Efficacy of community groups as a social prescription for senior health-insights from a natural experiment during the COVID-19 lockdown.

Loneliness and associated physical and cognitive health decline among the aging population is an important medical concern, exacerbated in times of abnormal isolation like the 2020-2021 Covid-19 pandemic lockdown. In this backdrop, recent "social prescribing" based health policy initiatives such as community groups as a support structure for the aging population assumes great importance. In this paper, we evaluate and quantify the impact of such social prescribing policies in combatting loneliness and related health degeneration of the aging population in times of abnormal isolation. To this end, we conduct a natural experiment across a sample of 618 individuals aged 65 and over with varying access to community groups during the Covid-19 lockdown period. Using a random-effects, probit model to compare the differences in health outcomes of participants with access to community groups (target) with those without access (control), we find that the target group was 2.65 times less likely to suffer from loneliness as compared to the control group, along with lower incidences of reported cardiovascular and cognitive health decline. These initial findings provide preliminary support in favor of the interventional power of social prescription tools in mitigating loneliness and its consequent negative health impact on the aging population.

How Time, Living Situation, and Stress Related to Technology Influence User Acceptance and Usability of a Socialization Service for Older Adults and Their Formal and Informal Caregivers: Six-Month Pilot Study.

Background: Considering the growing population of older adults, addressing the influence of loneliness among this demographic group has become imperative, especially due to the link between social isolation and deterioration of mental and physical well-being. Technology has the potential to be used to create innovative solutions to increase socialization and potentially promote healthy aging. Objective: This 6-month study examined the usability and acceptability of a technology-based socialization service and explored how stress and living situation affect older adults' and their ecosystem's perceptions of technology, investigating cross-sectional and longitudinal differences among and across user groups. Methods: Participants were recruited in Tuscany and Apulia (Italy) through a network of social cooperatives and a research hospital, respectively. A total of 20 older adults were provided with the same technology installed on a tablet and on a smart television. The technology has three functionalities: video calling, playing games, and sharing news. Additionally, 20 informal caregivers (IC) and 13 formal caregivers (FC) connected to the older adults were included in the study. After both initial training in the use of the system (T0) and 6 months of using the system (T6), questionnaires on usability, acceptability, and technostress were filled in by older adults, IC, and FC. Nonparametric or parametric tests were conducted to investigate group differences at both time points and changes over time. Additional analyses on older adults were done to assess whether differences in usability and acceptability were related to living situation (ie, alone or with someone). Furthermore, correlation analyses were performed between usability, acceptability, and stress toward technology at T0 and T6. Results: At both T0 and T6, older adults had lower usability scores than IC and FC and higher anxiety than IC. Over time, there was a significant decrease in older adults' attitudes toward technology score, depicting a negative attitude over time (T0 median 4.2, IQR 0.5; T6 median 3.7, IQR 0.8; Cohen d=0.7), while there was no change for IC and FC. At T0, those living alone had lower acceptability than those living with someone but this difference disappeared at T6. People or participants living with someone had a decline in anxiety, attitudes toward technology, enjoyment, and perceived usefulness. Stress toward technology affected usability and acceptability in the older adult group entering the study (ρ=-.85) but this was not observed after 6 months. In the IC group, stress affected trust at T0 (ρ=-.23) but not at T6. Conclusions: At the start of the study, older adults judged the system to be less usable and more stressful than did the caregivers. Indeed, at first, technostress was correlated with usability and acceptability; however, with repeated use, technostress did not influence the perception of technology. Overall, getting accustomed to technology decreased anxiety and stress toward technology.

Compassion Fatigue, Loneliness, and Hopelessness in Healthcare Workers: What Remains of the COVID-19 Pandemic?

