The recognition of dementia as a multifactorial disorder encourages the exploration of potentially modifiable risk factors. Social health might play a role in cognitive decline and dementia. The Social Health And REserve in the Dementia patient journey (SHARED) project aims to unravel the interplay between social health and biological and psychological factors on the trajectory from cognitive healthy. A multi-method approach is used, including the development of a conceptual framework for social health and its application in epidemiological and qualitative studies. Epidemiological studies in the SHARED project reveal potentially modifiable social health characteristics or markers associated with cognitive decline, dementia and mortality. This may shape new avenues for future interventions to prevent or delay cognitive decline and dementia and to enhance living well with dementia.

The recognition of dementia as a multifactorial disorder encourages the exploration of new pathways to understand its origins. Social health might play a role in cognitive decline and dementia, but conceptual clarity is lacking and this hinders investigation of associations and mechanisms. Social health might provide a new perspective on social connectedness. The objective is to develop a conceptual framework for social health to advance conceptual clarity in future studies and to identify potentially modifiable risk and protective factors in the “Social Health And Reserve in the Dementia patient journey (SHARED)” project.

The methods include the process of building the conceptual framework. We used the following steps: underpinning for concept advancement, concept advancement by the development of a conceptual model, and exploration of its potential feasibility.

Underpinning of the concept drew from a synthesis of theoretical, conceptual and epidemiological work, and resulted in the definition of social health as well-being that relies on capacities both of the individual and the social environment. In the conceptual framework the abstract definition has been elaborated into more precisely defined domains at both the individual and the social environmental levels. This allowed to identify domain related social health characteristics or markers in epidemiological data bases and to investigate associations between these markers and cognitive decline and dementia. The associated social health markers represent potentially modifiable risk and protective factors. Examples are “social engagement” in the participation domain at the individual level, and “frequency of contact” in the structure domain, “exchange of support” in the function domain and “loneliness” in the appraisal domain at the environmental level. The conceptual framework facilitated identification of domain related markers in the SHARED project, thus showing its potential feasibility.

The conceptual framework provides guidance for future research and facilitates identification of potentially modifiable risk and protective factors. These may shape new avenues for preventive interventions. We highlight the paradigm of social health in dementia as a priority for dementia research.

Besides aspects of physical and mental health and quality of life aspects the concept of social health is getting increasing attention in dementia research. Current research has led to a new umbrella concept of social health and first studies show relationships between social health markers and cognitive decline and dementia. But so far, no general overview exists how to measure social health in empirical studies.

The objective of this study therefore is to provide a systematic overview of instruments measuring aspects of social health and proposing a classification based on the new umbrella concept of social health.

Following the PRISMA 2020 guidelines a systematic review was conducted. The online search covered the databases PubMed/MEDLINE, PsychINFO, CINAHL within a publication period from 1st January 2000 till 15th October 2020 for English publications. To classify instruments a new multidimensional framework of social health was used.

A total of 150 studies with 68 single instruments were included into the study. A broad range of study types was covered (i.e., feasibility studies, cross-national panel studies) from all over the world, with the majority of studies being conducted in the USA. Most of the described instruments consist of self-report measures, but also proxy and hybrid tools were found. The length of the instruments in terms of the number of single items ranged from 3-126 items, with a median length of 13 items. On the individual level of social health with the three domains capacities, autonomy and social participation we classified 42 instruments and on the social environment level with the three domains structure, functions and appraisal we classified 53 instruments. A large part of the identified instruments only addresses single aspects of social health and does not address the multidimensionality of the concept.

A structured overview of measures related to the conceptual framework of social health can help develop appropriate interventions for people with dementia and improve the conditions for living well with dementia. Furthermore, the creation of new standardized and terminologically consistent measures of social health is one of the tasks for future research in the field of social health.

Good social connections are proposed to positively influence the course of cognitive decline by stimulating cognitive reserve and buffering harmful stress-related health effects. Prior meta-analytic research has uncovered links between social connections and the risk of poor health outcomes such as mild cognitive impairment, dementia, and mortality. These studies have primarily used aggregate data from North America and Europe with limited markers of social connections. Further research is required to explore these associations longitudinally across a wider range of social connection markers in a global setting.

We examined the associations between social connection structure, function, and quality and the risk of our primary outcomes (mild cognitive impairment, dementia, and mortality).

