Internet Use and Loneliness among Urban and Non-Urban Chinese Older Adults: The Roles of Family Support, Friend Support, and Social Participation.

OBJECTIVES: This study investigated the association between Internet use and loneliness among older Chinese adults, and the mediating effects of family support, friend support, and social participation. These associations were evaluated in the context of urban and non-urban geographic settings. METHODS: This study used data from the 2018 wave of the China Longitudinal Ageing Social Survey (N=10,126), examining samples of urban (n=3,917) and non-urban (n=6,209) older adults separately. Linear regression and path analysis within a structural equation modeling framework were employed. RESULTS: Internet use was negatively associated with loneliness for both urban and non-urban residing older adults. Family support and social participation mediated the association between Internet use and loneliness for both urban and non-urban residing older Chinese adults, but friend support mediated this association only for urban older residents. DISCUSSION: This study shed light on our understanding about the relationship between Internet use and loneliness among older adults in the Chinese context. Also, these findings suggested that digital interventions for loneliness should pay special attention to the different characteristics of urban and non-urban dwelling older Chinese adults.

Pathways Linking Information and Communication Technology Use and Loneliness Among Older Adults: Evidence From the Health and Retirement Study.

BACKGROUND AND OBJECTIVES: This study investigated the association between information and communication technology (ICT) use and loneliness among community-dwelling older adults (aged 65+), as well as the mediating effects of social relations, perceived control, and purpose-in-life. RESEARCH DESIGN AND METHODS: The study used data from the 2014 and 2018 Health and Retirement Study (N = 3,026), employing autoregressive path models with contemporaneous mediation to assess the association of 2 kinds of ICT use, social media communication and general computer use, with loneliness through the pathways of perceived social support, social contact, perceived constraints, and purpose-in-life. RESULTS: Social media communication had a negative association with loneliness. Perceived social support and social contact mediated this association, but not perceived constraints, or purpose-in-life. General computer use did not have a significant total effect on loneliness; however, a significant indirect effect through perceived constraints, purpose-in-life, and social contact was found. DISCUSSION AND IMPLICATIONS: Our findings extended the existing literature regarding the important factors associated with variation in loneliness among older adults. Health programs and ICT solutions could be more effective in mitigating loneliness if they target the root causes of loneliness, including reducing perceptions of constraints and increasing a sense of purpose-in-life, along with strengthening social relationships.

Social Contact, Social Participation, and Emotional Well-Being Among Older Adults During the COVID-19 Pandemic: The Roles of Giving and Receiving Social Support.

This study examined whether social contact, social participation, and social support during the COVID-19 pandemic were associated with depression and anxiety. Data were taken from the 2020 COVID-19 Supplement of the National Health and Aging Trends Study (N = 2,778). Depression and anxiety were regressed on social contact frequency, social participation, and social support. Path analyses were also performed. The results showed that in-person contact was related to lower levels of depression, while in-person contact and attending religious services were related to lower levels of anxiety. Giving and receiving support were associated with higher levels of depression and anxiety. Giving support mediated the link between virtual contact, volunteering, and depression, while receiving support mediated the link between virtual contact and depression. Receiving and giving support mediated the association between virtual social contact, volunteering, and anxiety. During the pandemic, being socially connected provided some benefits in terms of emotional well-being, but in some cases being socially connected did not provide salubrious effects.

Online engagement, resilience, and loneliness among older people during the COVID-19 pandemic.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic exacerbated the public health concerns of social isolation and loneliness for older people who are vulnerable due to their health conditions and more restrictive social measures. However studies revealed that many older adults demonstrated high resilience and remained emotionally stable during the pandemic, particularly those who had a broad engagement with online technology that could compensate for their isolation. Yet, little empirical research has examined explicitly the association between online engagement and loneliness among older adults, and the role resilience played in this relationship during the pandemic. This study contributed to the literature by addressing these research gaps. RESEARCH DESIGN AND METHODS: This study investigated the relationships between online engagement (sum of involvement in 31 online activities), resilience (sum of positive experiences and personal growth during COVID-19) and loneliness (mean of 11-items from the revised version of the UCLA loneliness scale) among community-dwelling older people (aged 60+), using national survey data from the 2020 Health and Retirement Study (HRS) collected during the COVID-19 pandemic (N = 3,552). RESULTS AND CONCLUSION: Online engagement was negatively associated with levels of loneliness (ß = -0.080, 95% CI [-0.118, -0.047]), and this association was partially mediated by levels of resilience (ß = -0.023, 95% CI [-0.031, -0.016]. The findings suggested that a broad integration of online technology into daily-life may have helped older people combat loneliness during the pandemic, and resilience could be one important mechanism that linked this association.

