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.

Elder Abuse in Association with Depression and Suicidal Ideation among Community-Dwelling Elderly in Korea.

There has been limited research on the association between elder abuse and depression, as well as elder abuse and suicidal ideation concurrently. Therefore, the present study aimed to investigate this association using the dataset from a nationally representative elderly sample in Korea. This study analyzed the dataset from the 2020 National Survey of Older Koreans. Elderly participants (aged over 65 years, n=9920) were included. Multivariate regression analysis was utilized to explore the risk factors associated with depression and suicidal ideation in the context of elder abuse. In this study, 5.1% of the elderly reported having elder abuse in the past year, while 12.8% and 1.9% reported having depression and suicidal ideation, respectively. In addition, among the elderly with depression, 8.4% had experienced elder abuse, while among those reporting suicidal ideation, 17.6% had suffered from elder abuse. Multiple logistic regression revealed that elder abuse is independently associated with both depression [odds ratio (OR) for elder abuse=1.642] and suicidal ideation (OR for elder abuse=3.237). Besides elder abuse, poor subjective health status and poor social support were linked to higher risk of depression and suicidal ideation. Our findings revealed that elder abuse represented a substantial risk factor associated with both depression and suicidal ideation. Implementing preventive interventions to address these risk factors could have significant implications for public mental health.

Psychological predictors of incident subjective cognitive complaints in community dwelling older adults.

BACKGROUND: Subjective cognitive complaint (SCC) is associated with future cognitive decline and may be a marker for clinical intervention in the progression to dementia. Among the viable predictors of SCC, psychological factors are clinically relevant, non-invasive early indicators of older adults at elevated risk.    This aim of this study is to determine whether psychological symptoms: dysphoria and apathy precede incident SCC in the dementia pathway. METHODS: Participants (n = 592) enrolled in the Central Control of Mobility in Aging Study were includes in the analyses, with prevalent cases excluded. Apathy and dysphoria scale scores were derived using confirmatory factor analysis of the Geriatric Depressive Scale. Cox regression analyses was used to determine the association between apathy and dysphoria scores and incident SCC. RESULTS: Over a mean follow up of 1.90 years, 44 individuals (9.26%) developed incident SCC. Baseline apathy scale score was significantly associated with 4-fold increased risk of SCC (HR 4.39, 95%CI: 1.32-14.67), adjusted for cognition but not age and dysphoria scale score. Baseline dysphoria scale score was not associated with increased risk of SCC in adjusted analyses. CONCLUSION: In this longitudinal analysis of community dwelling older adults, apathy was associated with an increased risk of SCC, when adjusting for cognition but not dysphoria. Finally, this study highlights apathy as an early risk factor, which may precede SCC in the progression to dementia and consequently, may identify a high risk group for clinical screening and intervention.

Determinants of depressive symptoms among persons 80 years and older: longitudinal national evidence from the health, aging, and retirement study in Thailand, 2015-2022.

BACKGROUND: Few studies have longitudinally assessed the determinants of depressive symptoms among persons 80 years and older. The aim of this study was to estimate the determinants of depressive symptoms among persons 80 years and older based on 4-wave national longitudinal data from Thailand. METHODS: Data from the Health, Aging, and Retirement in Thailand study from 2015, 2017, 2020 and 2022 were utilized. The sample was restricted to community-dwelling persons 80 years and older (analytic sample: n = 2763 observations). For the pooled sample, average age was 85.0 years (range 80-117 years). Established measurements were used to assess depressive symptoms. Linear fixed effects regression was applied to assess the time-variant determinants and outcomes. RESULTS: Regressions found that higher functional disability and an increase in the number of chronic conditions worsened depressive symptoms. More favourable self-rated physical health, and higher exercise frequency improved depressive symptoms. In addition, among women higher subjective economic status decreased depressive symptoms. CONCLUSIONS: This longitudinal study enhances our understanding of the determinants of depressive symptoms among persons 80 years and older. Strategies to delay or decrease functional disability, chronic conditions, increase physical activity, and improve subjective economic status may help in reducing depressive symptoms.

