Meeting the WHO Physical Activity Guidelines is Associated With Lower Odds of Depression in Older Adults: Potential Psychosomatic Mechanisms.

OBJECTIVES: Limited data exist on the association between physical activity (PA) and depression in older adults from low- and middle-income countries (LMICs). In this study, we examine the association between meeting the World Health Organization (WHO) PA guidelines and depression in adults aged ≥50 years in Ghana and investigate the psychosomatic factors explaining this association. METHODS: Cross-sectional data from the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study in Ghana (2016-18) were analyzed. Depression was assessed with the Center for Epidemiological Studies Depression Scale (CES-D-10). PA was assessed using the International Physical Activity Questionnaire Short Form (IPAQ-SF). Multivariable logistic regression and Hayes PROCESS macro with bootstrapping mediation analyses were performed to evaluate the hypothesized associations. RESULTS: The study included 1201 individuals (mean [SD] age 66.1 [11.9] years; 63.3% women). The prevalence of meeting PA guidelines and depression was 36.7% and 29.5%, respectively. Meeting the WHO-recommended PA guidelines was associated with a 16% lower rate of developing depression even after adjusting for potential confounders (OR = 0.84, p <0.001). This association was much stronger among men and those aged 50-64 years. Loneliness, social isolation, sleep problems, functional limitations, and pain characteristics largely mediated the association of PA with depression. CONCLUSIONS: PA was negatively associated with depression among older adults in Ghana, and psychosocial and physical factors partially explained the association. The promotion of PA in old age may aid in the prevention of depression, especially in men and those aged 50-64 years. Longitudinal data may confirm our findings.

Factors associated with institutionalization among the oldest old: Results based on the nationally representative study 'old age in Germany (D80+)'.

OBJECTIVES: To examine the factors associated with institutionalization among individuals aged 80 years and over in Germany (total sample and stratified by sex). METHODS/DESIGN: We used data from the nationally representative 'Old Age in Germany (D80+)' (analytic sample: n = 9572 individuals), including individuals aged 80 years and over in Germany. Institutionalization (private living vs. institutionalization) served as an outcome measure. For the written interview, data collection took place from November 2020 to April 2021. Multiple logistic regressions of the overall sample (also stratified by sex) were applied. RESULTS: In the analytic sample, 10.2% (95% CI: 9.2%-11.3%) of the participants were institutionalized. The odds of being institutionalized were positively associated with being female (OR: 2.02, 95% CI: 1.08 to 3.80), being 90 years and over (compared to 80-84 years, OR: 1.67, 95% CI: 1.17 to 2.40), not being married (e.g., being single compared to being married: OR: 14.06, 95% CI: 6.73 to 29.37), higher education (e.g., high education compared to low education: OR: 1.88, 95% CI: 1.25 to 2.84), more favorable self-rated health (OR: 1.32, 95% CI: 1.07 to 1.62) and greater functional impairment (OR: 15.34, 95% CI: 11.91 to 19.74). Sex-stratified regressions were also conducted, mostly yielding similar results. CONCLUSION: Our study highlighted the role of several sociodemographic factors (particularly marital status, e.g., being single) and functional impairment for the risk of institutionalization among the oldest old in Germany. This study confirms findings in studies in younger samples that functional decline is the main factor associated with institutionalization. As functional decline may be modifiable, efforts to maintain functional abilities may be important. This knowledge is important for relevant groups (such as clinicians and policy-makers) because it may guide early intervention and prevention efforts, can help allocate healthcare resources effectively and shape policies to support independent living. Further insights using longitudinal data is recommended.

The effect of depressive symptoms on quality of life and its different facets in the oldest age population: evidence from the AgeQualiDe prospective cohort study.

