The role of social network structure and function in moderate and severe social and emotional loneliness: The Dutch SaNAE study in older adults.

Background: Loneliness is a serious public health problem. This became even more visible during the COVID-19 pandemic. Yet, the key social network aspects contributing to loneliness remain unknown. Here, we evaluated social network structure and function and associations with (moderate/severe) social and emotional loneliness in older adults. Methods: This cross-sectional study includes online questionnaire data (SaNAE cohort, August-November 2020), in independently living Dutch adults aged 40 years and older. For the separate outcomes of social and emotional loneliness, associations with structural social network aspects (e.g., network diversity - having various types of relationships, and density - network members who know each other), and functional social network aspects (informational, emotional, and practical social support) were assessed and risk estimates were adjusted for age, educational level, level or urbanization, comorbidities, and network size. Multivariable logistic regression analyses were stratified by sex. Results: Of 3396 participants (55 % men; mean age 65 years), 18 % were socially lonely which was associated with a less diverse and less dense network, living alone, feeling less connected to friends, not having a club membership, and fewer emotional supporters (men only) or informational supporters (women only). 28 % were emotionally lonely, which was associated with being socially lonely, and more exclusively online (versus in-person) contacts (men only), and fewer emotional supporters (women only). Conclusion: Network structure and function beyond the mere number of contacts is key in loneliness. Public health strategies to prevent loneliness in older adults should be sex-tailored and promote network diversity and density, club membership, informational and emotional support, and in-person contact.

How public trust and healthcare quality relate to blood donation behavior: Cross-cultural evidence.

Blood donors are indispensable for enabling a myriad of medical procedures and treatments. We examined how public trust in the healthcare system and healthcare quality relate to individuals' likelihood of donating blood, using survey data from representative samples of 28 European countries (N = 27,868). Our preregistered analyses revealed that country-level public trust, but not healthcare quality, predicted individual propensity to donate blood. Notably, public trust decreased over time in many countries, while healthcare quality increased. Our results highlight the role of subjective perceptions of the healthcare system, rather than the objective state of healthcare, for blood donation behavior in Europe.

The social contagion of prosocial behaviour: How neighbourhood blood donations influence individual donation behaviour.

Life-saving transfusions and numerous other medical treatments are enabled by a minority of people that donate blood. But why do some people repeatedly engage in such prosocial behaviour, especially when it is costly to themselves? This study examines to what extent social contagion within neighbourhoods - changing behaviour in response to the behaviour of others - affects repeated blood donation behaviour. We draw on longitudinal survey and register data from a representative sample of blood donors in the Netherlands from 2007 to 2014 (N = 15,090). Using a panel data model and an instrumental variable approach, we find that donors are positively affected by donations made by other donors living in their neighbourhood. This effect does not seem to be mediated by normative or informational social influence. Exploratory analysis further attributes this finding to social contagion within donor couples. Our study contributes to the literature on repeated blood donation behaviour, and can inform retention strategies of blood banks.

Did you donate? Talking about donations predicts compliance with solicitations for donations.

Many forms of prosocial behaviour are highly institutionalized. They are facilitated by organizations that broker between donors and recipients. A highly effective tool that organizations use to elicit prosocial behaviour are solicitations for donations (e.g., of blood, time, or money). Using register and survey data on blood donations in the Netherlands, we examine to what extent compliance with these solicitations is predicted by being recruited via word of mouth (WOM) and talking about donations. Our model predicts that donors that are one unit higher on our measure of talking about donations (range = 1-4) have a 2.9 percentage points higher compliance with solicitations for donations. In addition, this association is stronger for novice donors. Our study demonstrates the social embedding of the donors' decision-making processes about compliance. For practice, our results imply that organizations may increase their contributors' communication about donations to increase the effectiveness of their solicitations.

Longitudinal Aging Study Amsterdam COVID-19 exposure index: a cross-sectional analysis of the impact of the pandemic on daily functioning of older adults.