The Impact of the COVID-19 Pandemic on Suicidal Ideation and Depression in Community-Dwelling Elderly.

INTRODUCTION: This study examined the effects of the coronavirus disease 2019 (COVID-19) pandemic on depression and suicidal ideation in community-dwelling elderly in Korea. METHODS: Data were employed from a survey on elderly mental health in Jeollanam-do (southwest province in Korea), conducted by the Jeollanam-do Provincial Mental Health and Welfare Center. A total of 2423 people were recruited from all 22 cities in Jeollanam-do from April to October, 2021. We used self-reported questionnaires including sociodemographic factors, COVID-19-related stress, the Geriatric Depression Scale-Short Form Korean Version, the Multidimensional Scale of Perceived Social Support, the Satisfaction With Life Scale and the Brief Resilience Scale. Logistic regression was performed to examine the factors of depression and suicidal ideation. RESULTS: Of the 2423 subjects, 622 (25.7%) reported depressive symptoms and 518 (21.4%) reported suicidal ideation. The multivariate logistic regression analysis revealed that living alone, poor perceived health status, worry of COVID-19 infection, and restriction of daily activities due to COVID-19 pandemic are significantly associated with depression. Female gender, poor perceived health status, inability to perform household chores, and depressive symptom are risk factors of suicidal ideation. CONCLUSION: These findings show that old age, negative perception of health, and restriction of daily activities due to COVID-19 are risk factors of depression in community-dwelling elderly in the context of the COVID-19 pandemic. Female gender, poor self-perceived health status, and depression increase the risk of suicidal ideation among the elderly. Social support and life satisfaction are protecting factors of both depression and suicidal ideation. Resilience decreased risk of depression but not in suicidal ideation.

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.

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.

The impact of fear of falling on health-related quality of life in community-dwelling older adults: mediating effects of depression and moderated mediation effects of physical activity.

BACKGROUND: The fear of falling is a common issue among older adults that negatively affects physical and psychological aspects of health-related quality of life, regardless of actual fall events. Interventions aimed at reducing fear of falling, independent of falls, may improve older adults' quality of life. This study examined the moderated mediation effect of physical activity in how fear of falling affects health-related quality of life through depression in community-dwelling older adults. METHODS: This study used secondary data from the Korea Centers for Disease Control and Prevention's 2019 Community Health Survey. The study included 73,738 adults aged 65 years or older. The researchers used the fear of falling scale, International Physical Activity Questionnaire, Patient Health Questionnaire-9, and EuroQol 5 Dimension as research tools, and performed descriptive statistics, Pearson's correlation coefficient, and SPSS PROCESS macro analysis. The study used the bootstrapping method to assess the adjusted mediating effect by resampling 5,000 times, and determined statistical significance with a 95% confidence interval. RESULTS: In the model in which fear of falling affects health-related quality of life by mediating depression, the moderated mediation effect of physical activity was statistically significant, as the bootstrapping result did not include 0 in the 95% confidence interval (Index of moderated mediation [95% CI] = 0.006 [0.004-0.007], 0.008 [0.006-0.009]). Depression and health-related quality of life impairment decreased as the level of physical activity increased through inactivity, minimal activity, and health promotion activities, as the negative mediating effects decreased. CONCLUSION: Physical activity reduces depression and improves health-related quality of life by influencing older adults' fear of falling. Community-based programs are needed to encourage and support older adults in maintaining moderate physical activity to manage the depression caused by fear of falling, which is common among older adults, and to improve their health-related quality of life.

The association between mental status, personality traits, and discrepancy in social isolation and perceived loneliness among community dwellers.

