Interventions to Improve the Occupational Performance of Youth With Persistent Postconcussion Symptoms: A Systematic Review.

IMPORTANCE: Persistent postconcussion symptoms (PPCS) may negatively affect youth's occupational performance in activities of daily living, education, play and leisure, social participation, and rest and sleep. OBJECTIVE: This review provides occupational therapists with evidence related to interventions for youth with PPCS. DATA SOURCES: Searches were performed in Embase, PubMed, SportDiscus, CINAHL, and Web of Science. STUDY SELECTION AND DATA COLLECTION: Inclusion criteria were as follows: studies published in English from January 1, 2013, to February 7, 2023; youth ages 3 to 18 yr old; PPCS for at least 2 wk after injury; interventions within the scope of occupational therapy; and outcomes related to areas of occupation. All levels of evidence (1-5) were included and graded for quality using the Oxford Centre for Evidence-Based Medicine (2009) levels of evidence. This review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. FINDINGS: Twenty articles met inclusion criteria (7 randomized controlled trials, 1 nonrandomized controlled group design, 3 single-group designs, 5 case series, and 4 single-subject designs). Interventions reviewed were active rehabilitation, vision-related interventions, psychoeducation, cognitive-behavioral therapy (CBT) techniques, the Cognitive Orientation to daily Occupational Performance (CO-OP), and music therapy. Strong evidence supports CBT, with significant clinical outcomes in sleep and education. Moderate strength of evidence supports psychoeducation and active rehabilitation for improving functional outcomes. More evidence is needed to make clinical recommendations regarding vision-related interventions, the CO-OP, and music therapy. CONCLUSIONS AND RELEVANCE: Occupational therapists should consider CBT, psychoeducation, and active rehabilitation to improve occupational performance among youth with PPCS. Plain-Language Summary: Some youth will have persistent symptoms that do not resolve within 2 weeks after a concussion. Because of these persistent symptoms, they may have difficulty completing everyday activities. This review evaluated evidence addressing the ability of youth with persistent postconcussion symptoms (PPCS) to complete everyday activities. The authors found that cognitive-behavioral therapy, psychoeducation (aimed at helping youth understand and cope with their concussion symptoms), and active rehabilitation (aerobic and coordination exercises, such as jumping jacks and ball skills) should be considered when working with youth (ages 3-18 years) with PPCS. Using these interventions in occupational therapy sessions may improve the ability of youth to complete their everyday activities after a concussion.

Role of Meaningful Social Participation and Technology Use in Mitigating Loneliness and Cognitive Decline Among Older Adults.

IMPORTANCE: Community social participation aids dementia prevention and alleviates loneliness among older adults. Incorporating occupational therapy using information and communications technology (ICT) could potentially delay dementia onset and reduce loneliness. OBJECTIVE: To quantify how meaningful social participation, participation frequency, ICT use, and expanded social networks influence cognitive function and loneliness among socially active older Japanese adults. DESIGN: Cross-sectional exploratory study using structural equation modeling. SETTING: Meetings organized by older adults at seven community gathering places in Osaka Prefecture, Japan. PARTICIPANTS: One hundred thirteen healthy older adult cohort members. MEASURES: Cognitive function assessed via Mini-Cog; loneliness assessed via the condensed UCLA Loneliness Scale. RESULTS: The final model demonstrated excellent fit, χ2(23) = 28.291, p = .205 (root mean square error of approximation = .045, 90% confidence interval [.000, .094]; confirmatory factor index = .995; Tucker-Lewis Index = .993). ICT use directly affected social networks (ß = 0.472), which directly influenced participation frequency (ß = 0.324) and meaningful social participation (ß = 0.381). The indirect effect of meaningful participation significantly improved cognitive function (ß = 0.237). The only indirect effect of meaningful interpersonal participation was a reduction in loneliness (ß = -0.235). CONCLUSIONS AND RELEVANCE: ICT use contributes to the expansion of social networks among elderly people. Furthermore, the frequency of social participation and the meaningfulness of such participation are related to reduction in loneliness and maintenance of cognitive function. Although the frequency of social participation was not directly related to these outcomes, the results suggest that meaningful social participation may play an important role in reducing loneliness and maintaining cognitive function. Plain-Language Summary: The promotion of social participation among older people is a global phenomenon, driven by the recognition of its positive relationship with cognitive function and the alleviation of loneliness. Nevertheless, older people's social participation is constrained by a combination of physical and social factors. To address this issue, there has been a push to promote social participation based on information and communications technology (ICT). However, no specific study has been conducted on occupational therapists' perspective in capturing social participation and the use of ICT. The findings of this study show that using ICT has the potential to enhance opportunities for social interaction for older adults, thereby improving the quality and quantity of social participation. The quality of social participation was identified as the sole factor that had a positive impact on cognitive function and loneliness. This study suggests the need for occupational therapists to consider means of facilitating the use of ICTs among older adults as well as interventions that use occupational therapy theory to enhance the meaningfulness of existing social participation opportunities.