PURPOSE: The present study aims to investigate the prospective effect of depressive symptoms on overall QoL in the oldest age group, taking into account its different facets. METHODS: Data were derived from the multicenter prospective AgeCoDe/AgeQualiDe cohort study, including data from follow-up 7-9 and n = 580 individuals 85 years of age and older. Overall QoL and its facets were assessed using the WHOQOL-OLD instrument. The short form of the geriatric depression scale (GDS-15) was applied to assess depressive symptoms. Cognitively impaired individuals were excluded. Linear mixed-effects models were used to assess the effect of depressive symptoms on QoL. RESULTS: Depressive symptoms were significantly associated with overall QoL and each of the different facets of WHOQOL-OLD, also after adjustment for time and sociodemographic characteristics such as age, gender, education, marital status, living situation, and cognitive status. Higher age and single as well as divorced marital status were also associated with a lower QoL. CONCLUSION: This work provides comprehensive longitudinal results on the relationship between depressive symptoms and QoL in the oldest age population. The results underscore the relevance of tailored and targeted care planning and the development of customized interventions.

How do individuals rate their health compared to others? findings based on a nationally representative sample in Germany.

BACKGROUND: The aim of this study is to explore the determinants of health comparisons (i.e., how individuals rate their health compared to other individuals in their age bracket) in the general adult population (total sample and in different age groups). METHODS: Data were used from the general adult population in Germany (wave 46, n = 3,876 individuals; November 2021 to January 2022), based on the GESIS panel, which is a probability-based mixed-mode panel. Health comparisons were used as outcome measure. Socioeconomic, lifestyle-related and health-related determinants were included in regression analysis. Robustness checks were conducted. RESULTS: Regressions showed that more favorable health comparisons were associated with being male (among individuals up to 39 years), higher age (among the total sample), higher education (among the total sample and individuals up to 39 years), higher income (among the total sample and individuals aged 40 to 64 years), not "being married, and living together with a spouse" (among the total sample), never eating meat (among the total sample, individuals up to 39 years and particularly individuals aged 40 to 64 years), drinking alcohol (among the total sample, individuals aged 40 to 64 years and individuals aged 65 years and over), a higher frequency of sports activities (all groups) and a higher satisfaction with health (also in all groups). CONCLUSION: In addition to the evident link between health satisfaction and health comparisons, regression analysis revealed that certain socioeconomic factors, such as a higher income level, along with positive lifestyle-related factors - especially among middle-aged individuals - were significantly associated with more positive health comparisons. This knowledge is required in order to support individuals at risk for negative health comparisons. This is important because negative health comparisons can contribute to poor well-being and poor health outcomes.

Pain: its prevalence and correlates among the oldest old.

BACKGROUND: There is very limited knowledge regarding pain among the oldest old. AIMS: To investigate the prevalence and correlates of pain among the oldest old. METHODS: Data were taken from the "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)", including individuals living in North Rhine-Westphalia aged 80 years and over. Pain was categorized as no pain, moderate pain and severe pain. Its prevalence was stratified by sex, age groups, marital status, place of residence and education. A multinomial logistic regression analysis was conducted. RESULTS: 28.50% of the participants reported no pain, 45.06% moderate pain and 26.44% severe pain. Regressions showed that being 85 years or older and a better self-rated health status decreased the likelihood of moderate pain. Being 85-89 years old, being male, highly educated and a better self-rated health status decreased the likelihood of severe pain. The likelihood of moderate and severe pain increased with a higher number of chronic diseases. DISCUSSION: Study findings showed a high prevalence of pain in the oldest old living in North Rhine-Westphalia, Germany. The likelihood of having moderate or severe pain was reduced among those who were older and presented with a better self-rated health but increased with a growing number of comorbidities. Severe pain was less likely among men and those with a higher education. CONCLUSION: This cross-sectional representative study adds first evidence of prevalence and correlations of pain among the oldest old. Longitudinal studies are required to further explore the determinants of pain in this age group.

Prevalence and factors associated with probable depression among the oldest old during the Covid-19 pandemic: evidence from the large, nationally representative 'Old Age in Germany (D80+)' study.

