Relationship between social participation and depressive symptoms in patients with multimorbidity: the chained mediating role of cognitive function and activities of daily living.

OBJECTIVE: The potential mechanisms linking social participation and depressive symptoms in Chinese individuals with multimorbidity are not yet fully understood. This study aims to explore how cognitive function and activities of daily living (ADLs) mediate the relationship between social participation and depressive symptoms in individuals with multimorbidity. METHODS: We selected 3782 participants with multimorbidity from the 2018 China Health and Retirement Longitudinal Study. Data related to social participation, cognitive function, ADLs, and depressive symptoms were extracted. Regression and Bootstrap analyses were used to explore the sequential mediating effects of social participation, cognitive function, ADLs, and depressive symptoms. RESULTS: (1) There was a significant correlation between social participation, cognitive function, activities of daily living, and depressive symptoms (p < 0.01). (2) Social participation directly affected depressive symptoms (ß = -0.205, p < 0.05). (3) Cognitive function (ß = -0.070, p < 0.01) and activities of daily living (ß = -0.058, p < 0.01) played separate mediating roles in the effect of social participation on depressive symptoms. (4) Cognitive function and activities of daily living had a chain-mediated role in the relationship between social participation and depressive symptoms in patients with multimorbidity (ß = -0.020, p < 0.01). CONCLUSION: A chained mediating effect was found between cognitive function, ADLs, social participation, and depressive symptoms in patients with multimorbidity. Social participation was found to improve the cognitive function of patients with multimorbidity, which in turn enhanced their daily life activities and ultimately alleviated their depressive symptoms.

"I became a person again": Social inclusion and participation experiences of Ethiopian women post-obstetric fistula surgical repair.

BACKGROUND: Childbirth-related mortality and morbidity affect many women globally, especially in low-income countries like Ethiopia. Obstetric fistula-a preventable condition mainly caused by prolonged and obstructed labor-can lead to physical, psychological, and social challenges, affecting women's social participation and inclusion. OBJECTIVE: This study aims to understand women's social participation and inclusion experiences post-obstetric fistula surgery. METHODS: This study is part of a larger research project investigating the social inclusion process of women who have had obstetric fistula surgery in Ethiopia. For this study, we conducted a qualitative exploration of women's experiences, guided by a constructivist grounded theory approach. Twenty-one women discharged from fistula treatment facilities following obstetric fistula surgery were interviewed using a semi-structured interview guide. Data was analyzed using Charmaz's inductive analysis approach, which involves an initial line-by-line coding followed by focused coding to identify the most significant codes. Subsequently, sub-themes and themes were developed from the focused codes. RESULT: The data analysis revealed four themes reflecting the women's experiences of social participation and inclusion. These are the experience of recovery and the journey toward social participation, participating in expected and meaningful activities, the continued challenge with a romantic relationship, and formal and informal support. Overall, the women who received fistula surgery reported positive life changes, especially regarding their physical well-being. However, they continued to face social challenges such as financial hardship, reproductive health problems, and issues with marriage and family life, which negatively impacted their social participation and inclusion experiences. CONCLUSION: While more research is needed, the findings of this study suggest that the social aspects of obstetric fistula are crucial for healthcare professionals to consider. Providing appropriate care and support to address unmet social relationship, employment, and childcare needs could enable women to lead fulfilling lives.

Social participation in the promoting activity, independence and stability in early dementia (PrAISED), a home-based therapy intervention for people living with dementia: a realist evaluation.

BACKGROUND: Interventions promoting social activity may reduce behavioural psychological symptoms and improve quality of life in people living with dementia. This study aimed to identify social benefits for participants living with dementia in the context of Promoting Activity, Independence and Stability in Early Dementia (PrAISED), an exercise intervention programme promoting physical activity and independence in participants living with dementia in England. METHODS: This was a multi-method realist evaluation undertaking secondary analysis of data collected during the PrAISED process evaluation, including qualitative interviews with participants with dementia, caregivers and therapists, personal notes of researchers, and video recordings of therapy sessions. The study consisted of four phases: (1) Setting operational definition of social outcomes in PrAISED; (2) Developing Context, Mechanisms, Outcome (CMO) configurations; (3) Testing and refining CMOs; and (4) Synthesising definitive CMOs into a middle range theory. RESULTS: Two CMOs were identified. (1) When therapists were able to make therapy sessions engaging and had the caregivers' support, the participants experienced therapy sessions as an opportunity to achieve goals in areas they were interested in. They also found the sessions enjoyable. This all led to the participants being highly engaged in their social interactions with the therapists. (2) When the participants realised that they were gaining benefits and progress through the PrAISED intervention, such as increased balance, this boosted their confidence in physical ability. It might also reduce caregivers' risk-aversion/gatekeeping attitude, which in turn would lead to participants' increased participation in social activities. CONCLUSION: The PrAISED intervention supported social participation in participants living with dementia. Under certain circumstances, home-based therapy interventions can be beneficial for social health (regardless of physical health gains). Given the limitations of currently available outcome measures to assess social participation, qualitative methods should be used to explore social health outcomes.