Developmental trajectories and heterogeneity of social engagement among Chinese older adults: a growth mixture model.

BACKGROUND: Social engagement is closely related to well-being among older adults. However, studies on the changing trajectory and influencing factors (especially time-varying factors) of social engagement are limited. This study aimed to examine the social engagement trajectory of older Chinese adults and explore its time-fixed and time-varying factors, thus providing evidence for the development of strategies to promote a rational implementation for healthy aging. METHODS: This study included 2,195 participants from a subset of four surveys from the Chinese Longitudinal Healthy Longevity Survey conducted from 2008 to 2018 (with the latest survey completed in 2018), with follow-ups conducted approximately every three years. Growth mixture modeling was used to explore the social engagement trajectory of older adults and the effects of time-varying variables. In addition, multinomial logistic regression was employed to analyze the association between time-fixed variables and latent classes. RESULTS: Three distinct trajectories of social engagement among older adults in China were identified: slow declining (n = 204; 9.3%), which meant social engagement score decreased continuously, but social engagement level improved; slow rising (n = 1,039; 47.3%), marked by an increased score of social engagement, but with an depressed engagement level; and middle stabilizing (n = 952; 43.4%), which meant social engagement score and engagement level remained quite stable. A time-fixed analysis indicated that age, marital status, educational level, and annual family income had a significant impact on social engagement (P < 0.05). In contrast, the time-varying analysis showed that a decline in functional ability, insufficient exercise (means no exercise at present), deteriorating self-reported health and quality of life, negative mood, monotonous diet, and reduced community services were closely related to the reduction in social engagement levels (P < 0.05). CONCLUSION: Three trends were observed at the social engagement level. Older adults with initially high levels of social engagement exhibited a continuous upward trend, whereas those with initially low levels experienced a decline in their social engagement, and those with initially intermediate levels remained quite stable. Considering the primary heterogeneous factors, it is imperative for governments to enhance basic services and prioritize the well-being of older adults. Additionally, families should diligently monitor the emotional well-being of older adults and make appropriate arrangements for meals.

The impact of social participation on the quality of life among older adults in China: a chain mediation analysis of loneliness, depression, and anxiety.

This cross-sectional study investigates the impact of social participation on the quality of life (QOL) among older adults in China. Using convenience sampling, data were collected from 508 individuals aged 60 and above (M_age = 70.53 ± 7.90 years; 56.5% women). Statistical analyses were conducted using SPSSAU software, including Pearson correlation analysis to assess relationships between social participation, psychological health indicators (loneliness, depression, and anxiety), and QOL. Multiple regression analysis and chain mediation analysis were subsequently performed to explore the mediating effects of loneliness, depression, and anxiety on the relationship between social participation and QOL. The results indicated significant correlations between social participation and loneliness (r = -0.313, p < 0.001), depression (r = -0.487, p < 0.001), anxiety (r = -0.305, p < 0.001), and QOL (r = 0.476, p < 0.001). The mediation analysis revealed significant chain mediation effects of loneliness, depression, and anxiety on the relationship between social participation and QOL (ß = 0.006, p < 0.001, 95% CI [0.001, 0.007]). Higher levels of social participation were associated with lower levels of loneliness, which in turn reduced depression and anxiety, thereby enhancing QOL. These findings highlight the importance of promoting social participation to improve psychological wellbeing and QOL among older adults in China. The study advocates for active social engagement and the provision of relevant services, as well as psychological support and emotional counseling for those facing mental health challenges due to insufficient social participation.

Association between different patterns of social participation and loneliness among the Chinese older people: is there a local-migrant gap?