BACKGROUND: To date, most studies examining the prevalence and determinants of depression among individuals aged 80 and over have used geographically limited samples that are not generalisable to the wider population. Thus, our aim was to identify the prevalence and the factors associated with probable depression among the oldest old in Germany based on nationally representative data. METHODS: Data were taken from the nationally representative 'Old Age in Germany (D80+)' study (n = 8386; November 2020 to April 2021) covering both community-dwelling and institutionalised individuals aged 80 and over. The Short Form of the Depression in Old Age Scale was used to quantify probable depression. RESULTS: Probable depression was found in 40.7% (95% CI: 39.5% to 42.0%) of the sample; 31.3% were men (95% CI: 29.7% to 32.9%) and 46.6% women (95% CI: 44.9% to 48.3%). The odds of probable depression were positively associated with being female (odds ratio (OR): 1.55, 95% CI: 1.30 to 1.84), being divorced (compared to being married, OR: 1.33, 95% CI: 1.01 to 1.76), being widowed (OR: 1.14, 95% CI: 1.00 to 1.30), having a low education (e.g., medium education compared to low education, OR: 0.86, 95% CI: 0.74 to 0.99), living in an institutionalised setting (OR: 2.36, 95% CI: 1.84 to 3.02), living in East Germany (OR: 1.21, 95% CI, 1.05 to 1.39), not having German citizenship (German citizenship compared to other citizenship, OR: 0.55, 95% CI: 0.31 to 0.95), poor self-rated health (OR: 0.31, 95% CI: 0.28 to 0.34), and the number of chronic conditions (OR: 1.12, 95% CI: 1.09 to 1.14). CONCLUSION: About four out of 10 individuals aged 80 and over in Germany had probable depression, underlining the importance of this challenge. Knowledge of specific risk factors for this age group may assist in addressing older adults at risk of probable depression.

Sleep and Happiness in Urban-Dwelling Older Adults in Ghana: A Serial Multiple Mediation Model of Generalized Anxiety and Depressive Symptoms.

OBJECTIVE: Sleep problems (SP) are highly prevalent and seriously affect health and well-being in old age. The aim of this study was to examine the association between SP and happiness in an urban-dwelling older sample. The authors further explore the effects of generalized anxiety and depressive symptoms in the SP-happiness link using serial mediating modeling. METHODS: Data came from the 2016 to 2018 Aging, Health, Psychological Well-being, and Health-seeking Behavior Study in Ghana (n = 661). The authors measured happiness with the cross-culturally validated item on a five-point scale. The GAD-7 and the CESD-8, respectively, assessed generalized anxiety and depressive symptoms. Participants reported nighttime and daytime SP in the last 30 days. The SPSS-based Hayes' PROCESS macro program (Model 6) was constructed to quantify the hypothesized mediation effect. RESULTS: The analysis included 661 adults aged greater than or equal to 50 years (mean age = 65.53 [SD] = 11.89 years; 65.20% women). After full adjustment, path models showed that SP was negatively associated with happiness (ß = -0.1277, 95%CI = -0.15950 to -0.096). Bootstrapping estimates revealed that the SP-happiness link was serially mediated via generalized anxiety representing 8.77%, depressive symptoms yielding 18.95%, and anxiety symptoms→depressive symptoms accounting for 26.70% of the total effect. CONCLUSION: Generalized anxiety and depressive symptoms may explain the negative association between SP and happiness in urban-dwelling older adults in the sub-Saharan African (SSA) context. Interventions, social and clinical, to improve happiness through sleep quality should include ways to improve mental health. Longitudinal and cross-cultural data are warranted to assess the bi-directionality of this relationship.

Community centers for older adults and psychosocial factors: Evidence from the German Ageing Survey.