Individual participant-level data were obtained from 13 longitudinal studies of ageing from across the globe. We conducted survival analysis using Cox regression models and combined estimates from each study using two-stage meta-analysis. We examined three social constructs: connection structure (living situation, relationship status, interactions with friends/family, community group engagement), function (social support, having a confidante) and quality (relationship satisfaction, loneliness) in relation to the risks of three primary outcomes (mild cognitive impairment, dementia, and mortality). In our partially adjusted models, we included age, sex, and education and in fully adjusted models used these variables as well as diabetes, hypertension, smoking, cardiovascular risk, and depression.

In our fully adjusted models we observed: a lower risk of mild cognitive impairment was associated with being married/in a relationship (vs. being single), weekly community group engagement (vs. no engagement), weekly family/friend interactions (vs. not interacting), and never feeling lonely (vs. often feeling lonely); a lower risk of dementia was associated with monthly/weekly family/friend interactions and having a confidante (vs. no confidante); a lower risk of mortality was associated with living with others (vs. living alone), yearly/monthly/weekly community group engagement, and having a confidante.

Good social connection structure, function, and quality are associated with reduced risk of incident MCI, dementia, and mortality. Our results provide actionable evidence that social connections are required for healthy ageing.

Dementia negatively affects the interaction with the social environment by changes in cognition and behavior. On the other hand, the social network may be an important enabler for persons with dementia to make use of their remaining capacities. Mechanisms driving and explaining these interactions are unknown. We aimed to explore how the social environment impacts the functioning and well-being of a person with dementia.

We performed a qualitative case study, conducting semi-structured interviews. We used the grounded theory approach, as defined by Strauss and Corbin, including alternate data collection and analysis. Per case, the person with dementia, the primary caregiver, significant kin or non-kin network member and the primary healthcare professional were interviewed individually. The interviews were conducted using a topic guide, which was adjusted according to preliminary analyses. Transcripts were coded by two researchers independently, where after axial codes, categories were formulated and a theory including a core phenomenon was identified with the entire research team.

Analyses revealed ‘creating a safe environment’ as a core phenomenon. This relates to encouragement and the created anchor points of the environment to compensate for the inevitable feelings of loss of control that persons with dementia experience. The ways safety is created include active acts of involvement and participation, trust, humor, reciprocity, appreciation and shared experiences. Suspicion, loss of initiative by the person with dementia and the inability to act and correcting by the environment were identified as major challenges to creating a safe environment.

A safe and supporting environment enables persons with dementia to use their remaining capacities. Active participation, trust, humor and reciprocity are key elements to create such a safe environment. These findings show that basic needs of persons with dementia for daily functioning and well-being are similar to these of all humans.

Social functioning is fundamental to human experience. The profound social functioning impairments affecting people with dementia are distressing to them and their families and account for significant individual, family and societal burden. There are no effective treatments that improve this major aspect of dementia, so there is urgent need to characterise social functioning decline in dementia and its consequences to inform future therapeutic approaches. In this symposium, an international panel will present perspectives on social functioning in dementia from across the disease course.

People with dementia commonly have impaired social functioning and may not recognise this. This lack of insight may result in worse outcomes for the person and their family carers. We aimed to characterise insight into social functioning in dementia, and describe its association with dementia severity.

Observational cross-sectional study of people aged >65 years with clinically diagnosed dementia and their family informants recruited from three sites in Germany, Japan and the United Kingdom. We used the Social Functioning in Dementia scale (SF-DEM), which assesses three domains: “spending time with other people” (domain 1), “communicating with other people” (domain 2), and “sensitivity to other people” (domain 3). We calculated lack of insight into social functioning as the discrepancy between the ratings of the participants with dementia and their informant. We described this discrepancy and the proportion of people with dementia whose rating was overestimated, congruent or underestimated compared to their family informant. We calculated the association between SF-DEM discrepancy score and total mini-mental status examination (MMSE) score and recall and attention/concentration subdomains.

In 108 participants with dementia (50.9% women), mean age = 78.9 (standard deviation, SD 6.5) years, and mean MMSE score = 22.7 (SD 3.7). Ratings of patients and informants for domain 1 did not differ, but patient-rating was higher than carer-rating for domain 2 (patient-rated score 11.2 (2.5), carer-rated score 10.1 (3.4); p = 0.003) and domain 3 (patient-rated score 9.7 (2.4), carer-rated score 8.1 (2.8); p < 0.001). Sixty (55.6%) people with dementia overestimated their overall social functioning, 30 (27.8%) underestimated, and 18 (16.7%) gave ratings congruent with their family informant. Performance on the MMSE, and its sub-domains was not associated with SF-DEM discrepancy score.