BACKGROUND: Little empirical evidences were provided on the disparity in the level of loneliness between the migrant older with children (MOC) and their local counterpart in China. This study aimed to explore the association between social participation and loneliness and verify whether there was a local-migrant difference in this association. METHODS: A total of 1332 older people (60 +) were included in this study with 656 MOC and 676 natives. Loneliness was assessed by the University of California Los Angeles Loneliness Scale with eight items (ULS-8). Social participation was evaluated by three kinds of social activities concerning sports activities, hobby activities and community resident interaction. Univariate analysis was conducted to compare the local-migrant disparity as well as the level of loneliness between different subgroups. Hierarchical multiple linear regression analysis was used to examine the proposed relationship and the moderating influence of migration status. RESULTS: The average ULS-8 scores were 11.73 ± 4.02 for local subjects and 12.82 ± 4.05 for MOC respectively, indicating a lower level of loneliness among local older people. Participating in hobby activities (ß = -0.092, P = 0.003) and interacting with residents (ß = -0.216, P = 0.001) more frequently were related to lower level of loneliness while participating in square dancing was related to higher level of loneliness (ß = 0.087, P = 0.001). The negative relationships between hobby activities as well as resident interaction and loneliness were more profound in migrants than natives. CONCLUSIONS: Only two types of social participation could help alleviate loneliness. More attention to older migrants' loneliness and extending the scale and types of social activities were recommended for policymakers.

Suicidal Ideation, Social Participation, Loneliness, and Mobility Limitations: Longitudinal Evidence in Older European Adults.

BACKGROUND: Suicide behavior represents a major public health problem for the older population. Within the continuum of suicidal behavior, suicidal ideation may lead to a suicide attempts/death. Risk factors for developing suicidal ideation include mobility limitations, lack of social participation and loneliness. However, there is a need for longitudinal studies to examine these relationships over time. METHOD: 50423 older people from three waves of the SHARE project formed the sample (60 years in the first wave; ± = 71.49 ± 8.15; 55% female). RESULTS: A series of nested Cross-Lagged Panel Models (CLPM) of suicidal ideation, mobility limitations, social participation and loneliness were tested. The best fitting model was that with equal autoregressive and cross-lagged effects across waves (( = 1220.56, CFI = .982, RMSEA = .028, SRMR = .024). The autoregressive effects showed high stability across waves. The cross-lagged effects between suicidal ideation and mobility limitations were strong, while the cross-lagged effects between suicidal ideation and social participation were comparatively smaller. In the case of loneliness, statistical significance was not achieved. CONCLUSIONS: These findings highlight the importance of promoting mobility programs and social activities to prevent suicidal ideation among older adults.

Impact of COVID-19 on the Participation of Iranian Adolescents in Daily Life: Development and Validation of the IAPAT-C Tool.

Background and Purpose: The present study is aimed at evaluating the effects of the COVID-19 pandemic on Iranian adolescents' participation in various domains of life. The electronic version of the Iranian Adolescent Participation Assessment Tool-COVID-19 (IAPAT-C) was developed and validated for this purpose. Methods: This study was conducted in two phases. In the first phase, the electronic version of the IAPAT-C was developed and validated through a methodological study involving five stages: content validity review, cognitive interviews, item analysis, structural validity assessment using confirmatory factor analysis, and reliability analysis. The tool was adapted from the previously validated IAPAT and revalidated for this study. In the second phase, the effects of COVID-19 on adolescents' participation were evaluated using a longitudinal one group before and after comparative design. The study involved 654 adolescents aged 13-18, and the data were analyzed using SPSS19 and G⁣∗Power 3 software. Results: The IAPAT-C evaluates the participation of Iranian adolescents in 54 daily life activities before and after the COVID-19 pandemic. It utilizes a 5-point Likert scale and was validated through an expert panel review for content validity. Additionally, cognitive interviews with six adolescents confirmed its comprehensibility, relevance, and comprehensiveness. Item analysis, based on data from 38 participants, demonstrated strong interitem correlations (0.6-0.94) and excellent internal consistency (Cronbach's alpha > 0.7). The tool's structural validity was supported by confirmatory factor analysis, which showed that the measurement model was a good fit. Convergent and discriminant validity of model constructs were also confirmed. Notably, COVID-19 significantly impacted all aspects of adolescents' lives, except for work. Conclusion: The electronic version of the IAPAT-C was valid and reliable. COVID-19 significantly affected various aspects of Iranian adolescents' daily lives. Accordingly, it is necessary to provide appropriate interventions and policies for this sensitive class.

Participation in Social and Community Life Before and After Spinal Cord Injury/Disease: Factors Influencing Changes in Short-Term and Long-Term Participation.