Economic Resources Shaping Grandparent Responsibility Within Three-Generation Households.

The purpose of this descriptive study was to explore factors associated with perceptions of grandparent responsibility for grandchildren in three-generation households, focusing especially on a comparison of grandparents' and parents' financial contributions to the household and ethnicity of grandparent(s). The analysis used information about three-generation families in the 2011-2015 American Community Survey, retrieved through the Integrated Public Use Microdata Series. In 30% of these families, grandparents said they were "primarily responsible" for the grandchildren, even though the child's parent was also in the household. Logistic regression models showed that grandparents who contributed a larger share of household income and grandparents who were householders were significantly more likely to report being primarily responsible for grandchildren in three-generation households, suggesting that the distribution of financial resources (or resource balance) within the household was associated with perceptions of responsibility. However, grandparents' race and ethnicity moderated this association, indicating that cultural norms may intersect with resources in shaping these reports. The findings suggest that perceived responsibilities of grandparents in three-generation households may be shaped by the balance of financial resources among household members, but also by cultural norms of grandparenting.

Spillover Benefits and Achieving Sustainability of Age-Friendly Communities.

As the age-friendly movement grows in its second decade, urgent questions of initiative sustainability have taken hold in the academic literature and among advocates implementing age-friendly changes. The creation of authentically age-inclusive environments requires not just the continuation of the initiative, but that its principles become embedded in formal and informal organizational processes, across sectors and beyond familiar networks focused on older populations. This embedding ensures the initiative's values take root permanently in a community's institutional culture. This article argues that the sustainability of age-friendly initiatives is enhanced by "spillover" effects, in which a behavioral or policy change in one environment spurs change in another environment. Evidence for such spillover and an understanding of how and when it occurs is currently limited in the context of age-friendly environments. This article draws on the experiences of Age-Friendly Boston, which has been working toward age-friendly goals for more than 5 years. Based on Boston's experience, we identify, describe, and exemplify 3 pathways to positive spillover across environments: (a) branding positively, (b) publicizing successes, and (c) embarking on new relationships, while strengthening existing ones, in pursuit of shared goals. We also draw conclusions about what positive spillover means for the sustainability of age-friendly environments.

Friendship and Cognitive Functioning Among Married and Widowed Chinese Older Adults.

OBJECTIVES: Guided by the social convoy model, this study investigated the association between friendship and cognitive functioning among older Chinese adults, as well as the moderating effect of marital status (married vs widowed). We also explored whether depression might account for the link between friendship and cognitive functioning. METHODS: We used data from the China Longitudinal Aging Social Survey in 2014 (N = 8,482). Cognitive functioning was measured with the Mini-Mental State Examination instrument and friendship was assessed with a 3-item Lubben Social Network Scale. Linear regression and path analyses within a structural equation modeling framework were performed to examine the hypotheses. RESULTS: Results indicated that friendship was significantly related to better cognitive functioning among older Chinese adults (ß = 0.083, p < .001) and marital status moderated this association (ß = -0.058, p < .01). In addition, depression partially mediated the relationship between friendship and cognitive functioning (ß = 0.015, p < .001). DISCUSSION: The results implied that friendship is important for maintaining cognitive functioning in later life and widowed older Chinese adults may benefit more from friendship in its relationship to cognitive functioning than married older Chinese adults. Further, one potential pathway linking friendship to cognitive functioning may be through depression; however, more research is needed to support this finding. Intervention programs aimed at building friendship opportunities may be one way to achieve better cognitive aging.

A Malady with No Name: Understanding Experiences of Depression Among Older Hmong Refugees.

