strategically included in interventions targeted to improve older age mental health.

Mental health change in the transition to permanent supportive housing: The role of housing and social networks

AIMS

Permanent Supportive Housing (PSH) may improve homeless adults' mental health via housing stabilization and/or improved relational factors, however, the role of housing and social networks on PSH residents' mental health change is minimally understood.

METHODS

Interviews were conducted with a baseline sample of adults experiencing homelessness ( N = 421), across their initial year in PSH (3-months, 6-months, and 12-months). Generalized linear mixed models assessed changes in positive past-month psychiatric disability screenings (Modified-Colorado Symptom Index [MCSI]) and probable posttraumatic stress disorder (PC-PTSD) in controlled models, and between and within-subject effects of time-varying social network correlates on mental health changes.

RESULTS

Compared with baseline, positive MCSI screens continuously decreased over time (56%, 54%, and 50%) while PC-PTSD screens declined initially (40%) with marginal decreases at remaining follow-ups (39% and 38%). These differences remained significant in controlled models. Gaining a romantic partner was associated with a longitudinal increase in a positive MCSI screening. Between subjects, emotional health counselors and conflicting network members were associated with an increased likelihood in positive screenings, while doctors and case managers were protective.

CONCLUSION

Housing may facilitate positive changes in PSH residents' mental health, yet positive screenings remain high. Social network interventions that increase residents' positive interpersonal exchanges and prosocial relationships are warranted.

Financial Inclusion, Health-Seeking Behavior, and Health Outcomes Among Older Adults in Ghana

PURPOSE

This study examines the associations between financial inclusion, health-seeking behavior, and health-related outcomes in older persons in Ghana.

METHOD

Employing data from a 2016/2017 Aging, Health, Psychological Well-Being and Health-Seeking Behavior Study (N = 1,200; mean age = 66.2 years [standard deviation = 11.9], we estimated regression models of self-rated health (SRH), psychological distress (PD), and health-care use (HCU) on a variable representing compositional characteristics of financial inclusion.

RESULTS

Multivariate logistic and generalized Poisson models showed that financial inclusion is positively associated with SRH (β = .104, standard error [SE] = .033, p < .001) but inversely related to both PD (β = .038, SE = .032, p < .005) and HCU (β = -.006, SE = .009, p < .05) independent of other factors. However, after adjusting for socioeconomic and health-related factors, the associations were tempered and the effect of SRH decreased by 0.094 and PD increased by 0.065 points but HCU became statistically insignificant (β = -.020, SE = .0114, p > .05).

CONCLUSIONS

Financial services inclusion profoundly appears to buffer against and retard health-related challenges in later life. Social and health policies targeted at improving the health outcomes of older people should include and build on the growing recognition of the importance of inclusive financial services and strategies.

Social support, physical activity and psychological distress among community-dwelling older Ghanaians

OBJECTIVE

Physical activity (PA) has often been linked with improved mental health outcomes among older people but the subject has received limited attention in sub-Saharan African context. This paper examines the moderating effect of social support (SS) on the association between PA and psychological distress (PD) among community-dwelling older persons in Ghana.

METHODS

Individuals 50 years or older (N = 1200) who participated in a 2016/2017 Aging, Health, Psychological Wellbeing and Health-seeking Behavior Study (AHPWHB) were included. PD outcome, measured by the Kessler Psychological Distress Scale (KPDS-K10) was regressed on PA levels, SS and the interaction term.

RESULTS

Findings suggest that regular PA (OR = 0.824; 95%CI: 0.610-0.913) and higher levels of SS (OR = 0.475; 95%CI: 0.360-0.626) were associated with reduced PD outcomes after adjusting for theoretically relevant confounding variables. More importantly, the inclusion of the interaction term (PA × SS) showed a significant negative relationship of regular PA with the PD outcome as SS levels increased (OR = 0.651; 95%CI: 0.376-0.727).

CONCLUSIONS

Although regular PA potentially contributes to reducing PD among older persons, the relationship is even stronger for those embedded in a higher constellation of SS. Policy and practical interventions seeking to improve regular PA engagement such as old-age friendly environment and psychological resources for socially isolated older persons are warranted.