OBJECTIVES: Examining changes in participation frequency (productive, leisure, and social activities) from pre-spinal cord injury/disorder to at least 2 yrs post-spinal cord injury/disorder and identifying sociodemographic and spinal cord injury/disorder characteristics associated with significant shifts in participation frequency. DESIGN: The study used a longitudinal design, using data from the Swiss Spinal Cord Injury Cohort study. Pre-spinal cord injury/disorder participation frequency was assessed retrospectively 12 wks after spinal cord injury/disorder and prospectively 1 and at least 2 yrs after spinal cord injury/disorder. Linear mixed-effects model trees were used to identify subgroups with participation changes and related sociodemographic and spinal cord injury/disorder characteristics. RESULTS: The study involved 550 individuals (median age at spinal cord injury/disorder onset: 53 yrs, 30% female, 63.9% with traumatic etiology, and 5.6 yrs since onset). Pronounced decrease was observed prominently in productive activities. Education and age at spinal cord injury/disorder onset served as initial variables to split the tree at first level for each of the participation dimensions. CONCLUSIONS: This research identified participation dimensions most susceptible to changes during the initial years after spinal cord injury/disorder and pinpointed subgroups displaying clinically meaningful longitudinal variations across productive, leisure, and social activities. These findings have the potential to enhance the efficiency of rehabilitation programs, leading to improvements in long-term participation levels for individuals with spinal cord injury/disorder.

The Practical and Social Functioning (PSF) scale: development and measurement properties of an instrument for assessing activity and social participation among people with serious mental illness.

BACKGROUND: Participation in society and the ability to perform various activities are crucial aspects of everyday functioning. The intertwined relationship between functioning, disability, and health is emphasized in the "International Classification of Functioning, Disability and Health (ICF)" framework. In recent decades, mental health care units have increasingly focused on this aspect. The Practical and Social Functioning scale (PSF) was developed and validated in Norwegian as an easy-to-administer instrument to assess practical and social functioning among patients with serious mental illness in different clinical settings. METHODS: The PSF was developed and revised using data from different Norwegian studies. Data from a total of 562 patients with serious mental illness in different clinical settings were included. The validation process included the evaluation of items into categories by 25 professionals. Development and revision took place in three different stages, and factor analyses were conducted. The quality of the PSF was assessed according to the COSMIN standards for systematic reviews on patient-reported outcome measures. RESULTS: The final version of the PSF comprises seven subscales, each consisting of four items, resulting in a total of 28 items. These subscales, along with their corresponding items, are loaded onto two factors representing the main dimensions of functioning: activity and participation. Content validity comprises three domains: relevance, comprehensiveness, and comprehensibility. Relevance and comprehensibility were found to be adequate, whereas comprehensiveness was doubtful. Structural validity was adequate, internal consistency was very good, and construct validity was adequate compared to the Global Assessment of Functioning scale. Responsiveness was found to be doubtful in our study with data from an 18-month observation period. Nearly 60% of the items showed a ceiling effect. No items showed a floor effect. CONCLUSION: The development and validation of the Norwegian version of the PSF resulted in an instrument consisting of seven subscales and a total of 28 items. The items and subscales assess functioning related to two key factors according to the ICF framework: activity and participation. Our results show that the PSF is an easy-to-administer instrument that may be particularly sensitive for detecting variation among persons with severely impaired functioning. TRIAL REGISTRATION: The study Implementation of Guidelines for the Treatment of Psychoses was registered retrospectively on 31 August 2017 at ClinicalTrials.gov (NCT03271242).

Dual trajectories of social participation and frailty in Chinese older adults: a longitudinal study based on CLHLS from 2008 to 2018.

Introduction: This study aimed to identify the dual trajectories of social participation (SP) and frailty index (FI) among Chinese older adults, and investigate common influential factors of both trajectories. Methods: Utilizing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2008-2018 surveys, 1,645 individuals were analyzed. A group-based dual trajectory model and logistic regression were used to examine trajectories, their interrelations and shared influencing factors. Results: This study identified three SP, two FI trajectories and six distinct sub-groups of individuals. The study confirmed a long-term, interrelated relationship between two outcomes and identified some common factors. Compared to participants in the lower SP trajectory, those who followed the middle SP trajectory and higher SP trajectory had increased probabilities of belonging to the slow-growth FI trajectory (90.28 and 99.71%, respectively). And the participants in the slow-growth FI exhibited higher probabilities of belonging to the middle SP and the higher SP trajectory (37.64 and 25.34% higher, respectively) compared with those in the rapid-growth FI trajectory. Age, marital status, and drinking status were mutual factors associated with the dual trajectories. Discussion: The results showed significant associations between higher levels of frailty and lower levels of social participation. Related intervention policies should consider the dual trajectories and the common factors that underlie these trajectories of SP and FI.

The influence of widowhood and social engagement on cognitive impairment among Chinese older adults and factors mediating their association.

