Associations of social isolation, social participation, and loneliness with frailty in older adults in Singapore: a panel data analysis

Abstract Background There is a shortage of research evidence about how social isolation, social participation, and loneliness were longitudinally associated with frailty. This study was to 1) examine the associations of social isolation, social participation, and loneliness with level of frailty among community-dwelling older adults using panel data, and 2) explore the moderating effect of gender on the association of social isolation, social participation and loneliness with frailty. Methods The study included 606 participants aged 60 years and above from the longitudinal Population Health Index Survey conducted in Singapore. At each timepoint, level of frailty was determined using the Clinical Frailty Scale. Social isolation was assessed by the Lubben Social Network Scale-6, and loneliness was assessed using the three-item UCLA Loneliness Scale. Fixed-effects ordinal logistic regressions were conducted with level of frailty as the dependent variable and social isolation and loneliness as the independent variables, adjusting for time-varying socio-demographic, lifestyle, and health-related factors. Results Increase in social participation was associated with lower level of frailty (odds ratio: 0.96, 95% confidence interval: 0.93–0.99) and feeling lonely was associated with higher level of frailty (odds ratio: 2.90, 95% confidence interval: 1.44–5.84). Social isolation was not associated with frailty. Gender did not have moderating effect on these associations. Conclusions This study observed that social isolation and loneliness had differential longitudinal association with level of frailty among community-dwelling older adults and suggested that loneliness and frailty should be measured and addressed concurrently among community-dwelling older adults.

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The Effects of Technological Interventions on Social Participation of Community-Dwelling Older Adults with and without Dementia: A Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm10112308 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2308

Author(s):

Pascale Heins ◽

Lizzy M. M. Boots ◽

Wei Qi Koh ◽

An Neven ◽

Frans R. J. Verhey ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Social Isolation ◽

Social Participation ◽

Methodological Quality ◽

Well Being ◽

Community Dwelling ◽

Cochrane Library ◽

Technological Interventions ◽

Community Dwelling Older Adults

Social isolation in community-dwelling older adults with dementia is a growing health issue that can negatively affect health and well-being. To date, little attention has been paid to the role of technology in improving their social participation. This systematic review aims to provide a systematic overview of the effects of technological interventions that target social participation in community-dwelling older adults with and without dementia. The scientific databases Medline (PubMed), PsycINFO, CINAHL, Web of Science, and the Cochrane Library were systematically searched and independently screened by two reviewers. Results were synthesized narratively. The methodological quality of included studies was independently assessed by two reviewers. In total, 36 studies of varying methodological quality were identified. Most studies evaluated social networking technology and ICT training programs. Three studies focused on people with dementia. Quantitative findings showed limited effects on loneliness, social isolation, and social support. Nevertheless, several benefits related to social participation were reported qualitatively. Social interaction, face-to-face contact, and intergenerational engagement were suggested to be successful elements of technological interventions in improving the social participation of community-dwelling older adults. Rigorous studies with larger sample sizes are highly needed to evaluate the long-term effects of technology on the multidimensional concept of social participation.

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The Influence of Social Isolation on the Preventive Behaviors for Non-Communicable Diseases in Community-Dwelling Older Adults in Japan

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17238985 ◽

2020 ◽

Vol 17 (23) ◽

pp. 8985

Author(s):

Yuko Yamaguchi ◽

Masako Yamada ◽

Elsi Dwi Hapsari ◽

Hiroya Matsuo

Keyword(s):

Older Adults ◽

Social Isolation ◽

Social Participation ◽

Communicable Diseases ◽

Community Dwelling ◽

Moderate Intensity ◽

Lifestyle Behaviors ◽

Cross Sectional ◽

Non Communicable Diseases ◽

Community Dwelling Older Adults

This study aimed to examine the relationship between one’s physical status related to non-communicable diseases (NCDs) and social isolation, and to identify lifestyle behaviors for the prevention of NCDs associated with social isolation among community-dwelling older adults in Japan. A cross-sectional study was conducted to investigate lifestyle behaviors for NCD prevention associated with social isolation in Japanese adults aged 60 years and above in a community setting. Out of 57 participants, 17.5% were not socially participative, 66.7% hardly ever, 29.8% sometimes, and 3.5% often felt loneliness. Non-social participation and loneliness were negatively related to the frequency of vegetable and fruit intake. Additionally, loneliness was positively associated with one’s duration of smoking and current smoking habits, and negatively associated with the frequency of moderate-intensity activities, with marginal significance. Those with non-social participation or loneliness were less likely to eat a healthy diet and live a smoke-free lifestyle. The findings of this study suggest that a mutual health support system in the community and the development of community-based approaches for the prevention of NCDs among Japanese older adults are needed.