BACKGROUND: Social isolation and loneliness can co-occur; however, they are distinct concepts. There is discrepancy as some people feel lonely in social isolation, while others do not. This study sought to enhance our understanding of this discrepancy between social isolation and loneliness by investigating its related factors, with a specific focus on mental status and personality traits. METHODS: This study adopted a cross-sectional study design and utilized data from the 2016 and 2018 waves of the University of Michigan Health and Retirement Study. The participants were community dwellers aged 50 years and older. The outcome measurement was defined as the discrepancy between social isolation, based on six criteria, and loneliness, assessed using the three-item version of the Revised UCLA Loneliness Scale. Multinomial logistic regression models were conducted to examine the factors associated with the discrepancy. RESULTS: Participants with fewer depressive symptoms and higher extraversion were associated with the only social isolation group and the only loneliness group rather than the group consisting of those who felt lonely with social isolation. In addition, lower neuroticism was associated with the only social isolation group. Participants with fewer depressive symptoms, lower neuroticism, and higher extraversion were more likely not to feel lonely even with social isolation, compared to feeling lonely even in the absence of isolation. CONCLUSIONS: Mental status and personality traits may be closely related to the discrepancy between social isolation and loneliness. This study suggests that incorporating social, mental, and psychological factors may be essential for interventions in social isolation and loneliness.

Mild Behavioral Impairment and Quality of Life in Community Dwelling Older Adults.

OBJECTIVES: Mild behavioral impairment (MBI) is a dementia risk indicator in older adults characterized by later-life emergent and persistent neuropsychiatric symptoms. Quality of life (QoL) is a multi-dimensional concept encompassing physical, spiritual, and emotional well-being. QoL aims to measure and quantify perceptions of individual health, well-being, standard of living, personal fulfillment, and satisfaction. As MBI symptoms may arise from early-stage neurodegenerative disease, MBI may contribute to declining QoL before dementia onset. In this study, we investigated the relationship between symptoms of MBI and QoL in older adults. METHODS: The sample comprised 1107 individuals aged ≥ 50 years from the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behavior, Function, and Caregiving in Aging (CAN-PROTECT). Multivariable linear regressions were used to model the associations between MBI symptom severity (exposure), measured using the MBI Checklist (MBI-C), and QoL (outcome) assessed by the EuroQol-5D (EQ-5D, higher score = poorer QoL) and the novel Quality of Life and Function Five Domain Scale (QFS-5) (QFS-5, lower score = poorer QoL). Covariates were age, sex, cognition, education, ethnocultural origin, marital status, employment status, high blood pressure, heart disease, and diabetes. Moderation analysis explored potential sex differences. A sensitivity analysis was performed removing anxiety/depression items from the EQ-5D score. RESULTS: Across the sample (mean age = 64.4 ± 7.2, 79.4% female) every 1-point increase in MBI-C score was associated with a 0.06-point standard deviation (SD) increase in EQ-5D score (95% confidence interval (CI): 0.05-0.06, p < 0.001) and 0.08 SD decrease in QFS-5 score (95% CI: -0.09 to -0.08, p < 0.001). Neither association depended on sex (p = 0.59 and p = 0.41, respectively). The association remained significant after removing anxiety/depression items from the EQ-5D score (ß = 0.04, 95% CI: 0.03- 0.04, p < 0.001). CONCLUSIONS: The study shows that MBI is associated with poorer QoL, independent of sex, on two QoL scales. We addressed depression/anxiety items in the EQ-5D as a potential confounder for the observed MBI-QoL association by conducting a sensitivity analysis that excluded those items from the EQ-5D total score and by employing a novel measure of QoL (QFS-5) that excludes psychiatric symptoms from measurement of QoL. Associations of MBI with the novel QFS-5 were similar to associations between MBI and the EQ-5D. Finding interventions to reduce the burden of MBI symptoms might improve quality of life.

Study of knee pain, fear of falling, and quality of life among community-dwelling older adults, Northern Thailand.