INTRODUCTION: There is a dearth of studies examining the association between the use of community centers for older adults and psychosocial factors. Thus, our aim was to examine the association between the use of community centers for older adults and psychosocial factors (in terms of loneliness, perceived social isolation, and life satisfaction; also stratified by sex)-which is important for successful aging. METHODS/DESIGN: Data were taken from a nationally representative sample-the German Ageing Survey-including older community-dwelling individuals. The De Jong Gierveld tool was used to measure loneliness, the Bude and Lantermann tool was used to measure perceived social isolation, and the Satisfaction with Life Scale was used to quantify life satisfaction. Multiple linear regressions were used to evaluate the hypothesized associations. RESULTS: In the analytical sample, n equaled 3246 individuals (mean age was 75 years, 65-97 years). After adjusting for various socioeconomic, lifestyle-related, and health-related covariates, multiple linear regressions showed that the use of community centers was associated with higher life satisfaction among men (ß = 0.12, p < 0.01), but not women. The use of community centers was not associated with loneliness or perceived social isolation for either gender. CONCLUSIONS: The use of community centers was positively associated with satisfaction with one's own life among male older adults. Thus, encouraging older men to use such services may be beneficial. This quantitative study provides an initial basis for further research in this neglected area. For example, longitudinal studies are required to confirm our present findings.

Determinants of psychosocial factors amongst the oldest old: Longitudinal evidence based on the representative "survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia".

OBJECTIVES: There are few studies investigating the determinants of psychosocial outcomes using data exclusively from the oldest old; and even fewer that use longitudinal data. Thus, our aim was to explore the determinants of psychosocial factors (in terms of life satisfaction, loneliness, and depressive symptoms) amongst the oldest old (also stratified by sex) based on representative, longitudinal data from Germany. METHODS/DESIGN: Data from "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)" were used. This study includes community-dwelling and institutionalized individuals aged 80 years and above (n = 1760 observations in the analytical sample) located in North Rhine-Westphalia (the most populous state in Germany). The mean age was 86.6 years (SD: 4.3 years). Established instruments were used to quantify life satisfaction, loneliness, and depressive symptoms. Linear FE regressions were used in this study to mitigate the challenge of unobserved heterogeneity. Sex-stratified regressions were also conducted. RESULTS: Regressions showed that the loss of a spouse was significantly associated with worsening psychosocial factors (in terms of increases in depressive symptoms and loneliness). Furthermore, regressions revealed that increases in functional impairment were significantly associated with poorer psychosocial outcomes. CONCLUSIONS: This longitudinal study enhanced our understanding of the factors contributing to poorer psychosocial outcomes among the oldest old. Efforts to avoid or postpone functional impairment may contribute to more favorable psychosocial outcomes. Moreover, our current study underlines the importance of spousal relationships for psychosocial outcomes in the oldest age group.

Health-related quality of life in seven European countries throughout the course of the COVID-19 pandemic: evidence from the European COvid Survey (ECOS).

PURPOSE: To investigate health-related quality of life (HRQoL) over the course of the COVID-19 pandemic in seven European countries and its association with selected sociodemographic as well as COVID-19-related variables. METHODS: We used longitudinal data from nine quarterly waves collected between April 2020 and January 2022 (sample size per wave ranging from N = 7025 to 7300) of the European COvid Survey (ECOS), a representative survey of adults in Germany, United Kingdom, Denmark, Netherlands, France, Portugal and Italy. HRQoL was measured using the EQ-5D-5L. The association of self-reported COVID-19 infection, perceived health risk from COVID-19, selected sociodemographic variables and the COVID-19 stringency index with HRQoL was analyzed by logistic and linear fixed effects regressions. RESULTS: On average across all nine waves, the proportion of respondents reporting any problems in at least one of the EQ-5D dimensions ranged between 63.8% (Netherlands) and 71.0% (Denmark). Anxiety/depression was the most frequently affected EQ-5D dimension in four countries (Portugal: 52.0%; United Kingdom: 50.2%; Italy: 49.2%; France: 49.0%), whereas pain/discomfort ranked first in three countries (Denmark: 58.3%; Germany: 55.8%; Netherlands: 49.0%). On average across all nine waves, the EQ-VAS score ranged from 70.1 in the United Kingdom to 78.4 in Portugal. Moreover, the EQ-5D-5L index ranged from .82 in Denmark to .94 in France. The occurrence of COVID-19 infection, changes in the perceived risk to one's own health from COVID-19, the occurrence of income difficulties and an increase in the COVID-19 stringency index were associated with increased likelihood of problems in EQ-5D dimensions, reduced EQ-VAS score and reduced EQ-5D-5L index. CONCLUSIONS: Across seven European countries, we found large proportions of respondents reporting problems in HRQoL dimensions throughout the pandemic, especially for anxiety/depression. Various sociodemographic and COVID-19-related variables were associated with HRQoL in longitudinal analysis.