Psychosocial Characteristics by Pain Presence and Limitations Among Older Adults.

PURPOSE: To compare psychosocial outcomes of older adults according to pain experience. METHOD: Using cross-sectional 2021 data from the National Health and Aging Trends Study, we examined psychosocial characteristics in older adults (N = 3,376) divided into three groups: no pain, pain without activity limitations, and activity-limiting pain. RESULTS: In multiple regression models, older adults with activity-limiting pain compared to those without pain had significantly higher depression, anxiety, and fear of falling, as well as reduced positive affect, self-realization, self-efficacy, resilience, and social participation. Older adults with non-activity-limiting pain had significantly higher social participation than those without pain, but no differences in self-realization, self-efficacy, or resilience. CONCLUSION: Pain is strongly associated with all psychosocial outcomes, especially in older adults with activity-limiting pain. Future research should examine the impact of self-realization, self-efficacy, resilience, and social participation on activity limitations. [Journal of Gerontological Nursing, 50(7), 27-34.].

Depression, loneliness, and lower social activity as partial mediators of the association between visual impairment and cognitive decline.

OBJECTIVES: Sensory impairment is a hypothesized risk factor for cognitive decline; however, the psychosocial pathways are not well understood. We evaluated whether the association between visual impairment (VI) and cognitive decline was partially mediated via depressive symptoms, loneliness, or social activity. METHODS: We used data from 2601 older adults enrolled in the Memory and Aging Project in 1997 and the Minority Aging Research Study in 2004 with neuropsychological tests across five domains measured annually for up to 16 years. VI was assessed with the Rosenbaum Pocket Vision Screener. Depressive symptoms, loneliness, and social activity were self-reported using validated scales. We used structural equation models to estimate the associations of VI with baseline and change in cognitive function, directly and indirectly through each mediator (depressive symptoms, loneliness, and social activity). We evaluated mediation via "psychological distress" using a latent variable combining depressive symptoms and loneliness. RESULTS: The association between VI and global cognitive decline was mediated via lower social activity (indirect effect) [95% confidence interval (CI)] of linear slope: -0.025 (-0.048, -0.011), via loneliness (-0.011 [95% CI: -0.028, -0.002]), and via psychological distress (-0.017 [95% CI: -0.042, -0.003]). We did not find sufficient evidence for mediation via depressive symptoms alone. CONCLUSIONS: The harmful effect of VI on cognitive decline may be partially mediated through loneliness and lower social activity.

The impact of social participation on the health status of the older adult: An empirical study based on CGSS 2021 data.

INTRODUCTION: With the rapid pace of population aging, the health issues of the older adult have garnered widespread attention. Social participation plays a pivotal role in the health of the older adult. This study aims to explore the impact of social participation on the health status of the older adult. METHODS: Using a binary logistic regression model, this study analyzes the influence of social participation methods on the health status of older adult individuals in China based on cross-sectional data from the "China Comprehensive Social Survey" in 2021. The study sample comprises individuals aged 60 to 99 years. RESULTS: It was found that participation in physical activities [P<0.001, OR = 1.907], social and recreational activities [P<0.001, OR = 1.387], and online activities [P<0.001, OR = 1.808] were significantly positively correlated with the health status of the older adult. CONCLUSIONS: The health of older adults is influenced by a combination of physical activities, social and recreational activities, and online activities. Good health is closely associated with high levels of physical activity. Engaging in physical exercise promotes physiological health, while participating in social and recreational activities has a significant impact on cognitive and depressive states. Additionally, involvement in online activities helps alleviate feelings of loneliness and enhances overall well-being. RECOMMENDATIONS: 1)Promote the development of physical activities for the older adult: Create an integrated environment for physical exercise. 2)Expand the social circle of the older adult: Construct diverse and structured communities to enhance well-being. 3)Develop online activities for the older adult: Facilitate their integration into the digital age. 4)Foster interdisciplinary collaboration for older adult health: Build partnerships across various domains to promote older adult health.