We found that insight varies according to subdomains of social functioning, with people with dementia rating their communication and sensitivity differently, and usually higher than their carers. Researchers and clinicians should consider insight into social functioning in dementia as a multidimensional, rather than a unified, concept. Clinicians should help family members understand and adapt by explaining their relative with dementia’s lack of insight about aspects of their social functioning.

Social connection is a basic human need and is important for quality of life and care for residents in long-term care (LTC) homes. Research has established associations between aspects of social connection (e.g., social engagement, social support and loneliness) and mental health outcomes (e.g., depression). Yet, despite living in a congregate setting, those in LTC homes often experience poor social connection. Social connection has unique considerations for LTC homes, including that most residents are living with cognitive impairment or dementia, which requires a customized measurement approach.

The social connection in long-term care home residents (SONNET) study aims to improve measurement of social connection in LTC homes by addressing three specific questions: (1) What existing measures assess social connection in LTC homes and what are their psychometric properties? (2) What do residents, families, staff and clinicians consider to be the important elements of social connection in LTC homes? (3) Can a new measure accurately assess social connection in LTC home residents?

The three study questions will be addressed through: (1) A systematic review of existing measures, where measures will be characterized using content analysis and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methods; (2) Qualitative interviews with residents, families, staff and clinicians to understand important aspects of social connection, and, (3) Development and testing of a new measure of social connection in Canada and the UK.

Previous research will be discussed, including a scoping review summarizing research evidence linking social connection to mental health outcomes as well as strategies to build and maintain social connection during the COVID-19 pandemic. The SONNET study update will include preliminary findings from the systematic review and qualitative interviews, as well as development of a conceptual model and key considerations for a new measure.

Social connection is an important concept in LTC homes. A robust measure of social connection, developed specifically for this setting, will enable researchers and care settings to test the effects of interventions and to report outcomes at the individual-, home- and system-level.

Aging has traditionally been studied from loss, disease, and dependency, limiting the conceptualization of Quality of Life (QoL) to health. The population group of older people characterize by its heterogeneity in which many older adults experience gains and age with good physical, psychological and social conditions. Ignoring these aspects can lead to ageism. It is necessary to offer a change of perspective in which older adults’ QoL is analyzed from a multidimensional perspective where not only losses are taken into account but also the strengths of the person and the satisfaction of their higher needs (self-fulfillment, control, autonomy and pleasure).

This symposium aims to develop an assessment to improve QoL in older people through the promotion of their strengths.

Four studies from different Spanish and Portuguese universities were presented

Older people have psychological strengths that enhance QoL.

This symposium seeks to promote QoL in older people from a change of perspective based on strengths in a society for all ages, in line with the decade of healthy aging (2021-2030) approved by the World Health Assembly and the United Nations General Assembly. Aging implies a range of personal and material losses to which older people must adapt to maintain adequate levels of QoL. The stress model of Lazarus and Folkman (1984) states that the impact of stress on the person depends on the resources that they use to face the factors associated with stress. Previous research has supported the protective role of reminiscence, personal growth, digital skills, psychological well-being, acceptance, resilience, gratitude, and family functioning in QoL. Likewise, interventions focused on these variables have shown an increase in QoL. However, studies based on a strengths model are still very limited in older people.

The COVID-19 situation could be considered as an uncontrollable stressful life event. It may exert an impact on their quality of life (QoL). Not only COVID related variables, sociodemographic characteristics, health and appraisal but also personal resources could have an impact on QoL.

This study aims to assess the association between QoL and sociodemographic characteristics (sex, age), levels of health (physical health, emotional distress, and psychological well-being), COVID-19 related variables (having got infected, having lost a loved person, being hospitalized or having had a loved one hospitalized), appraisal (fear of COVID-19 outbreak), personal resources (family function, resilience, acceptance and gratitude).

QoL was assessed in all participants using CASP-19. A regression model was tested. 361 older adults in Spain participated in this study. The average age was 68.44 (SD= 5.31) and 62.8% were women (N= 227) and 58.2% were married (N= 210).

The results suggest that the nature of the COVID-19 may not be as relevant for the older adults’ QoL as their levels of health, personal resources for managing COVID related and emotional status. We found that the older adults QoL increased when increased the levels of health, acceptance, gratitude, personal growth, and purpose in life and when there were lower scores in anxiety and depression. This model explained 66.4% of variance. In contrast, COVID-19 variables or appraisal did not show any association with QoL.

A better understanding of the factors associated with QoL could help health professionals to develop interventions that enhance it. Efforts to address older adults’ QoL focusing on older adults’ personal resources, perceived health and emotional status should be considered.