Determinants of health-related quality of life (HRQoL) among homeless individuals during the COVID-19 pandemic.

OBJECTIVE: Thus far, there is very limited knowledge regarding homeless individuals during the COVID-19 pandemic, particularly related to the health-related quality of life (HRQoL). Thus, our aim was to evaluate HRQoL and to clarify the determinants of HRQoL among homeless individuals during the COVID-19 pandemic in Germany. METHODS: Data were taken from the national survey on psychiatric and somatic health of homeless individuals during the COVID-19 pandemic-NAPSHI (n = 616). The established EQ-5D-5L was used to quantify problems in five health dimensions, and its visual analogue scale (EQ-VAS) was used to record self-rated health status. Sociodemographic factors were included in regression analysis. RESULTS: Pain/discomfort was the most frequently reported problem (45.3%), thereafter anxiety/depression (35.9%), mobility (25.4%), usual activities (18.5%) and self-care (11.4%). Average EQ-VAS score was 68.97 (SD: 23.83), and the mean EQ-5D-5L index was 0.85 (SD: 0.24). Regressions showed that higher age and having a health insurance were associated with several problem dimensions. Being married was associated with higher EQ-VAS scores. CONCLUSIONS: Overall, our study findings showed a quite high HRQoL among homeless individuals during the COVID-19 pandemic in Germany. Some important determinants of HRQoL were identified (e.g., age or marital status). Longitudinal studies are required to confirm our findings.

Gender Differences in Mental Health, Quality of Life, and Caregiver Burden among Informal Caregivers during the Second Wave of the COVID-19 Pandemic in Germany: A Representative, Population-Based Study.

INTRODUCTION: This study aimed to compare the mental health, quality of life, and caregiving burden between male and female informal caregivers of older adults (≥60 years) during the second wave of the COVID-19 pandemic in Germany. METHODS: The sample consisted of 301 female and 188 male informal caregivers of older adults in need of care (≥60 years). Data were used from a cross-sectional study in March 2021 that questioned a representative sample of adults aged 40 years and older from Germany. Information on informal care provision, mental health (depressive and anxiety symptoms), caregiving burden, and quality of life was assessed for the period between December 2020 and March 2021. Regression analyses, adjusted for (1) the sociodemographic background and health of the caregivers, (2) the caregiving time and caregiving tasks, and (3) the perception of impairment and danger posed by the pandemic, were conducted. RESULTS: Findings of the fully adjusted model indicated a higher level of anxiety and lower quality of life among female caregivers, compared to male caregivers. Gender differences in depression and caregiver burden were not significant in analyses that controlled for care tasks and time. Moderator analyses indicated that gender differences in caregiver's anxiety levels were influenced by the danger perceived to be posed by the pandemic: among men the danger to the care recipient, and among women the danger to themselves, increased anxiety. CONCLUSION: Female informal caregivers were more negatively affected than male informal caregivers during the pandemic, as indicated by higher levels of anxiety and lower quality of life. Gender differences in anxiety depended on the perceived danger posed by the pandemic. Thus, policy and pandemic measures should focus on gender-specific support of female caregivers who seem to be particularly vulnerable during the pandemic. More caregiver-specific support and information around protecting themselves and their care recipients are recommended. Also, further research on gender differences in care performance and their relation to psychosocial health outcomes is recommended.

Can Informal Caregiving be Perceived as Rejuvenating? Changes in Perceptions of Ageing at Onset and End of Informal Caregiving during Different Stages of Life.