Background: Prior studies exploring the impact of widowhood on cognitive impairment in later life have been focussed on the USA and Europe. We aimed to explore the mediating role of social engagement, health behaviours, and subjective well-being in the association between widowhood and cognitive impairment in the Chinese population. Methods: We conducted a study on 7796 older individuals enrolled in the 2018 wave of the Chinese Longitudinal Health Longevity Study. We used logistic regression models to analyse the impact of widowhood on cognitive health among older adults and performed mediation analysis to determine possible mediating factors in this relationship. Results: Widows and widowers had a higher risk of having cognitive impairment than married older adults (95% confidence interval (CI) = 1.312, 2.279). The results from structural equation modelling (SEM) provided a good fit to the observed data (χ2 = 24.909; P = 0.00) and indicated that the effect of widowhood on cognitive impairment was partially mediated by social engagement, lifestyle behaviours, and subjective well-being (ß = 0.075; P < 0.01). Conclusions: Our findings contribute to existing research on the mechanisms underlying the association between widowhood and cognitive impairment among older individuals, suggesting a need for policies targeted at the specific needs of this vulnerable population, such as the maintenance of social interactions, adoption of a healthy lifestyle, improvement of subjective well-being, and provision of necessary support systems.

Effectiveness of the Dyadic Coping Intervention of Social Participation (DCISP) for stroke survivors: study protocol for a randomized controlled trial.

BACKGROUND: Enhancing social participation is not only the main goal of stroke survivors' community rehabilitation but also a protective factor affecting their physical and emotional health. The current state of stroke survivors' social participation is not encouraging due to the high disability incidence of stroke. Spouses may play a facilitating role in the social participation of patients by providing them with support and assistance. However, there remains a lack of evidence specifically regarding dyadic coping interventions of social participation for stroke survivors, and the intervention strategies are still underdeveloped without clear theoretical frameworks. Therefore, this proposed study aims to develop and evaluate the effectiveness of the Dyadic Coping Intervention of Social Participation (DCISP) for survivors of first-episode homebound stroke. METHODS: A single-blind (assessor-blinded), randomized controlled trial will be conducted to verify the effectiveness of DCISP. The randomized controlled trial will be preceded by a feasibility study (N = 20) of DCISP in stroke survivors. Stroke survivors will be randomly classified (1:1) into either a control (N = 50) or an experimental group (N = 50). In addition to routine care, participants in the experimental group will receive six 40 ~ 45 min sessions of guidance, once every two weeks. The primary outcome is social participation of stroke survivors, measured using Impact on Participation and Autonomy Questionnaire (IPA) and Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P), and the secondary outcomes will be measured by Knowledge Questionnaire for Stroke Patients (SPKQ), Stroke-specific Quality of Life Scale (SS-QOL), Dyadic Coping Inventory (DCI), Modified Rankin Scale (mRS) and Zarit Caregiver Burden Interview (ZBI-22). These will be measured at baseline(T0), during the intervention (T1 = 1 month), and after intervention completion (T2 = 3 months, T3 = 6 months). DISCUSSION: Findings from the study will provide evidence of the effects of DCISP on improving the social participation of first-episode homebound stroke survivors. The results of this study may support the implementation of survivor-spouse dyads care support in stroke survivors and provide a reference for clinical rehabilitation nursing practice, offering new insights into nursing interventions for stroke patients. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR) ChiCTR2400083072. Registered on 20 July 2023.

Supporting Women after Obstetric Fistula Surgery to Enhance Their Social Participation and Inclusion.

Obstetric fistula is a childbirth complication causing abnormal openings between the urinary, bowel, and genital tracts, leading to involuntary leakage and potential long-term disability. Even after surgical repair, women continue to face psychological and social challenges that affect their social inclusion and participation. This study explored family and service provider perspectives on current support systems and identified gaps affecting women's inclusion and participation post-fistula surgery. Building on a prior study of women who underwent obstetric fistula surgical repair, we qualitatively examined available formal and informal post-surgical supports in Ethiopia. We conducted 20 interviews with family members and service providers and analyzed them using Charmaz's grounded theory inductive analysis approach. We identified four themes that indicated the available formal support in fistula care, the impact of formal support on women's social participation and inclusion, the gaps in formal support systems, and post-surgery informal supports and their challenges. Both groups believed support needs for women after surgery remain unmet, highlighting the need to strengthen holistic support services to improve women's social inclusion and participation. This study contributes to limited research on formal and informal support for women, emphasizing the need for enhanced economic, psychological, and sexual health-related support post-obstetric fistula surgery.