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 of 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.

Social Support Mediates the Association Between Abilities and Participation After Stroke.

Stroke survivors face participation restrictions, yet little is known regarding how social support affects the association between an individual's abilities and participation. Through a Person-Environment-Occupation-Performance (PEOP) model lens, social support was examined as a potential mediator between ability and participation in cognitively and mobility-demanding activities for stroke survivors with aphasia (persons with aphasia [PWA]) and without aphasia (persons without aphasia [PWOA]). A cross-sectional design, including PWA (n = 50) and PWOA (n = 59) examined associations among person factors (physical impairment, cognition), an environmental factor (social support), and occupational participation through cognitively- and mobility-demanding activity subscales of the Activity Card Sort. Cognition was associated with participation in cognitively demanding activities for both groups, though social support was a mediator only for PWA. Physical impairment was associated with participation in mobility-demanding activities for PWOA, though social support did not mediate that relationship. Social support is key to PWA participating in cognitively demanding activities post-stroke.

Social Support's Role in Tasks that Require Cognition or Mobility for Stroke Survivors with and without AphasiaAfter a stroke, people can face difficulties doing the things they need and want to do in their daily life. Sometimes a stroke can cause aphasia, a disorder that can make it hard for someone to communicate. Social support occurs when one person helps someone do the things they need and want to do. Certain tasks may require different skills, like cognition (being able to think) or mobility (being able to move). Results showed that cognition is important to do tasks that require a lot of thinking for people who experience a stroke and social support is essential for people with aphasia to do tasks that require a lot of thinking. In addition, mobility is important to do tasks that require walking or movement for people without aphasia.

"I'm Part of Something That Matters": Exploring What Older Adults Value Through Their Engagement in Age-Friendly Community Initiatives.

Older adults' engagement in age-friendly community (AFC) initiatives is considered an essential element of community transformation. However, research on older adults' experiences of engaging in AFC initiatives remains nascent. Based on qualitative interviews with 23 older adult participants from 15 AFC initiatives across four states in the United States (U.S.), our reflexive thematic analysisidentified three themes regarding what participants value from their engagement: (a) social contribution; (b) social connectedness and integration; and (c) staying active and personal growth. Exploring older adults' interest in contributing to, connecting with, and growing in their community can inform recruitment and retention in AFC initiatives.

What impact does hearing impairment have on cognitive health in older married couples in China?

Hearing impairment is a common geriatric health problem and chronic stressor, and it is associated with poor cognitive outcomes. However, little is known about the impact of hearing impairment in married couples, particularly its potential spillover effects on the cognitive health among spouses of individuals with impairment. Drawing on a stress-proliferation perspective, we used actor-partner interdependence models to examine (1) whether an individual's hearing impairment influences their spouse's cognitive function; and (2) whether AL, symptoms of depression, and social participation serve as mediators for such an association. We utilized data from the 2015 (baseline) and 2018 (3-year follow-up) waves of the China Health and Retirement Longitudinal Study. 4434 couples were included at baseline, and 2190 couples remained after the 3-year follow-up. Hearing impairment among married women was associated with negative impacts on their spouses' cognitive function. Symptoms of depression and social participation may have served as potential mediators in this relationship. For married men, there was no statistically significant association between hearing impairment and spouses' cognitive function. Our findings suggest that hearing impairment among one spouse can lead to negative impacts on the other, but that this effect may depend on gender. Early diagnosis and couple-based interventions for hearing impairment are important for the cognitive health of both hearing-impaired individuals and their spouses.

Counting the Ways That Aboriginal and Torres Strait Islander Older People Participate in Their Communities and Culture.