Although the end of the critical phase of the COVID-19 pandemic has been declared, its consequences are still observed in the general population and some categories of workers. HCWs have had to face the battle against this disease on the front lines. In our study, we evaluated the current state of the consequences of the pandemic on compassion fatigue, loneliness, empathy, anxiety, and hopelessness in a group of 71 HCWs from a rehabilitation center. This data, collected in the time of May-June 2024 (T2), was compared in the same sample in 2020 (T0) and 2023 (T1). The results highlighted increased burnout (P-Bonferroni: 0.005) and feelings of loneliness in T2 (P-Bonferroni: 0.005). Importantly, the results of the compassion satisfaction remained stable, providing reassurance about the resilience of HCWs. Secondary Trauma results decreased in T2, indicating less psychological pressure associated with COVID-19 pathology.

Stigma of coronavirus disease 2019 among hospitalized children and their parents: A prospective cohort study.

BACKGROUND: The stigma associated with coronavirus disease 2019 (COVID-19) is a global problem that causes psychosomatic distress, including depression, anxiety, and loneliness. However, few studies have investigated the stigma of COVID-19 and the associated mental health impact on children or parents. METHODS: We conducted a prospective cohort study at the National Center for Child Health and Development in Tokyo, Japan, between November 2021 and October 2022. Children (4-17 years of age) with COVID-19 and parents of hospitalized children (0-17 years of age) with COVID-19 were enrolled in the study. Children with special health-care needs were excluded. The questionnaires on stigma and mental health (depression, anxiety, and loneliness) were administered during hospitalization and at the 1 month follow-up evaluation after discharge. RESULTS: During the study period, 47 children and 111 parents were included. Thirty-eight children (81%) and 105 parents (95%) answered the questionnaires at the 1 month follow up, respectively. Approximately 70% of participants were categorized as a high-stigma group. In children, subjective stigma was associated with loneliness during hospitalization (mean difference [MD] 2.32; 95% confidence interval [CI], 0.11-4.52) and depression at the 1 month follow up (MD 2.44; 95% CI, 0.40-4.48). In parents, presumed stigma was associated with depression, anxiety, and loneliness at 1 month follow up (MD 2.24, 1.68, and 1.15; 95% CI, 0.58-3.89, 0.11-3.25, and 0.08-2.21). CONCLUSION: Our findings suggest that the stigma associated with COVID-19 continues to affect mental health for more than a month after discharge, and the effects of stigma on mental health differed between the children and parents.

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.

Social support and health behaviors of older adults during the COVID-19 pandemic in China: a moderated mediation model of loneliness and economic income.

BACKGROUND: The literature shows that social support is an important factor influencing health behaviors. This study aimed to explore the relationships and intrinsic pathways of social support, loneliness, economic income, and health behaviors among older adults during the Corona Virus Disease 2019 (COVID-19) pandemic, and to provide a theoretical basis for the implementation of health behaviors interventions for older adults. METHODS: A cluster-random-sampling survey was adopted within two towns in Dongguan, China. Demographic characteristics, social support, loneliness, economic income and health behaviors were measured. The Social Support Appraisals scale (SS-A), the ULS-8 Loneliness Scale, and the Self-rated abilities for health practice scale (SRAHPS) were used to measure social support, loneliness, and health behaviors in older adults, respectively. A moderated mediation model was built to examine the relationships among social support, loneliness, economic income, and health behaviors using the SPSS PROCESS 4.0 macro. We conducted bootstrapping of regression estimates with 5000 samples and a 95% confidence interval. RESULTS: 621 older adults completed the questionnaire. Most of the participants were female, accounting for 75.0%, and the average age was 81.11 years (SD = 8.11). The median (interquartile range) of the participants' average monthly economic income was 800 (500-1000)RMB. The results of the mediation analysis showed that loneliness partly mediated the relationship between social support and health behaviors (B = 0.024, 95%CI: 0.007, 0.042), with the mediating effect accounting for 4.56% of the total effect. The moderation mediation analysis revealed a positive moderating role of economic income in the relationship between social support and loneliness (B = 0.114, 95%CI: 0.054, 0.174). Specifically, the relationship between social support and loneliness was found to be weaker for older adults with a high economic income compared to those with a lower economic income. CONCLUSION: The provision of enhanced social support and the alleviation of loneliness among older adults during an epidemic can facilitate the development of healthy behaviours, particularly among those who are economically disadvantaged.