INTRODUCTION: Perceptions of ageing are a central predictor of health, wellbeing, and longevity. This study analyses the association between the onset and end of informal caregiving and perceptions of ageing in different stages of life. METHODS: Data from the German Aging Survey (2014, 2017) were used; a longitudinal dataset that is representative of community-dwelling individuals aged ≥40 years in Germany. Adjusted asymmetric fixed effects regression analyses were conducted to analyse the associations in three age groups (40 to <60, 60 to <80, and ≥80). Perceptions of ageing were measured in terms of attitude towards one's own ageing (Philadelphia Geriatric Centre Morale Scale), subjective age (felt age), and onset of old age (when someone is considered to be old). RESULTS: Significant changes in the perceptions of ageing were found only among individuals aged ≥80 years. In this group, the onset of informal caregiving was significantly associated with improved attitude towards one's own ageing and the end of informal caregiving was significantly associated with increased subjective age and earlier onset of old age. CONCLUSION: The perceptions of ageing improved with the onset and worsened with end of caregiving - but only among oldest old individuals. Thus, informal caregiving seems to be a significant predictor for perceptions of ageing in old age.

Changes in Network Size, Quality, and Composition among Informal Caregivers in Different Welfare Clusters: Longitudinal Analyses Based on a Pan-European Survey (SHARE).

INTRODUCTION: This study analyzed the association between transitions into informal caregiving, inside and outside their own household, and changes in network size, quality, and composition among older adults (≥50 years) in four different welfare systems in Europe. METHODS: Data from waves 4, 6, and 8 of the Survey of Health, Ageing and Retirement in Europe was used and included up to 110,823 participants (aged ≥50 years) from 12 countries. Participants were asked about informal caregiving inside and outside the household and their network size, quality (emotional closeness, contact frequency), and composition (family, friends, men, women). Adjusted linear and Poisson fixed effects regression analyses were conducted. RESULTS: Participants transitioning into any caregiving (inside or outside the household) had a larger network. More women and family members were found among all those transitioning into caregiving, but only outside caregiving was associated with more men and friends in the network. Transitioning into caregiving outside was associated with reduced network closeness and contact. Changes among caregivers outside were similar in all welfare states but were more pronounced among caregivers inside the household of Eastern Europe. CONCLUSION: Different patterns of changes in network size, quality, and composition were found among adults transitioning into caregiving inside and outside the household. All parameters changed among caregivers outside the household. However, the welfare system played a key role in the network changes among inside household caregivers. Thus, the micro as well as the macro context of caregiving is important for the support network of informal caregivers.

Wishing for an end? Longitudinal analysis of suicidal ideation among informal caregivers inside and outside their household in different welfare systems of Europe.

OBJECTIVE: This study examines whether transition to caregiving within or outside the household is associated with changes in suicidal ideation and whether this depends on the type of caregiver relationship, the age or gender of the caregiver, or the welfare system. DESIGN: Longitudinal study. SETTING: Ten European countries. PARTICIPANTS: Data from the Survey of Health, Ageing, and Retirement in Europe were used (waves 1, 2, 4, 5, and 6) including participants aged ≥40 years (pooled Observations = 171,848). MEASUREMENTS: Suicidal ideation was measured using the Euro-D scale. Caregiving was measured as care inside and outside the household, and for different recipients. Fixed effects logistic regression analyses, adjusted for health and sociodemographic factors, were used. RESULTS: Transitioning into caregiving inside the household was associated with higher odds of suicidal ideation, in particular if they transitioned into care for partners or parents and within Southern and Bismarckian welfare systems. Transitioning into caregiving outside the household was not associated with suicidal ideation, except among those transitioning into caregiving for non-relatives (higher odds of suicidal ideation), and among male and older caregivers (lower odds of suicidal ideation). Suicide ideation was higher among caregivers in Southern compared to Bismarckian or Scandinavian welfare systems. CONCLUSION: Informal caregiving is associated with suicidal ideation among caregivers inside but not among all caregivers outside the household. The caregiver's characteristics, the care relationship, and the welfare system play an important role. Preventing suicidal ideation requires interventions that focus on informal caregivers and consider their individual and contextual factors.

Do sexual minorities believe that they die earlier? Results from a large, representative survey.

