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Loneliness and social isolation are prevalent concerns among older adults and can lead to negative health consequences and a reduced lifespan. New technologies are increasingly being developed to help address loneliness and social isolation in older adults, including monitoring systems, social networks, robots, companions, smart televisions, augmented reality (AR) and virtual reality (VR) applications. This systematic review maps human-centered design (HCD) and user-centered design (UCD) approaches, human needs, and contextual factors considered in current technological interventions designed to address the problems of loneliness and social isolation in older adults. We conducted a scoping review and in-depth examination of 98 papers through a qualitative content analysis. We found 12 studies applying either an HCD or UCD approach and observed strengths in continuous user involvement and implementation in field studies but limitations in participant inclusion criteria and methodological reporting. We also observed the consideration of important human needs and contextual factors. However, more research is needed on stakeholder perspectives, the functioning of applications in different housing environments, as well as studies that include diverse socio-economic groups.
To explore the association of cardiovascular-kidney-metabolic (CKM) health with the risk of depression and anxiety and to investigate the joint association of CKM health and social connection with depression and anxiety.
Methods
This prospective cohort study included 344 956 participants from the UK Biobank. CKM syndrome was identified as a medical condition with the presence of metabolic risk factors, cardiovascular disease, and chronic kidney disease, and was classified into five stages (stage 0–4) in this study. Loneliness and social isolation status were determined by self-reported questionnaires. Cox proportional hazards models were applied for analyses.
Results
Compared with participants in stage 0, the HRs for depression were 1.17 (95% CI 1.10–1.25), 1.40 (95% CI 1.33–1.48), and 2.14 (95% CI 1.98–2.31) for participants in stage 1, 2–3, and 4, respectively. Similarly, participants in stage 2–3 (HR = 1.20, 95% CI 1.14–1.26) and stage 4 (HR = 1.63, 95% CI 1.51–1.75) had greater risks of incident anxiety. We found additive interactions between loneliness and CKM health on the risk of depression and anxiety. Participants simultaneously reported being lonely and in stage 4 had the greatest risk of depression (HR = 4.44, 95% CI 3.89–5.07) and anxiety (HR = 2.58, 95% CI 2.21–3.01) compared with those without loneliness and in stage 0. We also observed an additive interaction between social isolation and CKM health on the risk of depression.
Conclusions
Our findings suggest the importance of comprehensive interventions to improve CKM health and social connection to reduce the disease burden of depression and anxiety.
Loneliness and social isolation among older adults are emerging public health concerns. Older adults from ethnic minority communities or with immigration backgrounds may be particularly vulnerable when encountering loneliness and social isolation due to the double jeopardy of their old age and minority status. The goal of this study is to conduct a scoping review of published journal articles on ethnic minority/immigrant older adults' loneliness and social isolation experiences to show the extent, range and nature of empirical studies in this area across several high-income countries (i.e. European countries, United States of America (USA), Canada, Australia and New Zealand). This review uses Arksey and O'Malley's five-state framework, a well-established scoping review method. We identify and analyse 76 articles published between 1983 and 2021. This evidence base is largely US-focused (54%) with the vast majority (76%) having a quantitative design. We summarise and map factors of loneliness and social isolation into a multi-dimensional socio-ecological model. By doing so, we show how ethnicity/immigration-specific factors and general factors intersect in multiple dimensions across places and time, shaping ethnic minority/immigrant older adults' heterogeneous experiences of loneliness and social isolation. Several critical gaps that should be at the forefront of future research are highlighted and discussed.
Positively experienced relationships with family, partners and friends are the most important source of meaning in life for older persons. At the same time, Western countries are confronted with a growing number of socially isolated older adults who lack those relationships. This study aims to explore whether and how older adults who live in social isolation experience meaning in life. Data were collected via in-depth, semi-structured interviews with 24 socially isolated older adults, ranging in age from 62 to 94, all living in Rotterdam, The Netherlands. The criterion-based sampling of participants took place in close consultation with social workers of a mentoring project for socially isolated older adults. Follow-up interviews with 22 participants improved the credibility of findings and contributed to the breadth and depth of the researched casuistry. Data were analysed using an analytical framework based on seven needs of meaning identified by Baumeister (purpose, values, efficacy, self-worth) and Derkx (coherence, excitement, connectedness). The study demonstrates that isolated older adults may find anchors for meaning in life, although not all needs for meaning are satisfied, and there can also be tension between different needs. The needs-based model provides concrete distinctions for enabling care-givers to recognise elements of meaning.
People with schizophrenia on average are more socially isolated, lonelier, have more social cognitive impairment, and are less socially motivated than healthy individuals. People with bipolar disorder also have social isolation, though typically less than that seen in schizophrenia. We aimed to disentangle whether the social cognitive and social motivation impairments observed in schizophrenia are a specific feature of the clinical condition v. social isolation generally.