A Voice-Activated Device Exercise and Social Engagement Program for Older Adult-Care Partner Dyads: Pilot Clinical Trial and Focus Group Study Evaluating the Feasibility, Use, and Estimated Functional Impact of EngAGE.

BACKGROUND: Maintaining exercise is essential for healthy aging but difficult to sustain. EngAGE is a socially motivated exercise program delivered over a voice-activated device that targets older adult-care partner dyads. OBJECTIVE: This 10-week pilot study aimed to assess EngAGE feasibility and use, obtain user experience feedback, and estimate potential impact on function. METHODS: In total, 10 older adults aged ≥65 years were recruited from an independent living residence together with their self-identified care partners. EngAGE delivered National Institute on Aging Go4Life exercises to older adults daily, while care partners received progress reports and prompts to send encouraging messages that were read aloud by the device to the older adult. Older adults' use was tracked, and physical function was assessed at baseline and follow-up. Follow-up focus group data provided qualitative feedback. RESULTS: On average, participants completed 393.7 individual exercises over the 10-week intervention period or 39.4 exercises/wk (range 48-492, median 431, IQR 384-481, SD 112.4) without injury and used EngAGE on an average of 41 of 70 days or 4.1 d/wk (range 7-66, median 51, IQR 23-56, and SD 21.2 days). Mean grip strength increased nonsignificantly by 1.3 kg (preintervention mean 26.3 kg, SD 11.0; postintervention mean 27.6 kg, SD 11.6; P=.34), and 4 of 10 participants improved by a minimal clinically important difference (MCID) of 2.5 kg. Further, the time for 5-repeated chair stands significantly reduced by 2.3 seconds (preintervention mean 12, SD 3.6 s; postintervention mean 9.7, SD 2.7 s; P=.02), and 3 of 9 participants improved by an MCID of -2.3 seconds. Furthermore, 3-meter usual walk performance was brisk at baseline (mean 2.1, SD 0.4 s) and decreased by 0.1 seconds (postintervention 2, SD 0.4 s; P=.13), although 5 of 9 participants improved by a MCID of 0.05 m/s. Qualitative results showed perceived benefits, favored program features, and areas for improvement. CONCLUSIONS: We present a pilot study of a new voice-activated device application customized to older adult users that may serve as a guide to other technology development for older adults. Our pilot study served to further refine the application and to inform a larger trial testing EngAGE's impact on functional outcomes, a necessary step for developing evidence-based technology tools.

Association between widowhood and cognitive function among Chinese older adults with hearing impairment: the moderating effect of social support and participation.

BACKGROUND: Older adults with hearing impairments are vulnerable to cognitive impairment. Although previous reports suggest a correlation between widowhood and cognitive impairment, further investigation is needed to elucidate the effect of widowhood on cognitive function and the moderating effects of social support and participation on widowhood-related cognitive impairment in this vulnerable demographic. METHODS: The study's data were sourced from the nationally representative Chinese Longitudinal Healthy Longevity Survey (CLHLS) for the years 2011, 2014, and 2018. Multiple linear regression was used to analyze the association between widowhood and cognitive function among older adults. Multivariate logistic regression examined the effect of widowhood on the likelihood of experiencing various levels of cognitive impairment in older adults with hearing impairments. A moderating effect model explored the roles of social support and participation in mitigating widowhood-related cognitive impairment. RESULTS: The cognitive function of older adults with hearing impairment was found to be lower than that of those without hearing impairment. Widowhood was significantly negatively correlated with Mini-Mental State Examination (MMSE) scores in older adults, both with (Coef. = -0.898) and without (Coef.: = -0.680) hearing impairments. A stronger association was observed between widowhood and declining cognitive function among older adults with hearing impairment. Specifically, widowhood may be more likely to significantly increase the likelihood of moderate and severe cognitive impairment (RRR = 1.326, 1.538) among older adults with hearing impairments. Social support and social participation significantly moderated the cognitive impairment associated with widowhood among hearing-impaired older adults. These forms of support and engagement are buffers against the risk of widowhood-related cognitive impairment among this demographic. CONCLUSIONS: Our findings indicate that widowhood is significantly associated with cognitive impairment in older adults with hearing impairment. Social support and participation help mitigate this risk. Strategies should prioritize early screening, specialized cognitive rehabilitation, comprehensive care, and enhancing social support and participation to maintain cognitive health in this vulnerable population following widowhood.

Association between participation restriction due to hearing loss and self-perception of health, social support, and quality of life in elderly people: a cross-sectional study. / Associação entre restrição à participação decorrente de perda auditiva e autopercepção de saúde, suporte social e qualidade de vida da pessoa idosa: estudo transversal.