BACKGROUND: While various consequences of belonging to sexual minorities have been examined - it remains completely unclear whether sexual minorities believe that they die earlier. Thus, our aim was to investigate the association between sexual orientation and expected longevity. METHODS: Data from the German Ageing Survey, a nationally representative sample, were used (year 2014, n = 6,424 individuals; mean age: 63.6 years). It included individuals residing in private households aged 40 years and over in Germany. Sexual orientation (heterosexual; sexual minorities including homosexual, bisexual, or other) served as key independent variable. As outcome, we used the expected life expectancy. In multiple linear regressions it was adjusted for gender, age, education, marital status, labour force participation, BMI, smoking status, alcohol intake, sports activities, physical functioning, self-rated health and the number of chronic conditions. RESULTS: Adjusting for sociodemographic, lifestyle-related and health-related factors, our study showed that sexual minorities reported a lower expected longevity (ß=-0.69, p = .02) compared to heterosexuals. This association remained nearly the same in robustness checks. CONCLUSION: After adjusting for various other factors, our findings showed a lower life expectancy among sexual minorities compared to heterosexuals. Efforts are required to make sexual minorities believe in a high life expectancy (e.g., increased optimism or reduced perceived discrimination) - which in turn can help to increase their actual longevity and successful ageing. Future research is required to explore underlying mechanisms (such as expected stigma in later life).

Associations between changes in physical activity and perceived social exclusion and loneliness within middle-aged adults - longitudinal evidence from the German ageing survey.

BACKGROUND: Previous research showed negative associations between physical activity and loneliness in older adults. However, information on associations among middle-aged adults is scarce. In this prognostic factor study, we investigated if starting or stopping to follow the WHO physical activity recommendations was associated with changes in perceived social exclusion and loneliness in this age bracket. METHODS: We used longitudinal representative data of participants aged 40 to 64 years from the German Ageing Survey waves in 2014 and 2017 (analytical sample = 4,264 observations, 54% women). Perceived social exclusion was investigated with the scale from Bude and Lantermann. Loneliness was quantified with the 6-items loneliness scale from De Jong Gierveld. Information from the International Physical Activity Survey items on the time spend in moderate and vigorous physical activity per week was dichotomized. Participants were coded as either following or not following the WHO´s physical activity recommendations of spending at least 150 min of moderate, 75 min of vigorous or an appropriated combination of physical activity per week. We investigated the within (individual) association between starting and stopping to follow WHO´s physical activity recommendations and perceived social exclusion as well as loneliness in asymmetric fixed effects regressions. Analyses were adjusted for age, marital status, employment status, social-network size, general self-efficacy, depressive symptoms, self-rated health, BMI, comorbidities, and physical functioning (SF-36). RESULTS: Stopping to follow the physical activity recommendations from the WHO was associated with perceived social exclusion (ß= 0.09 p = 0.04) but not with loneliness (ß=-0.01, p = 0.71). Starting to follow the WHO physical activity recommendations was neither associated with social exclusion (ß=-0.02, p = 0.54) nor with loneliness (ß=-0.01, p = 0.74) in adjusted asymmetric fixed effects regressions. CONCLUSION: In middle-aged adults, longitudinal associations were found for physical activity and perceived social exclusion. Perceived social exclusion may be prevented by maintaining at least 150 min of moderate physical activities per week, which is the WHO physical activity recommendation. Future research should investigate moderators and mediators in the association between physical activity and social exclusion as well as loneliness.

Are transgender people satisfied with their lives?