OBJECTIVES: The aim of this study was to develop an index to measure older adults' exposure to the COVID-19 pandemic and to study its association with various domains of functioning. DESIGN: Cross-sectional study. SETTING: The Longitudinal Aging Study Amsterdam (LASA), a cohort study in the Netherlands. PARTICIPANTS: Community-dwelling older adults aged 62-102 years (n=1089) who participated in the LASA COVID-19 study (June-September 2020), just after the first wave of the pandemic. PRIMARY OUTCOME MEASURES: A 35-item COVID-19 exposure index with a score ranging between 0 and 1 was developed, including items that assess the extent to which the COVID-19 situation affected daily lives of older adults. Descriptive characteristics of the index were studied, stratified by several sociodemographic factors. Logistic regression analyses were performed to study associations between the exposure index and several indicators of functioning (functional limitations, anxiety, depression and loneliness). RESULTS: The mean COVID-19 exposure index score was 0.20 (SD 0.10). Scores were relatively high among women and in the southern region of the Netherlands. In models adjusted for sociodemographic factors and prepandemic functioning (2018-2019), those with scores in the highest tertile of the exposure index were more likely to report functional limitations (OR: 2.24; 95% CI: 1.48 to 3.38), anxiety symptoms (OR: 3.14; 95% CI: 1.82 to 5.44), depressive symptoms (OR: 2.49; 95% CI: 1.55 to 4.00) and loneliness (OR: 2.97; 95% CI: 2.08 to 4.26) than those in the lowest tertile. CONCLUSIONS: Among older adults in the Netherlands, higher exposure to the COVID-19 pandemic was associated with worse functioning in the physical, mental and social domain. The newly developed exposure index may be used to identify persons for whom targeted interventions are needed to maintain or improve functioning during the pandemic or postpandemic.

How does long-term care impact the psychological wellbeing of older adults in different care policy contexts in the Netherlands?: A comparison of 1998, 2008 and 2018: A comparison of 1998, 2008 and 2018.

Receipt of long-term care (LTC) is generally associated with worse psychological wellbeing for community-dwelling older adults. In addition to objective features of care use (e.g. formal vs. informal care), the subjective evaluation of care provision in terms of perceived sufficiency might be particularly predictive of one's wellbeing but is seldomly considered in the literature. Substantial changes in the availability of long-term care in past decades raise the question to what extent these effects, if present, are consistent over historic time. The present study, therefore, aims at better understanding the associations between types of LTC use and perceived care sufficiency on psychological wellbeing in a changing LTC context in the Netherlands. Data from the Longitudinal Aging Study Amsterdam (LASA) were used from three points in time: 1998 (N = 582), 2008 (N = 459) and 2018 (N = 415). At each wave, participants were between 75 and 85 years of age and living independently. The results show that after adjusting for age, gender, education and health, using formal LTC had a negative effect on depressive symptoms only in 2018, but that this effect was not significantly worse compared to previous cohorts. Perceived care sufficiency was consistently negatively associated with depressive symptoms in all three points in time. This suggests that despite a less generous Dutch LTC system, psychological wellbeing among LTC users remains stable. Perceiving care provision as sufficient, however, can help older adults maintain psychological wellbeing and should be considered by researchers and policymakers that aim to improve care recipients' wellbeing.

Genetic Liability for Depression, Social Factors and Their Interaction Effect in Depressive Symptoms and Depression Over Time in Older Adults.

OBJECTIVES: The objectives of this study were to investigate the effect of genetic and social factors on depressive symptoms and depression over time and to test whether social factors moderate the relationship between depressive symptoms and its underlying genetics in later life. METHODS: The study included 2,279 participants with a mean follow-up of 15 years from the Longitudinal Aging Study Amsterdam with genotyping data. The personal genetic loading for depression was estimated for each participant by calculating a polygenic risk scores (PRS-D), based on 23,032 single nucleotide polymorphisms associated with major depression in a large genome-wide association study. Partner status, network size, received and given emotional support were assessed via questionnaires and depressive symptoms were assessed using the CES-D Scale. A CES-D Scale of 16 and higher was considered as clinically relevant depression. RESULTS: Higher PRS-D was associated with more depressive symptoms whereas having a partner and having a larger network size were independently associated with less depressive symptoms. After extra adjustment for education, cognitive function and functional limitations, giving more emotional support was also associated with less depressive symptoms. No evidence for gene-environment interaction between PRS-D and social factors was found. Similar results were found for clinically relevant depression. CONCLUSION: Genetic and social factors are independently associated with depressive symptoms over time in older adults. Strategies that boost social functioning should be encouraged in the general population of older adults regardless of the genetic liability for depression.

The Social Support-Health Link Unraveled: Pathways Linking Social Support to Functional Capacity in Later Life.

Objective: Despite evidence that social support is strongly related to health, very little is known about the mechanisms underlying this association. This study investigates whether physical activity, depressive symptoms, and chronic diseases mediate the associations between social support and functional capacity. Method: Data from the Longitudinal Aging Study Amsterdam on 954 participants, aged 75 and older, covering 9 years, are analyzed with latent growth mediation models. Results: Only the indirect path from the initial level of emotional support to the initial level of functional capacity through the initial level of depressive symptoms was significant. All mediators however were significantly associated with the level of and changes in functional capacity. Models with reversed pathways were estimated, but model fit was worse. Discussion: Because only initial levels of social support relate to functional capacity, and changes in social support do not, older adults likely receive the support they need.

Cohort Difference in Age-Related Trajectories in Network Size in Old Age: Are Networks Expanding?