Animal-assisted intervention for geriatric well-being: A comprehensive review.

Background: In recent years, the size of geriatric population seems to have grown larger than that of younger children and is expected to grow even larger in few years from now. As older individuals are more vulnerable to health concerns and loneliness, it is necessary to focus on providing them opportunities for healthy ageing. Animal-assisted therapy (AAT) has emerged as one of the simple yet effective approach to enhance physical, psychological, and social well-being in older adults. Methods: This review article presents collective information from various experiments on AAT's effectiveness in promoting healthy ageing. Results: The physiological impacts of AAT, on cardiovascular health, mobility, and day to day activities have been discussed. The psychological benefits of AAT, such as improvement of mood, cognition, and alleviation of anxiety, loneliness, and depression, are explored. This review also presents the possible mechanisms underlying the effective-ness of AAT, such as release of oxytocin, dopamine, and endorphins, which contribute to emotional well-being along with reduction of stress. The human-animal bond established during AAT sessions is discussed as a significant factor in promoting positive outcomes. Challenges faced and limitations involved in employing therapy animals within ageing populations are also discussed. Conclusions: Avenues for future research and potential applications of AAT in diverse healthcare settings are proposed, emphasizing the need for further empirical investigation to fully elucidate the mechanisms and benefits of AAT for healthy ageing. Through this comprehensive review, we aim to highlight the potential of AAT as a holistic intervention to enhance the well-being of older adults, providing valuable insights for healthcare practitioners, researchers, and policymakers invested in promoting healthy ageing strategies.

The association between loneliness and frailty among community-dwelling older adults in five European countries: a longitudinal study.

BACKGROUND: Loneliness is described as the subjective experience of unfulfilled personal and social needs, with emotional and social domains. Frailty is a state of vulnerability to stressors, which is often characterised by impairment in the physical, psychological and/or social domain. OBJECTIVE: This study aims to examine the bidirectional association between loneliness and frailty across the different domains. METHODS: The study included 1735 older adults from the Urban Health Centres Europe project. Loneliness was assessed using the six-item De Jong Gierveld Loneliness Scale. Frailty was assessed by the Tilburg Frailty Indicator. Multivariate linear regression and cross-lagged panel models were used to explore the associations between the social and emotional loneliness dimensions and overall, physical, psychological and social frailty. RESULTS: A bidirectional association existed between overall loneliness and overall frailty (loneliness to frailty: ß = 0.09, 95% CI: 0.03, 0.15; frailty to loneliness: ß = 0.05, 95% CI: 0.004, 0.10). Higher levels of overall loneliness at baseline were associated with higher levels of psychological frailty at follow-up (ß = 0.05, 95% CI: 0.00, 0.10). The reverse association was not significant. A bidirectional association existed between overall loneliness and social frailty (loneliness to social frailty: ß = 0.05, 95% CI: 0.01, 0.10; social frailty to loneliness: ß = 0.05, 95% CI: 0.00, 0.09). CONCLUSION: This study confirms the importance of addressing loneliness among older adults. Interventions that increase social support, exercise engagement and promote healthy behaviours may be effective in reducing the risk of frailty among older adults and simultaneously preventing loneliness.

Empty nest but better off? Association between empty nest status and cognitive function among older adults with chronic diseases in rural China.