OBJECTIVES: This study aimed to determine the proportion of older Aboriginal and Torres Strait Islander peoples participating in cultural events and activities and determine the demographic and sociocultural characteristics associated with participation. METHODS: The Australian Bureau of Statistics National Aboriginal and Torres Strait Islander Social Survey (2014-2015) was used to measure the prevalence of participation in cultural events and activities. Multivariate logistic regression models were used to measure associations. Sociocultural factors were selected by matching survey items to the 12 sociocultural factors described in the Good Spirit Good Life Framework, a culturally validated quality-of-life tool for older people. RESULTS: The majority (62.0%) of survey respondents 45 years and older participated in cultural events (e.g., ceremonies, funerals/sorry business, NAIDOC week activities, sports carnivals, festivals/carnivals) or were involved in organizations. Many (58.5%) also participated in activities (e.g., fishing, hunting, gathering wild plants/berries, arts/crafts, music/dance/theater, writing/telling of stories). In regression models including demographic and cultural variables, participation in cultural events was highest among people living remotely (odds ratio [OR] = 2.71), reporting recognition of homelands (OR = 2.39), identifying with a cultural group (OR = 3.56), and those reporting having a say in their communities (OR = 1.57), with similar odds seen for participation in activities. Participation was inversely proportional to increasing age, with a greater proportion of females participating in events and males in activities. DISCUSSION: The social lives of older Aboriginal and Torres Strait Islander people were characterized by widespread participation in cultural events and activities. These findings provide important insights into services as they support older people to live a good life.

Lifestyle factors and subjective well­being among older adults in China: A national community-based cohort study.

There has been limited research on the relationship between health habits and subjective well-being (SWB) among Chinese oldest older adults. This study aims to explore lifestyle factors associated with SWB in this population. We analyzed data from three waves (2008-2014) of the CLHLS, including 28,683 older adults. Lifestyle factors analyzed included fruit and vegetable intake, smoking, alcohol consumption, physical exercise, and social participation. Results suggested that high frequency of fruit and vegetable intake, current and past physical exercise, and high levels of social participation were associated with increased SWB. SWB was lower in older adults who never smoked compared to persistent smokers and in those who never drank alcohol or ceased drinking compared to persistent drinkers. We encourage older adults to enhance SWB through increased fruit and vegetable intake, physical exercise, and social participation. However, quitting smoking and drinking may not necessarily improve SWB, particularly in the context of China.

A cohort study of self-perception of ageing and all-cause mortality among older adults in China: a multiple mediators analysis.

BACKGROUND: Positive self-perception of aging (SPA) is a well-known predictor of longevity, while how and to what extent SPA is linked with all-cause mortality among older adults is still unclear. This study aims to elucidate the relationship between positive SPA and all-cause mortality and its potential mediators among Chinese older adults. METHODS: This is a 20-year dynamic cohort study conducted among 22,957 older adults aged ≥ 65 years old from a nationally representative sample. Positive SPA was measured using a validated 7-item scale. Potential mediators including health behaviors and social participation were collected using a self-reported questionnaire. Cox proportional hazards regression models were conducted to examine the association between positive SPA and all-cause mortality. A mediation analysis was conducted to determine whether health behaviors and social participation mediated the association between SPA and all-cause mortality. RESULTS: Throughout follow-up (median [interquartile range], 46 [21-84] months), all-cause mortality was 87.4%. Compared with older adults with the lowest quartile positive SPA, hazard ratio(HR) of all-cause mortality among older adults with the second, third, and fourth quartile of positive SPA was 0.96(95%CI:0.93-1.00), 0.93(95%CI:0.90-0.99), and 0.92(95%CI:0.87-0.96) respectively after controlling for all potential mediators and covariates. The mediation analysis showed that regular daily vegetable intake, physical activity, and high social participation explained 41.1-48.5% of the variance in the association between positive SPA and all-cause mortality. CONCLUSIONS: In this cohort study, we found that high positive SPA was associated with decreased all-cause mortality directly, and indirectly through healthy lifestyle behaviors and social participation. These findings suggest that interventions targeted at promoting or maintaining positive SPA may contribute to healthy ageing among older adults in China.

Contribution of diversity of social participation on the mental health of humanitarian migrants during resettlement.