Methods
We compared four groups (clinically stable patients with schizophrenia or bipolar disorder, individuals drawn from the community with self-described social isolation, and a socially connected community control group) on loneliness, social cognition, and approach and avoidance social motivation.
Results
Individuals with schizophrenia (n = 72) showed intermediate levels of social isolation, loneliness, and social approach motivation between the isolated (n = 96) and connected control (n = 55) groups. However, they showed significant deficits in social cognition compared to both community groups. Individuals with bipolar disorder (n = 48) were intermediate between isolated and control groups for loneliness and social approach. They did not show deficits on social cognition tasks. Both clinical groups had higher social avoidance than both community groups
Conclusions
The results suggest that social cognitive deficits in schizophrenia, and high social avoidance motivation in both schizophrenia and bipolar disorder, are distinct features of the clinical conditions and not byproducts of social isolation. In contrast, differences between clinical and control groups on levels of loneliness and social approach motivation were congruent with the groups' degree of social isolation.
Edited by
Richard Williams, University of South Wales,Verity Kemp, Independent Health Emergency Planning Consultant,Keith Porter, University of Birmingham,Tim Healing, Worshipful Society of Apothecaries of London,John Drury, University of Sussex
The COVID-19 pandemic severely disrupted the educational and social lives of millions of children across the globe. Many governments attempted to curb the spread of the virus by closing schools or allowing them to remain open only for certain students, necessitating a rapid adjustment to remote home learning for schools and families. In the UK, this led to huge variability in the provision of educational materials, in children’s engagement, and in parents’ capacity to support home learning. This chapter describes the impacts of the school closures on families’ and students’ educational and socioemotional development.
Edited by
Rachel Thomasson, Manchester Centre for Clinical Neurosciences,Elspeth Guthrie, Leeds Institute of Health Sciences,Allan House, Leeds Institute of Health Sciences
Taking a history is an essential part of patient care for all clinicians but there can be a tendency for the social history to be brief, formulaic or even absent. The possible reasons for this and how liaison psychiatry might respond, given that history-taking skills are highly developed in the specialty, are described. The individual in the wider multidisciplinary team who is best placed to take a social history from a patient is considered, reviewing the attitudes of both doctors and nurses alongside evidence from studies where frameworks have been established to take the social history from all patients. The sources of information other than the patient that might be considered are described. Several key aspects of the social history are explored in detail – debt, employment, housing and social isolation. The evidence of impact on physical health and mental health is detailed for each, together with a summary of the evidence of benefit for interventions. Finally, the issue of how the information obtained should be shared and with whom and what can be done to improve patient outcomes is discussed.
Psychotic experiences (PEs) and social isolation (SI) seem related during early stages of psychosis, but the temporal dynamics between the two are not clear. Literature so far suggests a self-perpetuating cycle wherein momentary increases in PEs lead to social withdrawal, which, subsequently, triggers PEs at a next point in time, especially when SI is associated with increased distress. The current study investigated the daily-life temporal associations between SI and PEs, as well as the role of SI-related and general affective distress in individuals at clinical high risk (CHR) for psychosis.
Methods
We used experience sampling methodology in a sample of 137 CHR participants. We analyzed the association between SI, PEs, and distress using time-lagged linear mixed-effects models.
Results
SI did not predict next-moment fluctuations in PEs, or vice versa. Furthermore, although SI-related distress was not predictive of subsequent PEs, general affective distress during SI was a robust predictor of next-moment PEs.
Conclusions
Our results suggest that SI and PEs are not directly related on a moment-to-moment level, but a negative emotional state when alone does contribute to the risk of PEs. These findings highlight the role of affective wellbeing during early-stage psychosis development.
As the incidence of dementia is rapidly increasing around the world, especially in developing countries, it has become one of the most important health and social challenges facing humanity. This volume has reviewed research on social and psychological factors that could moderate the development of dementia in late life through social connection. This last chapter reviews psychosocial interventions connected with various aspects of social connection or lack thereof, such as social networks, social relationships, social engagement, loneliness, and sense of belonging, to examine interventions and their key factors that have shown efficacy in enhancing the moderators. It also introduces three evidence-based components that can be adopted in strategies and policies that aim to reduce the modifiable risks of dementia.