BACKGROUND: The increasing prevalence of cognitive impairment poses substantial risks to older adults, particularly those with chronic diseases. While existing studies have examined the connection between the empty nest phenomenon and cognitive function, few have attempted to consider endogeneity issues within this relationship, with limited attention given to older adults with chronic diseases. This study investigates the impact of empty nest status on cognitive function among rural Chinese older adults with chronic diseases and explores the possible mechanisms underlying this effect. METHODS: A cross-sectional study involved 365 older adults aged 60 or above with chronic diseases in rural areas of Shaanxi province, northwest China. Cognitive function was measured using the Mini-Mental State Examination. Multiple regression models and the instrumental variable (IV) method were employed to examine the association between empty nest and cognitive function. RESULTS: Among the 365 older adults aged 60 or above with chronic diseases, 43% experienced cognitive impairment. Results from both multiple regression and IV analyses consistently demonstrate a significant association between empty nest status and higher cognitive function scores (ß = 1.757, p = 0.007; ß = 3.682, p = 0.034, respectively). Mechanism analysis further supports that the positive association may arise from empty nesters receiving more social support from children and friends, and perceiving loneliness experiences as inadequate. Heterogeneity analysis reveals that the association between empty nest status and cognitive function is more pronounced among male adults with chronic diseases. CONCLUSIONS: This study challenges the notion that empty nest status is a risk factor for cognitive decline in older adults with chronic diseases in rural China. The positive impact is attributed to the robust social relationships of empty nesters, encompassing sustained support from their social network, and the absence of an increase in loneliness. Therefore, future interventions aimed at improving cognitive function in older adults may benefit from promoting the development of social relationships.

[Frailty, dependence, and unwanted loneliness in elderly. A review of the health plans]. / Fragilidad, dependencia y soledad no deseada en personas mayores. Una revisión de planes de salud.

OBJECTIVE: The health plan is a guiding tool for territorial health planning where the proposed objectives and measures should prioritize vulnerable groups. The aim of this study was to identify if the Regional Government health plans in Spain included measures related to frailty, dependence and unwanted loneliness aimed at elderly. METHODS: Institutional websites were scanned to identify the most recent health plan of each Regional Government. Information concerning the diagnosis, objectives, specific programs and types of measures on the three domains: frailty, dependence and loneliness was extracted manually. The search was performed on 10 July 2023. RESULTS: Sixteen health plans published between 2010 and 2023 were identified. Twelve of these had incorporated intervention measures on frailty, fourteen on dependence and eight on loneliness, with a considerable heterogeneity. Only eight Regional Governments provide for measures to detect and assess frailty. Aragón, Castilla-La Mancha, Cataluña, Extremadura, País Vasco, Principado de Asturias, Comunidad Foral de Navarra and Comunitat Valenciana were the Regional Governments that presented objectives in the three domains. CONCLUSIONS: The measures proposed by the Regional Governments on frailty, dependence and unwanted loneliness are highly heterogeneous. In the same manner that exists for frailty, it is recommended to stablish a consensus including dependency and unwanted loneliness. Surprisingly, the measures focus more on late stages (dependence) than on prevention (frailty). This study could serve the Regional Governments to in-depth review their health plans, and to examine the actions carried out in other regions to improve the quality of their proposals.

OBJECTIVE: El plan de salud es el instrumento director de la planificación en salud de un territorio, donde los objetivos y medidas planteados deben priorizar a los colectivos más vulnerables. El objetivo de este estudio fue conocer si se incluían medidas sobre la fragilidad, dependencia y soledad no deseada en los planes de salud dirigidos a personas mayores de las comunidades autónomas (CC. AA.) españolas. METHODS: Se realizó una búsqueda en los sitios web institucionales para identificar el plan de salud más reciente de cada comunidad autónoma. Se extrajo manualmente la información sobre el diagnóstico, los objetivos, los programas específicos y los tipos de medidas en tres ámbitos: fragilidad, dependencia y soledad. La búsqueda se completó el 10 de julio de 2023. RESULTS: Se localizaron dieciséis planes de salud publicados entre los años 2010 y 2023. De ellos, doce incorporaban medidas de intervención en fragilidad, catorce en dependencia y ocho en soledad no deseada, observándose mucha heterogeneidad entre ellos. Solo ocho CC. AA. contemplan medidas de detección y valoración de la fragilidad. Las CC. AA. con objetivos en los tres ámbitos fueron Aragón, Castilla-La Mancha, Cataluña, Extremadura, País Vasco, el Principado de Asturias, Comunidad Foral de Navarra y la Comunitat Valenciana. CONCLUSIONS: Las medidas relacionadas con fragilidad, dependencia y soledad no deseada son heterogéneas entre CC. AA. De la misma forma que existe en fragilidad, se recomienda establecer un consenso que incluya dependencia y soledad no deseada. Sorprende que las medidas inciden más en fases tardías (dependencia) que en prevención (fragilidad). Este estudio puede ayudar a las CC. AA. a hacer una profunda revisión de su plan de salud, así como consultar las acciones realizadas en otros territorios para mejorar la calidad de sus propuestas.