AIMS: By the end of 2022, an estimated 108.4 million individuals worldwide experienced forced displacement. Identifying modifiable factors associated with the mental illness of refugees is crucial for promoting successful integration and developing effective health policies. This study aims to examine the associations between the changes in the diversity of social participation and psychological distress among refugees throughout the resettlement process, specifically focusing on gender differences. METHODS: Utilizing data from three waves of a longitudinal, nationally representative cohort study conducted in Australia, this study involved 2399 refugees interviewed during Wave 1, 1894 individuals interviewed during Wave 3 and 1881 respondents during Wave 5. At each wave, we assessed psychological distress and 10 types of social participation across 3 distinct dimensions, including social activities, employment and education. The primary analysis employed mixed linear models and time-varying Cox models. Gender-stratified analyses and sensitivity analyses were performed. RESULTS: Refugees engaging in one type or two or more types of social participation, compared with those not engaging in any, consistently had lower psychological distress scores (ß = -0.62 [95% confidence interval (CI), -1.07 to -0.17] for one type of social participation; ß = -0.57 [95% CI, -1.04 to -0.10] for two or more types of social participation) and a reduced risk of experiencing psychological distress (hazard ratio [HR] = 0.81 [95% CI, 0.65-0.99] for one type of social participation; HR = 0.77 [95% CI, 0.61-0.97] for two or more types of social participation) during the resettlement period. When stratifying the results by gender, these associations in the adjusted models only remained significant in male refugees. Moreover, three specific types of social participation, namely sporting activities, leisure activities and current employment status, were most prominently associated with a reduced risk of psychological distress. CONCLUSIONS: The findings of this cohort study suggest that social participation was consistently associated with reduced risks of psychological distress among male refugees during resettlement. These findings highlight the significance of promoting meaningful social participation and interaction may be an effective strategy to improve the mental health of refugees and facilitate their successful integration into society, especially among male refugees.

Determinants of social participation in people with disability.

PURPOSE: In this study, it is aimed to determine personal wellbeing and social participation levels across different physical disability types and levels of mobility. METHODS: A sample of 85 individuals with physical disabilities, excluding those with mental disabilities were included. Sociodemographics, mobility of the participants, cause, duration of disability were recorded. Personal Wellbeing Index-Adult (PWI-A) scale was used for the assessment of wellbeing and Keele Assessment of Participation (KAP) for social participation. RESULTS: Female, single, unemployed subjects and individuals with neurologic disability showed significantly higher median KAP-scores(p = 0.009, p = 0.050, p<0.001, p = 0.050, respectively).The median KAP-score of the independently mobile group was significantly lower compared to the other two groups (p = 0.001). The factors affecting KAP were determined as employment, mobility level and personal wellbeing (p = 0.002, p = 0.024, p = 0.050, respectively). CONCLUSION: Mobility level, employment and personal wellbeing are the determinants of social participation in people with disabilities. Neurological disability, female gender, being single, unemployment and mobility limitations are factors that reduce social participation.

Mid-life social participation in people with intellectual disability: The 1958 British birth cohort study.

BACKGROUND: Low social participation is a potentially modifiable risk factor for cognitive deterioration in the general population and related to lower quality of life (QoL). We aimed to find out whether social participation is linked to cognitive deterioration and QoL for people with borderline intellectual functioning and mild intellectual disability. METHOD: We used data from the National Child Development Study, consisting of people born during one week in 1958, to compare midlife social participation in people with mild intellectual disability, borderline intellectual functioning, and without intellectual impairment. We defined social participation as 1. confiding/emotional support from the closest person and social network contact frequency at age 44, and 2. confiding relationships with anyone at age 50. We then assessed the extent to which social participation mediated the association between childhood intellectual functioning and cognition and QoL at age 50. RESULTS: 14,094 participants completed cognitive tests at age 11. People with borderline intellectual functioning and mild intellectual disability had more social contact with relatives and confiding/emotional support from their closest person, but fewer social contacts with friends and confiding relationships with anyone than those without intellectual disability. Having a confiding relationship partially mediated the association at age 50 between IQ and cognition (6.4%) and QoL (27.4%) for people with borderline intellectual functioning. CONCLUSION: We found adults with intellectual disability have positive family relationships but fewer other relationships. Even at the age of 50, confiding relationships may protect cognition for people with borderline intellectual functioning and are important for QoL.

The impact of social participation on Subjective Wellbeing in the older adult: the mediating role of anxiety and the moderating role of education.

Introduction: The study aims to examine the mediating role of anxiety in the relationship between social participation and Subjective Wellbeing among Chinese older adults. Additionally, it investigates the moderating ed of education in this relationship. Methods: The data came from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) published by peking University, with a sample size of 10,626 individuals aged 60 years and above. SPSS 21.0 was used for the statistical analysis of the data, and Mplus 8.0 was used for the statistical processing of the mediating and moderating effects analysis. Results: (1) The social participation significantly and positively predicated Subjective Wellbeing; (2) Anxiety partially mediated the eect between social participation and Subjective Wellbeing. The mediating eect value was 0.103; (3) Education plays a moderating role in the impact of social participation on subjective Wellbeing. Discussion: In summary, social participation can reduce the anxiety and enhance their Subjective Wellbeing. Meanwhile, the eet of social participation on Subjective Wellbeing was the greatest for the older adult with high education. The findings suggest that community-led activities can be initiated to improve social participation in the older adult. Furthermore, educational courses could be to support the healthy aging of older adults in China.