Social support for elderly people over 65 years in Spain

AIMS

To determine what social support is available in Spain to people over 65 who also dedicate hours of their time to the care of others who are older.

BACKGROUND

Demographic and social changes are leading to growth of the population. The social support available to older people in the final stage of life affects their health.

METHODS

A cross-sectional study was conducted involving the records of older, non-institutionalized individuals residing in Spain, obtained from the European Health Survey of 2014. The method of collecting information used in the European Survey was personal interviews assisted by a computer.

RESULTS

The records of 6520 older people were studied; 40.1% of the participants studied had expressed the possibility of having three to five people available in case of a serious problem, and 83.6% reported that the rest of the people around them were very interested in what happens to them. With respect to care, only 7% of the older people studied mentioned performing care tasks.

CONCLUSIONS

Social support is beneficial to older people, regardless of whether they perform care tasks, because it acts as a protective factor against problems such as loneliness, stress and depression. The profile of a primary caregiver in this age range is a married, middle-class woman with primary schooling who is caring for a first-degree relative.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

These data suggest that it is necessary for nurses to know about the needs of older people to implement societal measures of health promotion, prevention and education that favour social cohort. In addition, health policymakers should establish programmes that improve the social support of non-institutionalized older people.

Gender, self-rated health and functional decline among community-dwelling older adults

OBJECTIVE

This paper examines the association between self-rated health (SRH) and functional decline (FD) in older Ghanaian cohorts and investigates whether the effect differs by gender and also modified by marital status.

METHODS

The study used cross-sectional survey data (N = 1200) from an Aging, Health, Psychological Wellbeing and Health-seeking Behavior Study (AHPWHB) study conducted in between August 2016 and January 2017. A four-level gendered-stratified logit modeling estimated the SRH-FD association and the interaction terms.

RESULTS

Overall, 23% of male respondents and 34% of women revealed significant FD (p < 0.001). The fully-adjusted model showed that SRH status was a strong predictor of FD across genders but the effect was most pronounced among men. Compared with excellent/very good SRH, fair and poor SRH (β = 0.160; p < 0.05) and (β = 1.700; p < 0.001) for women and (β = 2.202; p < 0.001) and (β= 2.356; p < 0.001) for men respectively were significantly associated with increased FD. However, good (β = - 1.760; p < 0.001), fair (β = - 2.800; p < 0.001) and poor SRH (β = -2.088; p < 0.001) decreased FD if an older woman was married compared with unmarried women with excellent/very good SRH.

CONCLUSION

The strength of SRH-FDs association largely differed with gender and also moderated by marital status for women. Improving the SRH and marital quality could be protective of functional abilities, independence and quality of life for older people.

Retiring with Intention

: An increasing number of nurses are approaching retirement age and finding themselves faced with numerous challenges and opportunities. Yet many avoid thinking about and preparing for this important professional and personal transition. Some cannot imagine what they will do when their career ends, whereas others do not believe they are financially ready to retire. This article discusses strategies to address these and other common concerns and will help nurses embrace this new and exciting stage of their lives with deliberation, confidence, and financial security.

Adverse Events in Home Care: Identifying and Responding with interRAI Scales and Clinical Assessment Protocols

Outcomes of adverse events in home care are varied and multifactorial. This study tested a framework combining two health measures to identify home care recipients at higher risk of long-term care placement or death within one year. Both measures come from the Resident Assessment Instrument-Home Care (RAI-HC), a standardized comprehensive clinical assessment. Persons scoring high in the Method for Assigning Priority Levels (MAPLe) algorithm and Changes in Health, End-stage disease, Signs and Symptoms (CHESS) scale were at the greatest risk of placement or death and more than twice as likely to experience either outcome earlier than others. The target group was more likely to trigger mood, social relationship, and caregiver distress issues, suggesting mental health and psychosocial interventions might help in addition to medical care and/or personal support services. Home care agencies can use this framework to identify home care patients who may require a more intensive care coordinator approach.