South Korea is experiencing the fastest aging of its population in world history, and its dementia population has grown swiftly in the past three decades. This chapter proposes the country’s significance as a case of interest for understanding global population aging and the associated increasing dementia population. A brief history of South Korea, transforming from an agricultural society to a major industrialized nation in less than half a century, demonstrates how major societal changes accompanying industrial development and modernization in a relatively short period have shaped the population aging of a country and its older adults’ risks for dementia. Studies of cognitive aging among elderly Koreans have found greater effects of education on cognitive performance compared to their counterparts in developed countries. As the role of formal education in cognitive development and its moderating effects on neurodegeneration have been found consistently, lack of education has significant consequences on the prevalence of dementia in elderly Koreans, especially women. This has important implications for global aging and dementia epidemiology, as the current increase in the global dementia population is most concentrated in developing countries.
While social disconnection has been consistently perceived as a threat to human beings, objective and subjective social disconnectedness have been associated with poor physical well-being and a higher mortality rate. These factors are equivalent to or more significant than other well-known risk factors, such as smoking. Although mild to severe loneliness persists across the lifespan, correlates of loneliness show age differences, and loneliness affects late-life depression and accelerates the rate of physiological decline with age. In many societies, older adults undergo a transition in social life after retirement or bereavement, leading in many cases to social isolation, which may result in loneliness. This chapter reviews the effects of social isolation on late-life psychological health, focusing on the role of perceived isolation, also known as loneliness. It also discusses multiple risk factors contributing to loneliness, which can be described in terms of trait and state loneliness. Lastly, it notes that not all social connections are beneficial for all when discussing gender differences in social networks.
Being an active part of a group or society (i.e., social integration) has been recognized as an important factor in promoting health and well-being in later life. With increasing attention on how social integration can lower morbidity and all-cause mortality in later life, recent studies point to immune response as a candidate link between social integration and physiological mechanisms. Given that physical aging is accompanied by elevated levels of systemic pro-inflammatory markers, such as interleukin-6 and C-reactive protein, social relationships emerge as a factor that can counteract aging processes associated with systemic inflammations. This chapter reviews how the increased inflammatory response (i.e., inflammageing) in late life may facilitate cognitive decline. Moreover, it focuses on how social integration or support plays protective roles in systemic inflammation functions. Finally, it reviews recent findings from health psychology regarding psychological factors, such as purpose in life and alteration of gut microbiome, that moderate the age-related risk factors for maladaptive immune function.
Society within the Brain provides insightful accounts of scientific research linking social connection with brain and cognitive aging through state-of-the-art research. This involves comprehensive social network analysis, social neuroscience, neuropsychology, psychoneuroimmunology, and sociogenomics. This book provides a scientific discourse on how a society, community, or friends and family interact with individuals' cognitive aging. Issues concerning social isolation, rapidly increasing in modern societies, and the controversy in origins of individual difference in social brain and behaviour are discussed. An integrative framework is introduced to explicate how social networks and support alleviate the effects of aging in brain health and reduce dementia risks. This book is of interest and useful to a wide readership: from gerontologists, psychologists, clinical neuroscientists and sociologists, to those involved in developing community-based interventions or public health policy for brain health, to people interested in how social life influences brain aging or in the prevention of dementia.
Coronavirus disease (COVID-19) lockdowns disproportionately affect older people where most suffer from social isolation and loneliness, which translate into higher rates of depression and anxiety. This study aimed to explore the accessibility, outcomes, and challenges of social technology use among community-dwelling older adults, older adults in long-term care, older adults with neurocognitive disorder, and older adults with pre-frailty and frailty, to help guide future research in this area. A rapid review was conducted, and articles were retrieved from four online databases, including Medline, AgeLine, EconLit and CINAHL, and grey literature from Google Scholar. Of the 131 articles retrieved, 24 were included in this review. The positive outcomes of social technology use include improved mental and physical health, reduced health disparities, and increased autonomy. Adverse outcomes include furthering the digital divide. More research surrounding the economic impacts of social technologies is warranted.
Little information is available on the association between gender nonconformity during adolescence and subsequent mental health. While the distress related to gender nonconformity may be socially produced rather than attributed to individual-level factors, further research is needed to better understand the role of psychosocial factors in this context.
Method
We analyzed data from the Tokyo Teen Cohort, obtained through random sampling of adolescents born between 2002 and 2004. We used inverse probability weighting to examine the association of gender nonconformity at ages 12 and 14 as a time-varying variable with subsequent mental health at age 16, while accounting for time-fixed and time-varying confounders. Furthermore, we used a weighting approach to investigate the mediating role of modifiable psychosocial factors in this association, addressing exposure-mediator and mediator–mediator interactions.
Results
A total of 3171 participants were analyzed. Persistent gender nonconforming behavior at ages 12 and 14 was associated with subsequent depression (β = 2.02, 95% confidence interval [CI] 0.85 to 3.19) and psychotic experiences (β = 0.33, 95% CI 0.14 to 0.52) at age 16. The results remained robust in sensitivity analyses. Approximately 30% of the association between gender nonconformity and depression was consistently mediated by a set of psychosocial factors, namely loneliness, bullying victimization, and relationships with mother, father, and friends.