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Frailty as a Moderator of the Relationship Between Social Isolation and Health Outcomes in Community-Dwelling Older Adults

10.20944/preprints202102.0091.v1 ◽

2021 ◽

Author(s):

Fereshteh Mehrabi ◽

François Béland

Keyword(s):

Mental Health ◽

Older Adults ◽

Health Outcomes ◽

Cognitive Decline ◽

Social Isolation ◽

Social Participation ◽

Social Connectedness ◽

Extended Family ◽

Community Dwelling ◽

Community Dwelling Older Adults

This research investigated the effects of social isolation on frailty and health outcomes and tested whether these associations varied across different levels of frailty. We performed a multivariate analysis of data from the first wave of the FRéLE study among 1,643 Canadian older adults aged 65 years and over. We assessed social isolation using social participation, social networks, and support from various social ties, namely, friends, children, extended family, and partner. Frailty predicted disability, comorbidity, depression, and cognitive decline. Less social participation was associated with IADLs, depression, and cognitive decline. The absence of friends was associated with depression and cognitive impairment. Less social support from children and partner was related to comorbidity, depression, and cognitive decline. Overall, social isolation is linked to mental health, rather than physical health. The associations of having no siblings, receiving less support from friends, and participating less in social activities with ADL limitations, depression, and cognitive decline were higher among frail than pre-frail and robust older adults. This study corroborates the pivotal role of social connectedness, particularly the quality of relationships, on the mental health of older adults. Public health policies on social relationships are paramount to ameliorate the health status of frail older adults.

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Frailty as a Moderator of the Relationship between Social Isolation and Health Outcomes in Community-Dwelling Older Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041675 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1675

Author(s):

Fereshteh Mehrabi ◽

François Béland

Keyword(s):

Mental Health ◽

Older Adults ◽

Health Outcomes ◽

Cognitive Decline ◽

Social Isolation ◽

Social Participation ◽

Social Connectedness ◽

Extended Family ◽

Community Dwelling ◽

Community Dwelling Older Adults

This research investigated the effects of social isolation on frailty and health outcomes and tested whether these associations varied across different levels of frailty. We performed a multivariate analysis of the first wave of Frailty: A longitudinal study of its expressions (FRéLE) among 1643 Canadian older adults aged 65 years and over. We assessed social isolation using social participation, social networks, and support from various social ties, namely, friends, children, extended family, and partner. Frailty was associated with disability, comorbidity, depression, and cognitive decline. Less social participation was associated with limitations in instrumental activities of daily living (IADLs), depression, and cognitive decline. The absence of friends was associated with depression and cognitive impairment. Less social support from children and partner was related to comorbidity, depression, and cognitive decline. Overall, social isolation is linked to mental health rather than physical health. The associations of having no siblings, receiving less support from friends, and participating less in social activities with ADL limitations, depression, and cognitive decline were higher among frail than prefrail and robust older adults. This study corroborates the pivotal role of social connectedness, particularly the quality of relationships, on the mental health of older adults. Public health policies on social relationships are paramount to ameliorate the health status of frail older adults.

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One-Year Adherence to the Otago Exercise Program With or Without Motivational Interviewing in Community-Dwelling Older Adults

Journal of Aging and Physical Activity ◽

10.1123/japa.2017-0009 ◽

2018 ◽

Vol 26 (3) ◽

pp. 390-395 ◽

Cited By ~ 9

Author(s):

Marina Arkkukangas ◽

Anne Söderlund ◽

Staffan Eriksson ◽

Ann-Christin Johansson

Keyword(s):

Older Adults ◽

Confidence Interval ◽

Motivational Interviewing ◽

Odds Ratio ◽

Exercise Program ◽

Exercise Adherence ◽

Community Dwelling ◽

Behavioral Factors ◽

Exercise Interventions ◽

Community Dwelling Older Adults

This study investigated if behavioral factors, treatment with behavioral support, readiness to change, fall self-efficacy, and activity habits could predict long-term adherence to an exercise program. Included in this study were 114 community-dwelling older adults who had participated in one of two home-based exercise interventions. Behavioral factors associated with adherence to the exercise program over 52 weeks were analyzed. The behavioral factors, specifically activity habits at baseline, significantly predicted adherence to the exercise program, with an odds ratio = 3.39, 95% confidence interval [1.38, 8.32], for exercise and an odds ratio = 6.11, 95% confidence interval [2.34, 15.94], for walks. Being allocated to a specific treatment including motivational interviewing was also significantly predictive: odds ratio = 2.47, 95% confidence interval [1.11, 5.49] for exercise adherence. In conclusion, activity habits and exercise in combination with motivational interviewing had a significant association with adherence to the exercise program at a 1-year follow-up.