We interviewed older Hmong refugees in the U.S. to understand how they experience and define depression. Methods. Data were collected in California (N = 20). The study sample included Hmong immigrants aged 55 and over. The qualitative method allowed for an in-depth understanding of events that occurred throughout the participants' life course and how these events impacted depression in later life. Results. The participants' conceptualization of depression was defined with reference to their lived experiences. Three main conceptualizations emerged: behavioral descriptions of depression, mental or emotional descriptions, and physical descriptions of depression. The use of personal examples to describe depression was common. Our findings suggest that this sample's understanding of depression may not be fully captured by conventional measurement and thus more work is needed to develop a measure of depression that aligns with these respondents' descriptions.

Race and Ethnic Group Disparities in Emotional Distress Among Older Adults During the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVES: Framed within Conservation of Resources theory, this study addressed race-ethnic differences in the relationships between emotional distress and current and expected coronavirus disease 2019 (COVID-19) pandemic stressors. RESEARCH DESIGN AND METHODS: The study employed data from the Household Pulse Survey, a large national survey collecting weekly data to understand the experiences of Americans during the COVID-19 pandemic (age 55 and above; N = 94,550). Emotional distress included depression and anxiety symptoms. COVID-19 stressors included current and expected income, housing, health care, and food insecurities. RESULTS: Older persons of color reported higher rates of stressors and emotional distress than their White counterparts. In relation to current stressors, older Black persons responded with less emotional distress and older Latino persons responded with more emotional distress than older White persons. In addition, older persons of color were more likely to expect future resource losses related to COVID-19, and the association between these expectations and emotional distress varied by race-ethnic group. DISCUSSION AND IMPLICATIONS: The findings reflected the disproportionate negative impact of COVID-19 stressors on emotional distress among older persons of color, providing a baseline for future studies to further examine the impacts of the pandemic among diverse older adult populations.

Older Adults and the Economic Impact of the COVID-19 Pandemic.

The COVID-19 pandemic has impacted communities throughout the United States and worldwide. While the implications of the concomitant economic downturn for older adults are just beginning to be recognized, past experience suggests that the consequences could be devastating for many. Analyses indicate that more than one out of five Americans aged 65 years or older live in counties where high infection rates and high economic insecurity risks occur simultaneously. These findings highlight the overlap between current infection patterns and subsequent challenges to economic security that are impacting older people. Strategies and supports for getting people back to work must take into account the large segment of older people who rely on earnings well into later life. Social Security serves as the foundation of economic security for older adults across the income continuum, but it is frequently insufficient in and of itself, let alone during a crisis. Recognizing the importance of cost of living in shaping economic security highlights the need for the federal and state governments and municipalities to take older people into account in the economic recovery effort.

Volunteering, polygenic risk for Alzheimer's disease, and cognitive functioning among older adults.

OBJECTIVE: In the context of the public health burden posed by increases in Alzheimer's Disease (AD) prevalence around the globe and the related research efforts to identify modifiable risk factors for the disease, we sought to provide an empirical test of earlier claims that volunteering may be considered as a health intervention that could help to prevent or delay the onset of AD. METHOD: Using nine waves of panel data from the U.S. Health and Retirement Study (n=9,697), we examined whether volunteering conferred cognitive health benefits in later life and whether volunteering served a gene-regulatory function to help alleviate cognitive decline associated with polygenic risk for AD. Multilevel models were used to estimate associations between volunteering, polygenic risk for AD, and cognitive functioning over time. RESULTS: We found robust within-person associations between volunteering (assessed as volunteer status and time commitment) and cognitive functioning over time, such that volunteering was associated with higher levels of cognitive functioning and slower cognitive decline. The findings also provided evidence that the within-person associations for volunteering and cognitive decline were more pronounced for older adults at higher genetic risk for developing AD. CONCLUSIONS: Our findings are in line with a growing body of theoretical frameworks and empirical evidence suggesting that prosocial behaviors are directly associated with biological systems and may modify gene regulation to confer health benefits. The analytic approach taken in this study also provided a useful framework for investigating the effectiveness of other modifiable risk factors that vary over time in the context of cognitive decline related to genetic risk for AD.

The High Prevalence of Depressive Symptoms and Its Correlates With Older Hmong Refugees in the United States.