Social isolation, loneliness and low dietary micronutrient intake amongst older people in England.

BACKGROUND: Social isolation and loneliness are associated with increased risk of adverse health outcomes at older ages. This study evaluated whether isolation and loneliness are related to inadequate intake of micronutrients in the diet. METHODS: We tested associations between social isolation and loneliness and dietary micronutrient intake 2 years later in 3713 men and women (mean age 68.26, standard deviation 7.81 years) who completed two online 24-h dietary recalls. Associations of isolation and loneliness with intake of nine minerals and vitamins that fell below national recommendations were tested using logistic regressions, adjusting for age, gender, ethnicity, education, marital status, smoking and physical activity and total energy intake. RESULTS: The prevalence of low dietary intake varied markedly across micronutrients. Social isolation (1-point increase in a score ranging 0-5) was associated with increased odds (adjusted for covariates) of low intake of magnesium [odds ratio (OR) 1.153, 95% confidence interval (CI) 1.037-1.282, P = .009], potassium (OR 1.201, 95% CI 1.087-1.327, P < .001), vitamin B6 (OR 1.263, 95% CI 1.110-1.438, P < .001), folate (OR 1.211, 95% CI 1.093-1.341, P < .001) and vitamin C (OR 1.238, 95% CI 1.098-1.394, P < .001). These associations remained unchanged when food insecurity and impaired activities of daily living were taken into account. By contrast, loneliness was not related to the inadequate intake of any micronutrient. CONCLUSIONS: Low intake of micronutrients increases risk of age-related health problems. Attention to the dietary quality of older people with limited social contacts and little involvement in community activities might enhance health outcomes.

Feeling lonely and dissatisfied - understanding social network functioning in stroke survivors.

BACKGROUND: Post-stroke social networks are associated with functional recovery. However, there is little information on the social networks of stroke survivors and whether institutionalised and community-dwelling stroke survivors view their social relationships differently. PURPOSE: To i) examine social networks of stroke survivors and any influencing sociodemographic factors, as well as to ii) compare differences between institutionalised and community-dwelling stroke survivors. METHODS: Stroke survivors were recruited from eight healthcare institutions in Singapore. Stroke Social Network Scale (SSNS) was administered to assess the social network functioning. Multidimensional State Boredom Scale (MSBS) was used to evaluate state boredom levels. RESULTS: 160 stroke survivors completed the study. Stroke survivors reported a mean (SD) of 53.7(17.2) on the SSNS total score. Institutionalised stroke survivors reported significantly lower SSNS scores than community-dwelling stroke survivors, (U = 1856.5, z=-4.234, p < .001). Nearly a third (30.6%, n = 49) of the stroke survivors reported feeling lonely. Only 28.1% (n = 45) stroke survivors reported being 'Very Satisfied' with their overall social network. Compared to community-dwelling stroke survivors, institutionalised stroke survivors felt more lonely (40.7%) and only 25% were very satisfied with their social network with all p < .05. A moderate correlation was found between SSNS 'Satisfaction' subdomain score and MSBS total score, r=-.401, p < .001. CONCLUSIONS: Stroke survivors had poor functioning social relationships. This study found that the perceived social support of institutionalised stroke survivors was poorer than community dwelling stroke survivors. A large proportion of stroke survivors reported feeling lonely and were not satisfied with their social networks. Identifying those at risk may be a means to prevent loneliness, increase social network satisfaction to improve well-being and quality of life.

Relationship between loneliness and post-traumatic growth in patients with gynecologic malignancies: the mediating role of self-disclosure and psychological resilience.