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Plasma acylcarnitines and risk of lower-extremity functional impairment in older adults: a nested case–control study

Scientific Reports ◽

10.1038/s41598-021-82912-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Francisco Félix Caballero ◽

Ellen A. Struijk ◽

Alberto Lana ◽

Antonio Buño ◽

Fernando Rodríguez-Artalejo ◽

...

Keyword(s):

Older Adults ◽

Confidence Interval ◽

Lower Extremity ◽

Functional Impairment ◽

Odds Ratio ◽

Case Control Study ◽

Case Control ◽

Community Dwelling ◽

Control Study ◽

Long Chain

AbstractElevated concentrations of acylcarnitines have been associated with higher risk of obesity, type 2 diabetes and cardiovascular disease. The aim of the present study was to assess the association between L-carnitine and acylcarnitine profiles, and 2-year risk of incident lower-extremity functional impairment (LEFI). This case–control study is nested in the Seniors-ENRICA cohort of community-dwelling older adults, which included 43 incident cases of LEFI and 86 age- and sex- matched controls. LEFI was assessed with the Short Physical Performance Battery. Plasma L-carnitine and 28 acylcarnitine species were measured. After adjusting for potential confounders, medium-chain acylcarnitines levels were associated with 2-year incidence of LEFI [odds ratio per 1-SD increase: 1.69; 95% confidence interval: 1.08, 2.64; p = 0.02]. Similar results were observed for long-chain acylcarnitines [odds ratio per 1-SD increase: 1.70; 95% confidence interval: 1.03, 2.80; p = 0.04]. Stratified analyses showed a stronger association between medium- and long-chain acylcarnitines and incidence of LEFI among those with body mass index and energy intake below the median value. In conclusion, higher plasma concentrations of medium- and long-chain acylcarnitines were associated with higher risk of LEFI. Given the role of these molecules on mitochondrial transport of fatty acids, our results suggest that bioenergetics dysbalance contributes to LEFI.

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COVID-19 lockdown has altered the dynamics between affective symptoms and social isolation among older adults: results from a longitudinal network analysis

Scientific Reports ◽

10.1038/s41598-021-94301-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Junhong Yu ◽

Rathi Mahendran

Keyword(s):

Older Adults ◽

Social Isolation ◽

Anxiety Symptoms ◽

Community Dwelling ◽

Depression Symptoms ◽

Network Analyses ◽

Correlation Networks ◽

Affective Symptoms ◽

Tightly Coupled ◽

Community Dwelling Older Adults

AbstractThe COVID-19 lockdown has drastically limited social interactions and brought about a climate of fear and uncertainty. These circumstances not only increased affective symptoms and social isolation among community dwelling older adults but also alter the dynamics between them. Using network analyses, we study the changes in these dynamics before and during the lockdown. Community-dwelling older adults (N = 419) completed questionnaires assessing depression, anxiety, and social isolation, before the COVID-19 pandemic, as part of a cohort study, and during the lockdown period. The total scores of these questionnaires were compared across time. For the network analyses, partial correlation networks were constructed using items in the questionnaires as nodes, separately at both timepoints. Changes in edges, as well as nodal and bridge centrality were examined across time. Depression and anxiety symptoms, and social isolation had significantly increased during the lockdown. Significant changes were observed across time on several edges. Greater connectivity between the affective and social isolation nodes at lockdown was observed. Depression symptoms have become more tightly coupled across individuals, and so were the anxiety symptoms. Depression symptoms have also become slightly decoupled from those of anxiety. These changing network dynamics reflect the greater influence of social isolation on affective symptoms across individuals and an increased vulnerability to affective disorders. These findings provide novel perspectives and translational implications on the changing mental health context amidst a COVID-19 pandemic situation.