Fall is the leading cause of disability and mortality due to unintentional injury in older adults. The aim of this study was to determine the prevalence and risk factors associated with knee pain, fear of falling, and quality of life among community-dwelling older adults in Northern Thailand. A cross-sectional study was conducted among older adults aged 60 and over. A total of 369 participants were enrolled from April to May 2024. Oxford knee score, a short version of the Falls Efficacy Scale International (FES-I) and World Health Organization quality of life-BREF-Thai, was measured. The results showed that the mean age was 69.4 years and 47 (12.7%) had a history of falls in the previous year. The prevalence of fear of falling was 39.3% for low, 22.5% for moderate, and 38.2% for high concern. Age, marital status, alcohol, history of falls, hypertension, arthritis, and osteoporosis were associated with fear of falling. After adjusting to age, gender, body mass index, education, marital status, smoking, alcohol, history of falls, and chronic disease, osteoarthritis of the knee was positively associated with increasing fear of falling (ß: 0.361; p<0.001), while quality of life was negatively associated with fear of falling (ß: -0.064; p<0.011). In conclusion, the identified determinants of fear of falling among the elderly indicated the need for fear of falling prevention programs targeting not only individual lifestyles but also chronic diseases. This study provides useful information that might help to develop and adopt effective policies for fear of falling control in Thailand.

Self-management experiences in fall prevention among community-dwelling older adults in China: a descriptive qualitative study.

BACKGROUND: Falls are the most common injuries in older adults, and fall prevention is one of the primary measures to achieve healthy aging. Self-management refers to the measures taken by individuals to avoid various adverse factors and health damage to protect and promote their health. This study aimed to explore the factors and measures of self-managed fall prevention among community-dwelling older adults. METHODS: A qualitative study based in two communities under the jurisdiction of Ninghua Street and Shanghai Street was conducted in Fuzhou, China. Semi-structured and face-to-face individual interviews were conducted with 15 community-dwelling older adults. Interviews were conducted by the first and second authors who had participated in qualitative training and were audio-recorded and transcribed. The data were analysed deductively with content analysis. RESULTS: The research revealed two themes with associated sub-themes: 1) influencing factors of self-managed fall prevention, and 2) promoting self-managed measures to prevent falls. CONCLUSIONS: Individual, social support, community advocacy, and road condition influenced self-managed fall prevention. Active exercise, adjusting home environment and clothing, and multi-channel acquisition of self-managed fall prevention knowledge can reduce the incidence of falls among older adults. Identifying these experiences will help older adults improve their awareness of preventing falls, take responsibility for themselves, and reduce the incidence of falls. TRIAL REGISTRATION: Chinese Clinical Trial Register: ChiCTR2200060705; reg. date: June 8, 2022.

Prevalence and potential influencing factors for social frailty among community-dwelling older adults: a systematic review and meta-analysis.

OBJECTIVE: To explore the prevalence and potential influencing factors of social frailty among community-dwelling older adults from a global perspective. METHODS: Systematic searches were conducted on multiple databases including CNKI, VIP, Wanfang Data, CBM, Pubmed, Cochrane Library, Web of Science, and Embase from inception to January 9, 2024. Two researchers performed a thorough literature search, gathered data, and independently evaluated the quality of the articles. RESULTS: 2,426 literatures were examined, 45 were found to meet the specified criteria for inclusion, encompassing 314,454 participants. The combined prevalence of social pre-frailty and social frailty among community-dwelling older adults were found to be 34.5% and 21.1%, respectively. Depression, activities of daily living (ADL), physical inactivity, motor deficits, cognitive impairment, and physical frailty are potential risk factors. CONCLUSIONS: Social pre-frailty and social frailty are frequent challenges faced by older adults living in the community. The prevalence of these conditions has been on the rise in recent years, underscoring the importance of implementing effective interventions. Early identification and intervention for individuals at risk of social frailty are essential for promoting healthy and active aging globally.

Understanding resilience: Lifestyle-based behavioral predictors of mental health and well-being in community-dwelling older adults during the COVID-19 pandemic.