BACKGROUND: To explore the relationship between loneliness and post-traumatic growth, with a focus on the mediating role of psychological resilience and self-disclosure. METHODS: This study was a cross-sectional survey using the Loneliness Scale for Cancer Patients, the Distress Expression Index Scale (for measuring self-disclosure), the Psychological Resilience Scale, and the Posttraumatic Growth Scale on 215 inpatients with gynecologic malignancies at a tertiary care hospital in Guangzhou. Subsequently, Correlation, regression, and mediation analyses were performed using SPSS to test the relationships between the variables. RESULTS: The results showed that loneliness was negatively correlated with posttraumatic growth (r = -0.261, P < 0.001), self-disclosure was positively correlated with posttraumatic growth (r = 0.360, P < 0.001), and psychological resilience was positively correlated with posttraumatic growth (r = 0.475, P < 0.001); loneliness was correlated with self-disclosure (r = -0.194, P < 0.01), loneliness was negatively correlated with psychological resilience (r = -0.287, P < 0.001), self-disclosure was correlated with psychological resilience (r = 0.287, P < 0.001); loneliness was significantly correlated with self-disclosure (r = -0.314, P < 0.001); loneliness was not a direct predictor of posttraumatic growth (ß = -0.108, t = 1.734, P > 0.05), but could influence posttraumatic growth through the mediated effect of self-disclosure and psychological resilience, where the total indirect effect of self-disclosure and psychological resilience was - 0.155 (95% CI: -0.236, -0.081, P < 0.001). CONCLUSIONS: The mechanism of loneliness on post-traumatic growth in patients with gynecologic malignancies is mainly through the indirect effect of self-disclosure and the indirect impact of psychological resilience. Great attention should be paid to patients' loneliness, to find factors promoting patients' self-disclosure, to improve the level of patients' psychological resilience, and promote post-traumatic growth of gynecologic malignant tumors.

Social prescription for the elderly: a community-based scoping review.

AIM: This scoping review aimed to identify the social prescription activities that exist for the elderly in a community context. BACKGROUND: The increase in population ageing imposes the need to implement specific actions that guarantee elderly people the possibility of experiencing this phase with quality. The pandemic significantly exacerbated the needs of the elderly, leading to, regarding the loss of functional capacity, quality of life, well-being, mental health, and increased loneliness. Social prescription emerges as an innovative and non-clinical strategy, being a personalized approach that focuses on individual needs and objectives (Islam, ). By referring primary health care users to resources available in the community, obtaining non-medical support that can be used in conjunction with, or instead of, existing medical treatments (Chng et al., ). METHODS: A scoping review was conducted based on preferred reporting items for systematic reviews and meta-analyses, extension for scoping reviews (PRISMA-ScR). Searches were performed in electronic databases for potential studies: Scopus, PubMed, Medline, and Psychology and Behavioral Sciences Collection. Studies were included if they: (1) addressed social prescription interventions; (2) were community based; and (3) included elderly participants. Data extraction followed predefined criteria. FINDINGS: Of a total of 865 articles identified, nine were selected. The social prescription activities identified fall into eight main domains: arts, personal development, social interaction, physical activity, gardening, cultural activities, religious activities, and technological activities. The interventions resulted in improved well-being, enhanced quality of life, health promotion, and reduced isolation and loneliness. Social prescription, while innovative, is still an evolving intervention, which can respond to the needs of the elderly population, given the range of activities that may exist in the community. Primary care professionals must develop these interventions, establish a link between health and the community, respond to these needs, and promote healthy ageing.

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.

The mediating role of perceived social support on loneliness and depression in community-dwelling Nepalese older adults.