Objective: We estimate depressive symptoms in a sample of older Hmong refugees in the United States, and investigate factors shaping risk of depression in this population. Method: Data were collected in California and Minnesota (N = 127). The study sample included Hmong immigrants aged 55 and over. The measure of depression used is the Hopkins Symptom Checklist-10 (HSCL-10) inventory. Linear regression models were used to identify significant correlates of depressive symptoms. Results: More than 72% of the participants indicated being symptomatic of depression, as reflected by having a HSCL-10 score of 1.85 or higher. Self-reported health was a risk factor for depression. Protective factors from depression were larger household size and older age of arrival into the United States. Discussion: This study updated knowledge about the mental health status of Hmong refugees, who are now at later life. Our findings suggest that depression may be a lifelong experience in this high risk population.

Do consequences of hardship narrow in later life? The impact of hardship on self-rated health among older adults.

PURPOSE: The purpose of this study was to investigate the association between hardship and self-rated health among older adults and determine whether this association differed by age. METHODS: Using data from the 2014 Survey of Income and Program Participation, we conducted logistic regression analysis to examine the association between hardship and self-rated health among adults aged 55 years and older in the United States, and the moderating effect of age on this relationship. Analyses were weighted using replicate weights provided by the survey. Indicators of hardship were dichotomized (1 = experienced hardship, 0 = no hardship). RESULTS: Analyses indicated that individuals who were unable to pay utility bills, unable to pay rent or mortgage, or who experienced food insecurity had higher odds of reporting fair or poor health relative to those not experiencing these hardships. The association between hardship and self-rated health was moderated by age. CONCLUSIONS: Hardship is directly relevant to health outcomes as it signals unfulfilled needs experienced by individuals lacking adequate economic resources. This study contributes to our understanding of the role of age in the association between hardship and self-rated health.

How strong is the Social Security safety net? Using the Elder Index to assess gaps in economic security.

Older Americans rely heavily on Social Security benefits (SSBs) to support independent lifestyles, and many have few or no additional sources of income. We establish the extent to which SSBs adequately support economic security, benchmarked by the Elder Economic Security Standard Index. We document variability across U.S. counties in the adequacy levels of SSBs among older adults. We find that the average SSBs fall short of what is required for economic security in every county in the United States, but the level of shortfall varies considerably by location. Policy implications relating to strengthening Social Security and other forms of retirement income are discussed.

Surrogate Preferences on the Physician Orders for Life-Sustaining Treatment Form.

BACKGROUND AND OBJECTIVES: The purpose of this study is to compare treatment preferences of patients to those of surrogates on the Physician Orders for Life-Sustaining Treatment (POLST) forms. RESEARCH DESIGN AND METHODS: Data were collected from a sequential selection of 606 Massachusetts POLST (MOLST) forms at 3 hospitals, and corresponding electronic patient health records. Selections on the MOLST forms were categorized into All versus Limit Life-Sustaining Treatment. Multivariable mixed effects (grouped by clinician) logistic regression models estimated the impact of using a surrogate decision maker on choosing All Treatment, controlling for patient characteristics (age, severity of illness, sex, race/ethnicity), clinician (physician vs non-physician), and hospital (site). RESULTS: Surrogates signed 253 of the MOLSTs (43%). A multivariable logistic regression model taking into consideration patient, clinician, and site variables showed that surrogate decision makers were 60% less likely to choose All Treatment than patients who made their own decisions (odds ratio = 0.39 [95% confidence interval = 0.24-0.65]; p < .001). This model explained 44% of the variation in the dependent variable (Pseudo-R2 = 0.442; p < .001); mixed effects logistic regression grouped by clinician showed no difference between the models (LR test = 4.0e-13; p = 1.00). DISCUSSION AND IMPLICATIONS: Our study took into consideration variation at the patient, clinician, and site level, and showed that surrogates had a propensity to limit life-sustaining treatment. Surrogate decision makers are frequently needed for hospitalized patients, and nearly all states have adopted the POLST. Researchers may want study decision-making processes for patients versus surrogates when the POLST paradigm is employed.

Health Benefits Associated With Three Helping Behaviors: Evidence for Incident Cardiovascular Disease.