PURPOSE: To verify the association between participation restriction due to hearing loss and self-perception of health, social support, and quality of life in elderly people. METHODS: This is a cross-sectional, observational, and descriptive study with a quantitative data approach. A database with information collected in a medium-sized Brazilian municipality was used. The study was conducted with 235 elderly people registered in five Family Health Strategy Units. Sociodemographic and health information and the results of the following questionnaires were used: Hearing Handicap Inventory for the Elderly - Screening Version (HHIE-S), Medical Outcomes Study (MOS) Social Support Survey, Subjective Health Assessment, and Short-Form 6-Dimension (SF-6D) Health and Quality of Life Index. Groups with and without participation restriction were compared according to sociodemographic, health, social support, and quality of life variables. A multivariate binary logistic regression method was employed to evaluate the associations between the independent variables and participation restriction. RESULTS: The group with participation restriction is composed of older individuals with lower quality of life and poorer self-perception of health. Poorer self-perception of health was the only predictor of participation restriction related to hearing loss. CONCLUSION: Participation restriction is associated with poorer self-perception of health. The study highlights the importance of assessing individuals' self-perception regarding biopsychosocial issues, in addition to considering the environmental context to understand the social and emotional impacts caused by hearing loss.

OBJETIVO: Verificar a associação entre a restrição à participação decorrente de perda auditiva e a autopercepção da saúde, do suporte social e da qualidade de vida em pessoas idosas. MÉTODO: Estudo com delineamento transversal, observacional, descritivo e com abordagem quantitativa dos dados. Foi utilizado um banco de dados com informações coletadas em um município brasileiro de médio porte, sendo incluídas no estudo 235 pessoas cadastradas em cinco unidades de Estratégia de Saúde da Família. Utilizou-se informações sociodemográficas, de saúde e os resultados dos questionários: avaliação à restrição à participação (Hearing Handicap Inventory for the Elderly Screening Version - HHIE-S), Suporte Social (Escala de Apoio Social do MOS), Avaliação Subjetiva de Saúde e a Qualidade de Vida (Short-Form 6 dimensions- SF-6D). Comparou-se os grupos com restrição e sem restrição à participação segundo as variáveis sociodemográficas, de saúde, suporte social e qualidade de vida. Um método de regressão logística binária multivariado foi utilizado para avaliar as associações entre as variáveis independentes e a restrição à participação. RESULTADOS: O grupo com restrição à participação é mais velho, possui menor qualidade de vida e pior autopercepção de saúde. Esta se mostrou ser o único preditor da restrição à participação relacionada à perda auditiva. CONCLUSÃO: A restrição à participação está associada a uma pior autopercepção de saúde. O estudo revela a importância de avaliar a autopercepção dos indivíduos quanto às questões biopsicossociais, além de considerar o contexto ambiental para a compreensão dos impactos sociais e emocionais da perda auditiva.

A qualitative study of healthy ageing and co-production.

Europe's ageing population increases the demand for housing solutions targeting older citizens' needs and preferences. Establishing age-friendly communities fostering social participation is essential for healthy ageing and various housing options with shared facilities prioritizing social contact have emerged. While involving older people in public service delivery is emphasized, studies on co-production with older people in building age-friendly communities remain limited. This study explores a co-production initiative between older citizens, a municipality and a real estate company in a newly established senior village focusing on organizational settings and physical facilities. A qualitative study inspired by the BIKVA methodology was conducted using focus group interviews with citizens, frontline staff, and management. Through reflexive thematic analysis, the physical environment, organizational setting and other factors influencing the co-production process were analysed. Citizens expressed satisfaction with the unique physical environment, the different activities and being involved in the co-production process on development and building up the senior village. However, the co-production initiative was influenced by the lack of frontline staff involvement, how the physical facilities were organized for building inclusive communities as well as the level of information provided to align expectations among stakeholders. Involving older citizens in the co-production of age-friendly community initiatives has the potential to take the identified challenges into account. To understand what constitutes an optimal environment for healthy ageing further research in collaboration with older citizens is needed.

Effects of a Mobile App to Promote Social Participation on Older Adults: Randomized Controlled Trial.