BACKGROUND: Loneliness has been identified as a significant independent predictor of depression among older adults. Social support has been reported to play a protective role against both loneliness and depression in older adults. However, few studies to date have investigated the three constructs concurrently and the mediating role of Perceived Social Support (PSS) on the relationship between loneliness and depression in this age group. The current study aimed to assess the relationship between loneliness and depression among community-dwelling Nepalese older adults based on the mediating role of PSS. METHODS: This descriptive cross-sectional research study included 367 community-dwelling older adults from a randomly selected ward in Kathmandu, Nepal. The University of California, Los Angeles Loneliness Scale, Geriatric Depression Scale, and Multidimensional Scale of Perceived Social Support were used. Correlation analysis, regression analysis, and the PROCESS 4.1 macro developed by Hayes with a bootstrapping procedure were used to test the mediating effect of the PSS on the relationship between loneliness and depression. RESULTS: Loneliness was negatively associated with the PSS (ß = -0.405; 95% CI: -0.473, -0.337; P < 0.001), and the PSS was positively associated with depression (ß = 0.057; 95% CI: 0.014, 0.099; P = 0.009). The direct effect of loneliness on depression was positive and significant (ß = 0.151; 95% CI: 0.117, 0.184; P < 0.001), whereas the indirect effect of loneliness on depression through the PSS was negative (path c; ß = -0.023, 95% CI: -0.041, -0.005). The results indicated that the PSS partially mediated the relationship between loneliness and depression. CONCLUSION: These findings suggest that interventions focusing on reducing loneliness and fostering social support may be able to lessen depressive symptoms in older adults. By addressing these factors, healthcare providers and carers can promote the mental health of older adults.

Association between loneliness and incident atrial fibrillation across different genetic predisposition: findings from the UK Biobank.

BACKGROUND: Loneliness has garnered significant attention globally, with extensive exploration of its association with cardiovascular disease. However, a notable research gap persists concerning loneliness and its potential link to atrial fibrillation (AF). METHODS: This prospective cohort study utilized data from the UK Biobank (UKB), encompassing 441,056 participants. Loneliness was assessed through self-reported questionnaires gauging feelings of isolation and willingness to confide. AF diagnoses were ascertained using hospitalization records and cause-of-death registry data. The association between loneliness and AF risk was analyzed through multivariable Cox proportional hazard models. RESULTS: Over a median follow-up period of 13.9 years, 25,386 AF cases were identified. In comparison to individuals without reported loneliness, those in the loneliness group exhibited a significantly higher risk of AF (loneliness vs. non-loneliness: hazard ratio [HR]: 1.11, 95% confidence interval [CI] 1.07-1.16). Subgroup analysis revealed that the association between loneliness and increased AF risk was significant solely in individuals without heart valve disease (HR: 1.12, 95% CI 1.07-1.16). Additionally, significant associations between loneliness and heightened AF risk were noted across strata of genetic susceptibility to AF, with no observable impact on these associations by genetic susceptibility (P for interaction = 0.070). CONCLUSIONS: This study establishes a robust association between loneliness and an elevated long-term risk of AF. Notably, this association is particularly pronounced in individuals without valvular disease and does not appear to be influenced by genetic predisposition to AF.

Loneliness and pain among community-dwelling middle-aged and older Black, Latino, and White adults in the United States.

Background: Prior research has demonstrated a strong and independent association between loneliness and pain, but few studies to date have explored this relationship in racially and ethnically diverse groups of midlife and older adults. We drew on the diathesis stress model of chronic pain and cumulative inequality theory to examine the relationship of loneliness and the presence and intensity of pain in a nationally representative sample of Black, Latino, and White adults aged 50 or older in the United States. Methods: Data were from Wave 3 of the National Social Life, Health, and Aging Project (n = 2,706). We used weighted logistic and ordinary least squares regression analyses to explore main and interactive effects of loneliness and race and ethnicity while adjusting for well-documented risk and protective factors (e.g., educational attainment, perceived relative income, inadequate health insurance, perceived discrimination) and salient social and health factors. Results: Almost half (46%) of the participants reported feeling lonely and 70% reported the presence of pain. Among those who reported pain (n = 1,910), the mean intensity score was 2.89 (range = 1-6) and 22% reported severe or stronger pain. Greater loneliness was associated with increased odds of pain presence (AOR = 1.154, 95% CI [1.072, 1.242]) and higher pain intensity (ß = 0.039, p < 0.01). We found no significant interaction effects involving Black participants. However, Latino participants who reported greater loneliness had significantly higher levels of pain (ß = 0.187, p < 0.001) than their White counterparts with similar levels of loneliness. Discussion: Loneliness is an important correlate of pain presence and intensity and may have a stronger effect on pain intensity among Latino adults aged 50 or older. We discuss clinical and research implications of these findings, including the need for more fine-grained analyses of different types of loneliness (e.g., social, emotional, existential) and their impact on these and other pain-related outcomes (e.g., interference). Our findings suggest a need for interventions to prevent and manage pain by targeting loneliness among middle-aged and older adults, particularly Latino persons.