Objective: The purpose of this study was to investigate the association between three helping behaviors and incident cardiovascular disease (CVD; heart attack, stroke; fatal and nonfatal), with an exploration of gender differences. The study is framed within the caregiving system model. Helping others is argued to be an evolved characteristic of humans that yields beneficial health effects. Methods: Data were taken from the 2004-2014 waves of the Health and Retirement Study. The three forms of helping others considered were formal volunteering, informal helping, and caregiving for a parent or spouse. Cox proportional hazards models were estimated for gender-stratified samples. Results: Women who volunteered showed a lower risk of incident CVD compared to women who did not volunteer. Men who informally helped others in the community exhibited a lower risk of incident CVD compared to men who did not provide this form of help. Caregiving status was generally not associated with incident CVD for women or men. Discussion: The results demonstrated that specific types of prosocial behavior may be beneficial for women and men. However, tests for effect differences showed that gender did not moderate the relationships between these helping behaviors and CVD risk.

Coping and resiliency enhancement program (CARE): a pilot study for interpreters in cancer care.

OBJECTIVE: There is a growing demand for interpreters in the cancer setting. Interpreters, the link to quality care for limited English proficiency patients, face many psychosocial stressors in their work. This project assessed interpreters' experiences of stress and piloted a resiliency program to help interpreters cope with stressors. METHODS: From 2013 to 2014, we pilot tested a targeted resiliency program with interpreters from three Boston-based hospitals. In Phase 1, we conducted five focus groups (n = 31) to identify interpreters' psychosocial needs. In Phase 2, we developed and tested a 4-h group program with 29 interpreters (response rate = 90%; 69% female, 54% Hispanic, 85% born outside of the U.S.). RESULTS: Phase 1. Stressors were patient-based (seeing young patients decline), interactions with medical team (unsure of role), and systems-based (appointment unpredictability). Phase 2. At baseline interpreters reported low abilities to cope with stress (measured by the Measure of Current Status (MOCS-A)). At 4-week follow-up we found improvements in job satisfaction (p = .02; Cohen's d = .41) and declines in sick days (p = .08; Cohen's d = .38). Stress reactivity (MOCS-A) improved; specifically participants reported feeling more assertive about their needs (p = .10; Cohen's d = .30) and more able to relax at will (p = .10; Cohen's d = .35)-important mechanisms to lower distress. CONCLUSIONS: We piloted a resiliency program for medical interpreters in cancer care. We found that interpreters experience distress and have low coping skills. This program resulted in improved work factors and stress reactivity. Future research should include further implementation and testing in a larger, randomized trial.Copyright © 2016 John Wiley & Sons, Ltd.

The Role of Aging and Disability Resource Centers in Serving Adults Aging with Intellectual Disabilities and Their Families: Findings from Seven States.

For the first time, adults with intellectual and developmental disabilities (I/DD) are living to experience old age. The purpose of this project was to assess the activities of aging and disability resource centers (ADRCs) as they seek to serve older adults with intellectual disabilities and their family caregivers. Data come from 21 in-depth qualitative interviews with ADRC staff in seven states. Results of this qualitative analysis indicate that ADRCs are not focusing explicitly on adults aging with I/DD and their family caregivers, but meeting the needs of this population is a future goal of ADRCs. Challenges related to accessing and providing information and referral services for adults aging with I/DD were described and highlight existing unmet needs of this population. Supporting adults who simultaneously require aging and disability services requires true coordination of aging and disability service systems.

The emergence of a positive gerontology: from disengagement to social involvement.

The latter part of the 20th century was a period characterized by a fundamental transition in scholarship on activity and the aging process. Theory emphasizing the inevitable decline of human capacity was gradually replaced with concepts stressing positive, multidimensional views of aging. In this article, we highlight the key contributors and trace the origins and overlapping themes of successful aging, productive aging, and civic engagement in later life: 3 examples of scholarship representing a "positive" gerontology. Rowe and Kahn's model of successful aging highlights the interplay between social engagement with life, health, and functioning for a positive aging experience. Productive aging, led by Robert Butler, recognizes the previously underappreciated participation of older adults in activities such as volunteering, paid work, and caregiving, and generates interest in the individual and societal barriers to and benefits of participation. Civic engagement in later life raises public awareness about the need to involve older adults in the community, creates opportunities for participation, and generates further interest in the mutual benefit of participation for community beneficiaries and participants. Successful aging, productive aging, and civic engagement represent important contributions to the field of gerontology through applications to policy, advocacy, and theory development.