BACKGROUND: Changes in sleep, physical activity and mental health were observed in older adults during early stages of the COVID-19 pandemic. Here we describe effects of the COVID-19 pandemic on older adult mental health, wellbeing, and lifestyle behaviors and explore predictors of better mid-pandemic mental health and wellbeing. METHODS: Participants in the Adult Changes in Thought study completed measures of lifestyle behaviors (e.g., sleep, physical activity) and mental health and wellbeing both pre-pandemic during regular study visits and mid-pandemic via a one-time survey. We used paired t-tests to compare differences in these measures pre- vs. mid-pandemic. Using multivariate linear regression, we further explored demographic, health, and lifestyle predictors of pandemic depressive symptoms, social support, and fatigue. We additionally qualitatively coded free text data from the mid-pandemic survey for related comments. RESULTS: Participants (N = 896) reported significant changes in mental health and lifestyle behaviors at pre-pandemic vs. mid-pandemic measurements (p < 0.0001). Qualitative findings supported these behavioral and wellbeing changes. Being male, never smoking, and lower pre-pandemic computer time and sleep disturbance were significantly associated with lower pandemic depressive symptoms. Being partnered, female, never smoking, and lower pre-pandemic sleep disturbance were associated with higher pandemic social support. Pre-pandemic employment, more walking, less computer time, and less sleep disturbance were associated with less pandemic fatigue. Participant comments supported these quantitative findings, highlighting gender differences in pandemic mental health, changes in computer usage and physical activity during the pandemic, the value of spousal social support, and links between sleep disturbance and mental health and wellbeing. Qualitative findings also revealed additional factors, such as stresses from personal and family health situations and the country's concurrent political environment, that impacted mental health and wellbeing. CONCLUSIONS: Several demographic, health, and lifestyle behaviors appeared to buffer the effects of the COVID-19 pandemic and may be key sources of resilience. Interventions and public health measures targeting men and unpartnered individuals could promote social support resilience, and intervening on modifiable behaviors like sleep quality, physical activity and sedentary activities like computer time may promote resilience to fatigue and depressive symptoms during future community stressor events. Further research into these relationships is warranted.

Short-Term Coupling Associations Between State Loneliness and Cognitive Performance in Daily Life Among Older Adults.

OBJECTIVES: Despite extensive efforts to study individual differences in loneliness and neurocognitive health, little is known about how within-person changes in state loneliness relate to cognitive performance. This study addressed this gap by examining the association between within-person variation in state loneliness and cognitive performance assessed objectively in daily life. METHODS: Participants were 313 community-dwelling older adults (70-90 years) who reported momentary feelings of loneliness and completed smartphone-based cognitive tests 5 times daily for 14 consecutive days. Mobile cognitive tests assess visual associative memory, processing speed, and spatial memory. RESULTS: At the day level, average state loneliness levels were negatively related to cognitive performance on the same day and subsequent day. Consistent with the day-level analysis, momentary assessments of increased loneliness were consistently linked to worse cognitive performance on concurrent assessments. However, moments characterized by lower cognitive performance predicted higher levels of loneliness 3-4 hr later (next occasion), but not vice versa. DISCUSSION: The findings suggest a prospective association between loneliness and cognitive performance, with higher daily loneliness negatively associated with cognitive performance on the same day and predicting worse performance the following day. Notably, within a single day, lower cognitive performance at a given moment predicted elevated loneliness later in the day. This highlights a complex, reciprocal relationship-loneliness predicting and being predicted by cognitive performance depending on timescale.

Advance personal planning knowledge, attitudes, and participation amongst community-dwelling older people living in regional New South Wales, Australia: A cross-sectional survey.

BACKGROUND: Advance personal planning (APP) involves planning for future periods of incapacity, including making legal decisions and documents. APP ensures that a person's values and preferences are known and respected. This study aimed to examine knowledge of APP, attitudes and confidence towards APP, and participation in APP activities among older people residing in regional and rural areas. METHODS: A cross-sectional survey was conducted with people aged over 65 years residing in and around regional towns in New South Wales, Australia. Participants responded to a social media advertisement or information provided through a community organisation. Data was collected via pen and paper survey or an online survey. The survey was developed for the study and included questions about the participant and their experiences with APP. Poisson regression modelling was conducted to explore the relationship between APP participation and APP knowledge, confidence and attitudes as well as the participant characteristics associated with APP participation. RESULTS: Overall, 216 people completed the survey. Most participants had a will (90%) but only a third (32%) had documented an advance care directive. Knowledge of APP was low with only 2.8% of participants correctly answering all 6 knowledge questions. Participants had a positive attitude towards APP and high level of confidence that they could discuss APP issues with important people in their life. Those with increased knowledge, confidence and attitude towards APP were significantly more likely to participate in APP activities. Older age and having private health insurance were significantly associated with engaging in APP activities. Increased frailty and the presence of health conditions were not associated with increased APP participation. CONCLUSIONS: There is a need to increase engagement with APP particularly among those who may be considered frail or have chronic health conditions. Increasing knowledge of, confidence and attitudes towards, APP could help to increase engagement in APP activities.