BACKGROUND: Social participation is crucial for healthy aging, improving physical and mental health, cognitive function, and quality of life among older adults. However, social participation tends to decline with age due to factors like loss of social networks and health issues. Mobile health apps show promise in promoting healthy behaviors among older adults, but their effectiveness in increasing social participation remains understudied. OBJECTIVE: This randomized controlled trial aimed to evaluate the efficacy of a mobile app called Encouragement of Social Participation (ESP, "Shakai Sanka no Susume;" Hitachi) in promoting social participation and physical activity among community-dwelling older adults. METHODS: The study recruited 181 community-dwelling adults aged 60 years or older from 2 municipalities in Japan and through a web-based research panel. Participants were randomly assigned to either the intervention group (n=87), which used the ESP app for 12 weeks, or the control group (n=94), which used only Google Fit. The ESP app incorporated features such as self-monitoring of social participation, personalized feedback, gamification elements, and educational content. Primary outcomes were changes in social participation frequency over the previous 2 months and changes in step counts, measured at baseline and week 12. Secondary outcomes included changes in specific types of social activities and subjective well-being. Data were analyzed using analysis of covariance and linear mixed-effects models. RESULTS: The intervention group showed a significantly greater increase in social participation frequency compared with the control group (adjusted difference 3.03; 95% CI 0.17-5.90; P=.04). Specifically, the intervention group demonstrated higher frequencies of participation in hobbies (adjusted difference: 0.82; 95% CI 0.01-1.63) and cultural clubs (adjusted difference 0.65; 95% CI 0.07-1.23) compared with the control group. However, there were no significant differences in weekly step counts between the groups. Subgroup analyses suggested potentially larger effects among participants who were older than 70 years, female, had lower educational attainment, and were recruited from community settings, although only females and the lower educational attainment subgroups demonstrated 95% CIs that did not encompass zero. CONCLUSIONS: The ESP mobile app effectively promoted social participation among community-dwelling older adults, particularly in hobbies and cultural club activities. However, it did not significantly impact physical activity levels as measured by step counts. These findings suggest that mobile apps can be valuable tools for encouraging social engagement in older populations, potentially contributing to healthy aging. Future research should focus on optimizing app features to maintain long-term engagement and exploring strategies to enhance physical activity alongside social participation. TRIAL REGISTRATION: University Medical Information Network Clinical Trial Registry UMIN000049045; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055781.

Exploring the challenges of social participation during COVID-19 in Saudi Arabia through an occupational therapy lens.

Aim: To measure the social participation of people in Saudi Arabia during the COVID-19 pandemic. Subject and methods: A cross-sectional survey was conducted among people in Saudi Arabia to measure their participation in social activities during the COVID-19 pandemic. A validated questionnaire of Social Participation Scale was used to collect data from five main regions in Saudi Arabia through social media platforms. Means, frequencies, and percentages were calculated through descriptive analysis. Mean scores and standard deviation of social participation of participants were also presented. Results: The total number of participants was 1,560 including Saudi (87.3%) and non-Saudi (12.7%) nationals. Most participants (60.2%) were female. The age of participants ranged between 16 and 24 years old. Around 62.1% of participants were married, 63.2% were educated, 48.4 were employed and 82% were from the Eastern region. Around 72% of participants earned <10,000 riyals per month compared to those (27.3%) who earned <5,000 riyals per month. A total 72.7% of the participants have been diagnosed by COVID-19. The mean score of social participation was 47.81 (SD = 0.27). Most participants (62.7%) reported that social participation was severely restricted. Around 68.2% of the participants were quarantined at the facilities. Conclusion: The social participation of people in Saudi Arabia had been severely restricted during the COVID-19 pandemic. An early assessment of people's social participation would help to identify their problems and needs, to help them improve their participation in social activities and thus increase their overall quality of life.

Development and Validation of the Questionnaire of Young People's Participation-Young Adults (QYPP-YA).

BACKGROUND: The Questionnaire of Young People's Participation (QYPP) was developed for use in children and adolescents. To track participation throughout transition from childhood to adulthood, we adapted it for young adults using focus groups. Aim of this study was to validate this measure, the QYPP-Young Adults (QYPP-YA). METHODS: We recruited young adults with cerebral palsy (CP) and a representative, same-aged sample of the general population (GP). The GP-sample was split into two equivalent subsamples, one part to identify the factor structure via exploratory factor analysis and another part to test the resulting model via confirmatory factor analysis. Reliability and different forms of validity were investigated. RESULTS: The final QYPP-YA includes 17 items assigned to six domains (Autonomy, Independency, Intimate Relationships, Interpersonal Relationships, Social Life, Online Communication). Scales show satisfying internal consistencies in the CP-sample and in the GP-sample, except for 'Online Communication'. Convergent, divergent and known-group validity were confirmed. CONCLUSIONS: The QYPP-YA instrument features promising psychometric characteristics to assess key domains of participation in healthy and disabled young adults. It provides a multidimensional, economic and sound assessment for use in population surveys and clinical trials.