Person and Environment Factors Supporting Self-Care Performance and Social Participation After Mild Stroke.

Mild stroke survivors seldom receive occupational therapy services as their deficits are assumed to be minor enough to not affect their daily occupations. Yet many mild stroke survivors report deficits in self-care performance and social participation. This study investigates person and environment factors influencing self-care performance and social participation among mild stroke survivors, using the Person-Environment-Occupation-Performance (PEOP) model. A retrospective cohort analysis of 736 mild stroke survivors was conducted using electronic health records. Person factors included demographic characteristics and clinical characteristics, and environment factors included the Social Vulnerability Index. The analysis included logistic regression. Approximately, 10% of patients reported deficits in self-care or social participation. Disability level was the only person factor associated with self-care performance. Person factors affecting social participation included mobility and unemployment. Socioeconomic status was associated with both occupation measures. Occupational therapy practitioners must address the person and environment factors affecting mild stroke survivors' self-care performance and social participation.

Person and Environment Factors Supporting Mild Stroke Survivors' Ability to Take Care of Themselves and Their Social LivesThis study looked at what happens to people after they have had a mild stroke. We wanted to find out what makes some people independent in taking care of themselves and able to socialize after a mild stroke, whereas others have more difficulty. To do this, we looked at many factors that were measured in the patients' hospital record, such as age, type of stroke, and where they live. We used their address to determine information about their neighborhood and how that may affect their independence and social lives. We found that patients who were less disabled had an easier time taking care of themselves. We found that patients who had difficulty moving or were unemployed had difficulty with their social lives. A patient's social life was also associated with whether they got therapy. Patients who lived in low-income neighborhoods had difficulties with taking care of themselves and with their social lives. Occupational therapists must understand the importance of addressing these factors when supporting patients with a mild stroke with their ability to take care of themselves and engage in their social lives.

The mediating roles of depressive symptoms and social participation in the relationship between the effects of pain and cognitive function among Chinese older adults: A longitudinal study.

Decline in cognitive function poses a substantial burden on individuals, families, and society. However, the longitudinal potential mechanism underlying the link of pain and cognitive function remains unclear. Using data of 4247 participants aged 60 years and over from the China Health and Retirement Longitudinal Study in 2011, 2013, 2018, and 2020, we discussed the longitudinal predictive effect of pain on cognitive function and the mediating effects of depressive symptoms and social participation. The longitudinal mediation model analysis revealed that pain could not directly influence cognitive function, but it could indirectly predict cognitive function through the independent mediation effects of depressive symptoms and social participation. Moreover, the association between pain and cognitive function was serially mediated by depressive symptoms and social participation. Diversified interventions aimed at relieving pain and depressive symptoms, and increasing social participation in older adults would be beneficial for their cognitive function.

The Longitudinal Dyadic Associations Between Social Participation and Cognitive Function in Older Chinese Couples.

OBJECTIVES: Based on the "linked lives" tenant of the life course perspective, this longitudinal study aims to examine the actor and partner effects of social participation on cognitive function in older Chinese couples. METHODS: A total of 1,706 couples aged 60 and older were included in the final analyses. Social participation was measured using 2 questions regarding types of activities and frequency. Cognitive function was measured using a combination of memory, orientation, visuoconstruction, attention, and calculation. The lagged-dependent APIM was used to model the dyadic associations between social participation and cognitive function. RESULTS: The time-averaged actor effects of both husbands' and wives' social participation on their own cognitive function were significant (p < .001 for both). The time-averaged partner effect of husbands' social participation on wives' cognitive function was significant (p < .001) but the reverse-the effect of wives' social participation on husbands' cognitive function-was not (p = .381). The time-specific actor and partner effects were not significant (p > .05 for all). DISCUSSION: Our findings indicate an asymmetrical pattern of actor-partner interdependence, where husbands' social participation may affect their wives' cognitive function on average, but wives' social participation does not affect their husbands' cognitive function. Clinical practitioners should invite both partners, especially husbands, to participate in social participation interventions to facilitate crossover benefits for wives. Moreover, policymakers should build more facilities to encourage older couples to engage in social activities to prevent cognitive decline.