Exploring social activity patterns among community-dwelling older adults in South Korea: a latent class analysis.

BACKGROUND: With the trend of digitalization, social activities among the older population are becoming more diverse as they increasingly adopt technology-based alternatives. To gain a comprehensive understanding of social activities, this study aimed to identify the patterns of digital and in-person social activities among community-dwelling older adults in South Korea, examine the associated factors, and explore the difference in depressive symptoms by the identified latent social activity patterns. METHODS: Data were extracted from a nationwide survey conducted with 1,016 community-dwelling older adults (mean age 68.0 ± 6.5 years, 47.8% male). The main variables assessed were digital social activities (eight items), in-person social activities (six items), and depressive symptoms (20 items). Data were analyzed using latent class analysis, multinomial logistic regression, and multiple linear regression. RESULTS: We identified four distinct social activity patterns: "minimal in both digital and in-person" (22.0%), "moderate in both digital and in-person" (46.7%), "moderate in digital & very high in in-person" (14.5%), and "high in both digital and in-person" (16.8%). Younger age, living in multi-generational households, and higher digital literacy were associated with a higher likelihood of being in the "moderate in both digital and in-person" than the "minimal in both digital and in-person" group. Younger age, male, living in multi-generational households, residing in metropolitan areas, no dependency on IADL items, doing daily physical exercise, and higher digital literacy were associated with a higher likelihood of being in the "moderate in digital & very high in in-person" than the "minimal in both digital and in-person" group. Younger age, living in multi-generational households, no dependency on IADL items, doing daily physical exercise, and higher digital literacy were associated with a higher likelihood of being in the "high in both digital and in-person" than the "minimal in both digital and in-person" group. Depressive symptoms were significantly higher in the group with minimal engagement in both digital and in-person activities, compared to other three groups. CONCLUSIONS: This study highlights distinct patterns of social activities among Korean community-dwelling older adults. Since older adults with minimal social activity engagement can be more vulnerable to depressive symptoms, interventions that address modifiable attributes, such as supporting digital literacy and facilitating physical activity of older adults, could serve as potential strategies to enhance their social activity engagement and, consequently, their mental well-being.

Distinct impulsivity profiles in subtypes of violence among community-dwelling patients with severe mental disorders: a longitudinal study.

BACKGROUND: Although only a few patients with severe mental disorders (SMD) can commit violent behaviour in the community, violent behaviour aggravates the stigma towards patients with SMD. Understanding the subtypes of violent behaviour may be beneficial for preventing violent behaviour among patients with SMD, but it has rarely been studied. METHODS: This longitudinal study investigated 1914 patients with SMD in the community at baseline, and the follow-up period ranged from February 2021 to August 2021. The Barratt Impulsiveness Scale Version-11, the Buss-Perry Aggression Questionnaire, the Impulsive/Premeditated Aggression Scale, the Personality Diagnostic Questionnaire and the MacArthur Community Violence Instrument were used at baseline. The Modified Overt Aggression Scale was used to assess the occurrence of violent behaviour (outcome) during the follow-up period. Cox regression models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Latent class analysis was used to characterise the subtypes of patients with SMD who engaged in violent behaviour at follow-up. RESULTS: We found that 7.2% of patients with SMD presented violent behaviour within six months in the community. Younger age (OR = 0.98, 95% CI = 0.96-1.00, p = 0.016) and no economic source (OR = 1.60, 95% CI = 1.10-2.33, p = 0.014) were risk factors for violent behaviour. Patients with SMD who engaged in violent behaviour could be classified into three subtypes: one class characterised by a history of violence and impulsivity, another class characterised by high levels of aggression and motor impulsivity, and the last class characterised by median cognitive impulsivity. CONCLUSIONS: Socio-demographic factors were risk factors for violent behaviour among patients with SMD, which could eliminate the discrimination toward this group. Impulsivity played a vital role in identifying the three subtypes of patients with SMD who engaged in violent behaviour. These findings may be helpful for the development of a personalised violence risk management plan for patients with SMD who commit violent behaviour in the community.