The group population of older adults has suffered the highest number of deaths and impact on health associated with the COVID-19 pandemic. Many older adults can perceive this pandemic as a traumatic experience. However, many older adults may have also experienced positive changes, defined as post-traumatic growth (PTG). Several factors may enhance or hinder this possibility of development.

This study aimed to analyze if the effects of COVID-19 affection (direct and indirect), anxiety and depression on PTG would be mediated by the protective variables life purpose and resilience.

359 older adults over 60 years old completed a web-based survey during the COVID-19 pandemic including sociodemographic data, direct/indirect affectation by COVID-19, anxiety, depression, resilience, life purpose and PTG.

63.2% of the participants were women and 58.2% were married. 89.1% had been infected by COVID-19, 1.7% had been hospitalized, 15.6% had lost a loved one and 17.2% have had a relative hospitalized because of COVID-19. Women (M = 56.77; SD = 18.00) showed higher levels of PTG than men (M = 52.41; SD = 17.84) (t = -2.19; p < .05). Differences in the outcome variables based on direct or indirect COVID-19 affection were not found. The path analysis showed that the effect of COVID-19 symptoms on PTG was mainly mediated by life purpose, and anxiety to a lesser extent. We also confirmed two indirect effects: (1) the negative effect of depression on PTG through resilience and life purpose assessed simultaneously; (2) the positive effect of resilience on PTG through life purpose. Results showed an excellent model fit to this model (χ² = 3.759; χ²/gl = 5; p = .585; GFI = .997; CFI = .999; RMSEA = .001).

The identification of protective and vulnerability variables is essential to protect older adults from mental disorders. This study highlights the need for developing interventions that aim to increase PTG by promoting life purpose and resilience.

New technologies have many benefits for the quality of life of older people, but their use also carries risks and can transforms older people in potential victims of cyber-attacks. The increase of ICT use has caused many older adults to be displaced from these social advances, resulting in greater isolation, negative feelings related to ICTs and less access to services.

Due to the absence of extensive and generalisable studies in this area with this population, we consider it necessary to analyse older people's behaviour in relation to ICT and the psychosocial variables that are related to their adaptation.

To determine the effect of different psychosocial variables that may be related to the adaptation to TIC and protection measures used in cyberspace in older adults.

We have used a mixed research methodology: Firstly, a quantitative pilot study, analysing the variables descriptively; secondly, using qualitative interviews and an exploratory analysis. The next step is to design and validate a questionnaire that will include the 4 factors that we found relevant: victimisation, use of new technologies, fear of cybercrime and use of online protection barriers.

The 84% of the sample uses ICT more than one hour per day and 77%, had not received training in TIC and their perception of online vulnerability is low. The need for social support for the management of these tools was observed. Older people who use ICT less are those who are not digitally literate, perceive themselves as more vulnerable in their use of ICTs and have no one to help them with these tools.

The identification of variables related to the use of TIC, the perception of vulnerability and the online protection of older adults is fundamental for the development of effective interventions. It would be desirable not only to offer them training in digitalisation but also to provide them with the social support they demand.

Although the losses associated with aging activate additional psychological resilience resources, dependency settings, which often require admission to Residential Care Facilities (RCF's), need adequate care so that the person can maintain his/her dignity and quality of life. The activation of mechanisms for regulating losses and the preservation of the identity and autonomy of the person respecting his/her decision-making capacity are central for the preservation of the well-being of people with dependence. Portuguese RCF's are mainly based on care models that are opposed to the models of attention centered on the person, which value the person's potential and decision-making capacity. The COVID-19 pandemic has tested RCF's, highlighting their weaknesses and limitations.

This study aimed to identify ways to improve the provision of care in RCF's during the pandemic.

This is a qualitative study, with data collection through an online questionnaire. Participants were invited to indicate strategies to improve the provision of care to elderly residents in RCF's. The study included 198 RCF ́s workers during the COVID-19 pandemic. Content analysis of the collected data was performed.

Preliminary results on the ongoing study: The results indicate that the strategies that RCF´s workers consider most necessary are at the level of human resources, also highlighting the need for greater proximity, affection and attention to residents, the personalization of care and the valorization of the resident person and his/her opinions. These are considered by the participants as central strategies for the quality of care and satisfaction of RCF ́s workers.

The needs identified are in line with the guiding principles of Person-Centered Care. The use of reminiscence as a strategy for valuing the person and his/her identity, as well as the promotion of self-determination, evaluating and allowing the person to make decisions may be central to meeting the needs identified at the level of care. The necessary transition from RCF's in Portugal to paradigms of centered care is thus reinforced by the results of this study.