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Association between Phthalate Exposure and Frailty among Community-Dwelling Older Adults: A Repeated Panel Data Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041985 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1985

Author(s):

Hongsoo Kim ◽

Seyune Lee ◽

Young-Il Jung ◽

Yun-Chul Hong

Keyword(s):

Older Adults ◽

Panel Data ◽

Positive Impact ◽

Environmental Pollutants ◽

Community Dwelling ◽

Metabolite Concentrations ◽

Males And Females ◽

Korean Elderly ◽

Community Dwelling Older Adults ◽

Ethylhexyl Phthalate

Only a few studies have examined the impacts of environmental exposure on frailty. This study investigated the association between phthalates and frailty among community-dwelling older adults. The Korean Elderly Environmental Panel II (KEEP II) study is a repeated panel data study of 800 community-dwelling older adults in South Korea. Frailty was measured with five items defined by Fried and colleagues. Environmental pollutants in the form of two types of metabolites for Di-ethylhexyl phthalate (DEHPs)—Mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and Mono (2-ethyl-5-oxohexyl) phthalate (MEOHP)—were obtained from urine specimens. Analyses were performed using repeated linear mixed models. The concentration levels of both MEOHP and MEHHP in urine were significantly higher in the pre-frail or frail group than its counterparts. While adjusting for covariates, MEOHP level was positively associated with the likelihood of being pre-frail or frail in both males and females; the concentration level of MEHHP also had a positive impact on the likelihood of being pre-frail or frail in females. The DEHP metabolite concentrations were significantly lower among adults with daily fruit consumption in both males and females. DEHPs, measured by metabolite concentrations, may increase the risk of frailty among older men and women; further studies are necessary. The preventive effects of nutrition on DEHP risk should also be further investigated.

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Cognitive Outcomes during COVID-19 confiNemeNt in Elderly and their Caregivers using Technologies for DEMentia (CONNECT DEM): study protocol (Preprint)

10.2196/preprints.26431 ◽

2020 ◽

Author(s):

Jessica Marian Goodman-Casanova ◽

Elena Dura-Perez ◽

Gloria Guerrero-Pertiñez ◽

Pilar Barnestein-Fonseca ◽

Jose Guzman-Parra ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Social Isolation ◽

Community Dwelling ◽

Mild Dementia ◽

Care Services ◽

Health And Social Care ◽

The Impact ◽

Community Dwelling Older Adults

BACKGROUND Coronavirus disease 2019 has forced worldwide the implementation of unprecedented restrictions to control its rapid spread and mitigate its impact. The Spanish government has enforced social distancing, quarantine and home confinement. This restriction of daily life activities and separation from loved ones may lead to social isolation and loneliness with health-related consequences in community-dwelling older adults with mild cognitive impairment or mild dementia and their caregivers. Additionally, an inadequate access to healthcare and social support services may aggravate chronic conditions. Technology home-based interventions emerge for combating social isolation and loneliness preventing the risk of viral exposure. OBJECTIVE The aim of this cohort study is to explore, analyze and determine the impact of social isolation on: 1) cognition, quality of life, mood, technophilia and perceived stress of community-dwelling older adults with mild cognitive impairment or mild dementia, and on caregiver burden; 2) health and social care services access and utilization, and 3) cognitive, social and entertainment use of ICTs. METHODS This study will be conducted in the Spanish region of Andalucía (Málaga). In total 200 dyads, consisting of a person with mild cognitive impairment or mild dementia (PMCI/MD) and their informal caregiver will be contacted by telephone. Potential respondents will be participants of the SMART 4 MD (N=100) and TV-AssistDem (N=100) clinical trials. RESULTS The change in means in the variables will be analyzed comparing baseline results in the previous studies with those during and after confinement using the ANOVA test of repeated measures or the non-parametric Friedman test if appropriate. The performance of a multivariate analysis of variance (ANCOVA) to introduce possible covariates will also be contemplated. A 95% confidence level will be used. CONCLUSIONS If the hypothesis is proven, these findings will demonstrate the negative impact of social isolation due to the COVID-19 confinement on cognition, quality of life, mood, and perceived stress of community-dwelling older adults with mild cognitive impairment and mild dementia, the impact on technophilia, caregiver burden, and health and social care services access and utilization; and the cognitive, social and entertainment use of ICTs during the COVID-19 confinement and afterwards. CLINICALTRIAL NCT: 04385797

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