Does Escalating Violence and Associated Fear of Crime Worsen Psychological Well-Being in Community Dwellers Living in a Rural Setting? Results From the Atahualpa Project Cohort.

BACKGROUND: Escalating street violence and criminal homicides have an adverse impact on psychological well-being. However, these consequences have been difficult to evaluate. Using a recently validated scale, we aimed to assess the impact of fear of crime on the psychological status of middle-aged and older adults living in a rural setting afflicted by endemic violence. METHODS: Participants were selected from Atahualpa residents included in previous studies targeting psychological distress in the population. A validated scale was used to objectively quantify fear of crime in participants. Differences in symptoms of depression and anxiety between baseline and follow-up were used as distinct dependent variables and the continuous score of the fear of crime scale was used as the independent variable. Linear regression models were fitted to assess the association between the exposure and the outcomes, after adjusting for relevant confounders. RESULTS: A total of 653 participants (mean age = 53.2 ± 11.5 years; 57% women) completed the requested tests. We found a 13% increase in symptoms of depression and anxiety during the peak of violence in the village compared with previous years. Linear regression models showed a significant association between the total score on the fear of crime questionnaire and worsening symptoms of depression (ß = .24; 95% CI = 0.14-0.35) and anxiety (ß = .31; 95% CI = 0.24-0.37), after adjustment for relevant confounders. CONCLUSIONS: This study shows a significant aggravating effect of fear of crime on pre-existing symptoms of depression and anxiety and a deleterious effect of these conditions on overall well-being.

Biopsychosocial factors of depression among community-dwelling geriatric population with low perceived social support; a population-based study.

BACKGROUND: Although significant and disabling consequences are presented due to geriatric population-related depression, an insufficient comprehension of various biological, psychological, and social factors affecting this issue has been observed. Notably, these factors can contribute to geriatric population-related depression with low social support. This study aimed to identify factors associated with depression among the community-dwelling geriatric population with low social support in Malaysia. METHODS: This study used secondary data from a population-based health survey in Malaysia, namely the National Health Morbidity Survey (NHMS) 2018: Elderly Health. The analysis included 926 community-dwelling geriatric population aged 60 and above with low social support. The primary data collection was from August to October 2018, using face-to-face interviews. This paper reported the analysis of depression as the dependent variable, while various biological, psychological and social factors, guided by established biopsychosocial models, were the independent variables. Multiple logistic regression was applied to identify the factors. Analysis was performed using the complex sampling module in the IBM SPSS version 29. RESULTS: The weighted prevalence of depression among the community-dwelling geriatric population aged 60 and above with low social support was 22.5% (95% CI: 17.3-28.7). This was significantly higher than depression among the general geriatric Malaysian population. The factors associated with depression were being single, as compared to those married (aOR 2.010, 95% CI: 1.063-3.803, p: 0.031), having dementia, as opposed to the absence of the disease (aOR 3.717, 95% CI: 1.544-8.888, p: 0.003), and having a visual disability, as compared to regular visions (aOR 3.462, 95% CI: 1.504-7.972, p: 0.004). The analysis also revealed that a one-unit increase in control in life and self-realisation scores were associated with a 32.6% (aOR: 0.674, 95% CI: 0.599-0.759, p < 0.001) and 24.7% (aOR: 0.753, 95% CI: 0.671-0.846, p < 0.001) decrease in the likelihood of developing depression, respectively. CONCLUSION: This study suggested that conducting depression screenings for the geriatric population with low social support could potentially prevent or improve the management of depression. The outcome could be achieved by considering the identified risk factors while implementing social activities, which enhanced control and self-fulfilment.