Conclusions
Persistent gender nonconformity during adolescence is associated with subsequent mental health. Psychosocial factors play a vital mediating role in this association, highlighting the essential need for social intervention and change to reduce stigmatization and ameliorate mental health challenges.
This participatory action research (PAR) aimed to understand the health implications of guidelines impacting social isolation among frail community-dwelling older adults and their family and formal caregivers during the coronavirus disease (COVID-19) pandemic. Reflexive thematic analysis (RTA) of data collected from 10 policy/procedural documents revealed four themes: valuing principles, identifying problem(s), setting priorities, and making recommendations. Interviews with 31 participants from Peterborough, Ontario, also revealed four themes: sacrificing social health, diminishing physical health, draining mental health, and defining supports. Recommendations to decision makers were finalized at a knowledge exchange event involving participants and members of Age-friendly Peterborough. Key findings demonstrate the need for Canadian governments and health and social service agencies to enhance access to technology-based interventions, and educational and financial resources for caregivers. Meaningful communication and collaboration between older adults, caregivers, and decision makers are also needed to reduce the gap between policy and practice when addressing social isolation.
Many social interventions have been developed with the hopes of reducing and preventing social isolation among older people (e.g., recreation, arts-based programs and social prescription). Friendly visiting programs, also known as befriending schemes, have been a mainstay in this area for decades and are largely thought to be effective at reconnecting older people (≥ 60 years of age) experiencing isolation. Research and evaluations have yet to determine, however, how and why these programs may be most successful, and under what conditions. This article presents the findings of a realist synthesis aimed at identifying the critical mechanisms and contextual factors that lead to successful outcomes in friendly visiting programs. Seven studies are synthesized to inform a friendly visiting program theory accounting for key mechanisms (e.g., provision of informal support) and underlying contexts (e.g., training of volunteers) that can be used to inform future programs. Recommendations for future research are also presented.
Older brain age – as estimated from structural MRI data – is known to be associated with detrimental mental and physical health outcomes in older adults. Social isolation, which has similar detrimental effects on health, may be associated with accelerated brain aging though little is known about how different trajectories of social isolation across the life course moderate this association. We examined the associations between social isolation trajectories from age 5 to age 38 and brain age assessed at age 45.
Methods
We previously created a typology of social isolation based on onset during the life course and persistence into adulthood, using group-based trajectory analysis of longitudinal data from a New Zealand birth cohort. The typology comprises four groups: ‘never-isolated’, ‘adult-only’, ‘child-only’, and persistent ‘child-adult’ isolation. A brain age gap estimate (brainAGE) – the difference between predicted age from structural MRI date and chronological age – was derived at age 45. We undertook analyses of brainAGE with trajectory group as the predictor, adjusting for sex, family socio-economic status, and a range of familial and child-behavioral factors.
Results
Older brain age in mid-adulthood was associated with trajectories of social isolation after adjustment for family and child confounders, particularly for the ‘adult-only’ group compared to the ‘never-isolated’ group.
Conclusions
Although our findings are associational, they indicate that preventing social isolation, particularly in mid-adulthood, may help to avert accelerated brain aging associated with negative health outcomes later in life.
Social networks are critical social health factors for older adults. This study examined the association between social networks and dietary variety among community-dwelling older adults.
Design:
A cross-sectional study, using the dietary variety score (DVS) developed for older Japanese people to assess dietary variety and the Lubben Social Network Scale (LSNS-6) to assess social networks.
Setting:
N City, H Prefecture, Japan.
Participants:
Community-dwelling older adults aged ≥ 65 years (n 1229).
Results:
The LSNS-6 score in the low DVS group was lower than that in the middle and high DVS groups (12·2 ± 5·6 v. 13·4 ± 5·4 and 14·4 ± 5·7, P < 0·001). The population of social isolation (LSNS-6, < 12) in the low DVS group was higher than that in the middle and high DVS groups (43·5 % v. 35·8 % and 31·0 %, P = 0·005). Multivariate linear regression analysis showed that the LSNS-6 score was positively correlated with DVS (standardised coefficient, 0·092; P = 0·002). Social isolation was also significantly associated with a low DVS in the multivariate-adjusted logistic analysis model (OR, 1·30; 95 % CI 1·00, 1·68; P = 0·048). Stratified analysis results revealed the LSNS-6 and DVS were significantly associated in participants with the following characteristics: younger age (< 75 years), women and those living with someone.
Conclusions:
Social networks were associated with dietary variety; social isolation was related to poor dietary variety among community-dwelling older adults. An association between social networks and dietary variety was observed among young-old older adults, women and those living with someone.