United Voices Group-Singing Intervention to Address Loneliness and Social Isolation Among Older People With HIV During the COVID-19 Pandemic: Intervention Adaption Study.

BACKGROUND: People living with HIV experience HIV stigma alongside a spectrum of aging-related health conditions that accelerate their vulnerability to the ill effects of loneliness and social isolation. Group-singing interventions are efficacious in improving psychosocial well-being among older people in the general population; however, the social curative effects of group singing have not been explored in relation to HIV stigma. By promoting group identification, bonding, and pride, group singing may reduce loneliness, social isolation, and other negative impacts of HIV stigma among older people living with HIV. Access to group-singing programs may be enhanced by technology. OBJECTIVE: While group singing has been extensively studied in older adults, group-singing interventions have not been adapted for older people living with HIV to target loneliness and social isolation in the context of HIV stigma. The objective of this study was to describe the systematic development of a group-singing intervention to reduce loneliness and social isolation among older people living with HIV. METHODS: In the San Francisco Bay Area between February 2019 and October 2019, we engaged older people living with HIV in a rigorous, 8-stage, community-engaged intervention adaptation process using the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT) framework. On the basis of a formative assessment of the needs and preferences of older people living with HIV, we selected an evidence-based group-singing intervention for older adults and systematically adapted the intervention components by administering them to a community advisory council (n=13). RESULTS: The result was United Voices, a 12-week hybrid (web-based and in-person) group-singing intervention for older people living with HIV. United Voices comprises 12 web-based (ie, via Zoom [Zoom Video Communications]) rehearsals, web-based and in-person drop-in helpdesk sessions, and a professionally produced final concert recording. CONCLUSIONS: Through an iterative process and in consultation with stakeholders and topic experts, we refined and manualized United Voices and finalized the design of a pilot randomized controlled trial to evaluate the feasibility and acceptability of the intervention protocol and procedures. The findings provide insights into the barriers and facilitators involved in culturally tailoring interventions for older people living with HIV, implementing intervention adaptations within web-based environments, and the promise of developing hybrid music-based interventions for older adults with HIV.

The temporal sequence and reciprocal relationships of frailty, social isolation and loneliness in older adults across 21 years.

BACKGROUND: It is unclear whether social isolation and loneliness may precede frailty status or whether frailty may precipitate social isolation and loneliness. We investigated the reciprocal and temporal sequence of social isolation, loneliness, and frailty among older adults across 21 years. METHODS: We used seven waves of the Longitudinal Aging Study Amsterdam from 2302 Dutch older adults (M = 72.6 years, SD = 8.6, 52.1% female) ages 55 or older. Using random intercept cross-lagged panel models, we investigated between- and within-person associations of social isolation and loneliness with frailty. Frailty was measured using the Frailty Index. Loneliness was measured using the 11-item De Jong Gierveld Loneliness Scale. Social isolation was measured using a multi-domain 6-item scale. RESULTS: Social isolation and loneliness were weakly correlated across waves. At the between-person level, individuals with higher levels of frailty tended to have higher levels of social isolation but not loneliness. At the within-person level, the cross-lagged paths indicated that earlier frailty status predicted future social isolation and loneliness over time. However, prior social isolation was not associated with subsequent frailty except at time point 5 (T5). Loneliness at specific time points (T1, T4 and T6) predicted greater frailty at later time points (T2, T5 and T7). The results also supported reciprocal and contemporaneous relations between social isolation, loneliness and frailty. CONCLUSIONS: Social isolation and loneliness are potential outcomes of frailty. Public health policies and health practitioners should prioritise interventions targeting social connection among older adults with pre-frailty or frailty.