BACKGROUND: Our goal was to examine the proportion of transgender people satisfied with their lives (i.e., cognitive evaluation of life as a whole) and the determinants of life satisfaction level among transgender individuals. METHODS: Data were taken from the HH-TPCHIGV study. Included were 104 transgender people who had joined self-help groups to get and share information about the gender-affirming surgeries performed at the Division of Plastic, Reconstructive and Aesthetic Surgery at the University Medical Center Hamburg-Eppendorf. The established Satisfaction with Life Scale was used to quantify life satisfaction. Sociodemographic-, lifestyle-related and health-related determinants were included in multiple linear regressions. In regression analysis, life satisfaction served as outcome measure and in a robustness check ordered probit regressions were used. RESULTS: Among transgender people, 12.9% can be classified as "extremely dissatisfied", 18.3% can be classified as "dissatisfied", 12.9% can be classified as "slightly dissatisfied", 7.5% as "neutral", 30.1% as "slightly satisfied", 17.2% as "satisfied" and 1.1% as "extremely satisfied". Higher levels of life satisfaction were associated with higher age (ß = .15, p < .05), higher school education (ß = 5.54, p < .001), and favorable self-rated health (ß = 2.20, p < .001). CONCLUSIONS: Nearly half of the transgender people were at least "satisfied" with their lives. Knowledge about the correlates of life satisfaction may assist in addressing unsatisfied individuals.

Trajectories of generalized anxiety disorder, major depression and change in quality of life in adults aged 50 + : findings from a longitudinal analysis using representative, population-based data from Ireland.

PURPOSE: To investigate the longitudinal association between trajectories (incidence, remission) of generalized anxiety disorder (GAD), major depression (MD) and change in quality of life (QoL) in adults aged 50 + , and to assess the symmetry in these relationships using observational study data. METHODS: Data were derived from two waves of The Irish Longitudinal Study on Aging (2014-2015, wave 3: n = 6400; 2016, wave 4: n = 5715), a nationally representative cohort of community-dwelling adults aged 50 +. GAD and MD were assessed by means of the short form of the Composite International Diagnostic Interview. QoL outcomes were assessed using the Control, Autonomy, Self-realization, and Pleasure scale (CASP-12 with two domains control/autonomy and self-realization/pleasure). Covariate-adjusted, asymmetric fixed effects panel regressions and post-estimation Wald tests were used for statistical analysis. RESULTS: Regarding incident disorders, only incident MD was significantly associated with a reduction in QoL over time (control/autonomy domain: b = - 0.74, SE: 0.30). Regarding remission, both remission of MD (b = 0.61, SE: 0.20) and remission of GAD (b = 0.61, 0.26) were significantly associated with an increase in the self-realization/pleasure domain over time. Subsequent Wald tests of the estimates were not significant, indicating symmetric effects. CONCLUSION: Particularly the remission of GAD and MD was associated with a significant improvement in one of the QoL domains, indicating domain- and trajectory-specific differences. However, symmetric effects observed in this study indicate that gains and losses in QoL associated with remission and incidence of GAD and MD are of similar magnitude in adults aged 50 +.

Prevalence and correlates of loneliness and social isolation in the oldest old: a systematic review, meta-analysis and meta-regression.

PURPOSE: Conducting a systematic review, meta-analysis and meta-regression regarding the prevalence and correlates of loneliness and social isolation amongst the community-dwelling and institutionalised oldest old (80 years and over). METHODS: Three electronic databases (PsycINFO, CINAHL and Medline) were searched, including studies from inception to January 5, 2023. An additional hand search was conducted by checking included studies' references, and studies that cited included studies. We included observational studies describing the prevalence and (ideally) the correlates of loneliness, or social isolation, amongst individuals aged 80 years and over. Study design, operationalization of loneliness and social isolation, statistical analysis, characteristics of the sample and key findings were extracted. A random-effects meta-analysis was conducted. RESULTS: We included 22 studies. The estimated prevalence of severe loneliness was 27.1% (95% CI: 23.7-30.4%). The estimated prevalence of moderate loneliness equalled 32.1% (95% CI: 15.8-48.4%). Moreover, the estimated prevalence of social isolation was 33.6% (95% CI: 28.9-38.2%). There was heterogeneity between the studies. Egger tests suggest the absence of potential publication bias. Meta-regressions showed that the heterogeneity could neither be attributed to the assessment of loneliness nor to the continent where the study was conducted. CONCLUSION: Loneliness and social isolation are important problems in the oldest old. In this age group, studies are required, in particular from regions outside Europe. Additionally, longitudinal studies are required to investigate the determinants of loneliness and social isolation amongst individuals aged 80 years and over. Studies using more sophisticated tools to quantify loneliness and social isolation are required.