OBJECTIVES: Contemporary societal views on old age as well as a rise in retirement age raise the question whether patterns of stability and/or decline in network size as found in earlier studies similarly apply to later birth cohorts of older adults. METHODS: Change score models are estimated to determine cohort differences in age-related trajectories in network size. Two birth cohorts (1928-37 and 1938-47, 55-64 at baseline in 1992 and 2002) of the Longitudinal Aging Study Amsterdam are followed across 4 observations over a time span of 9 years. RESULTS: Age-related trajectories in network size differ between the early and late birth cohort. The late birth cohort makes large gains in network size around retirement age, but this increase does not hold over time. Increased educational level and larger diversity in social roles relate to the cohort difference. Nonetheless, cohort difference prevails even after adjusting for these factors. DISCUSSION: The peak level in the network size in the late birth cohort hints at stronger preference and more opportunities to gain and maintain social relationships around retirement age in the current societal structure and culture. The subsequent drop-off in network size suggests that these ties are mostly used to adapt to the retirement transition.

Loneliness declines across birth cohorts: The impact of mastery and self-efficacy.

In the public debate and media, it has been suggested that there currently is a "loneliness epidemic" in Western societies. To shed light on this pressing issue we investigated whether age-related changes in loneliness found in early studies also pertain to later-born cohorts, and whether mastery and self-efficacy have become increasingly important for explaining differences in loneliness. We used data from the Longitudinal Aging Study Amsterdam. Observations were of 4,880 Dutch people aged 55 and older between 1992 and 2016. We employed multilevel regression analyses incorporating birth cohort while controlling for age. Older adults were less lonely in later-born cohorts, although the effect size was small (d = .11 at Age 65 comparing Cohorts 1918-1927 and 1948-1957; and d = .11 at Age 75 comparing cohorts 1908-1917 and 1938-1947). Furthermore, we found a sharp age-related increase in loneliness; older people were lonelier than younger people (d = .83 comparing Ages 75 and 95 in Cohort 1908-1917; and d = .21 comparing Ages 55 and 78 in Cohort 1938-1947). Age effects thus clearly outweigh cohort effects in size. Increasing levels of mastery and self-efficacy across birth cohorts explain the observed cohort-related decline in loneliness. Mastery contributes similar to the effect size of partner status in the explanation of differences in loneliness. We conclude that there is no evidence of a loneliness epidemic among later-born cohorts of older adults relative to earlier-born cohorts. Also, mastery and self-efficacy are crucial to fully understanding loneliness in today's society. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Unmarried Older People: Are They Socially Better Off Today?

OBJECTIVES: Previous studies have shown that unmarried older adults are generally at disadvantage in personal networks and social well-being compared with the married. It can be questioned whether their situation has improved in contemporary society, as among others the stigma of divorce and being never-married has declined. We hypothesize differential developments in networks and well-being according to marital status (married, widowed, divorced, and never-married) across birth cohorts. METHOD: Data are from the 1993 and 2013 observations of the Longitudinal Aging Study Amsterdam on Dutch people aged 55-69 (N = 2,894) and 70-84 years (N = 2,317). We employ general linear modeling of network size and diversity, received emotional and instrumental support, emotional and social loneliness, and depressive symptoms. RESULTS: The widowed are better off socially in 2013 than in 1993. Similar to the divorced they have a larger network, and similar to the never-married they receive more emotional support and are less emotional lonely. We find some gender differences in these developments. DISCUSSION: Societal change has not radically altered networks and well-being of unmarried older people. The widowed seem to benefit most, possibly because they are better able to retain relationships after widowhood.

Societal participation of individuals aged 55-64 years with and without chronic disease.

Background: It is unknown whether an increase in societal participation is important for individuals with a chronic disease. This study explores whether having paid work, volunteer activities or informal care giving differs for individuals with a chronic disease and those without. Methods: Respondents (n = 1779) aged 55-64 years who participated in the Longitudinal Ageing Study Amsterdam in 2002/2003 or 2012/2013 were included. We tested differences in (combinations of) performing paid work, volunteer activities or informal care giving between participants with and without a chronic disease by regression analyses, while taking into account sociodemographic confounders and effect modification by year. Results: Having a chronic disease was associated with having paid work in 2002/2003 (OR: 0.5; 95% CI: 04-0.7), but not in 2012/2013 (OR: 0.7; 95% CI: 0.4-1.1). Work participation of participants with (OR: 1.5; 95% CI: 1.0-2.2) and without a chronic disease (OR: 2.3; 95% CI: 1.3-3.9) increased in 2012/2013. Participants with a chronic disease are more likely to participate in volunteer activities than paid work. No statistically significant associations were found between having a chronic disease and informal care giving. Conclusion: Participation in paid work differs between individuals aged 55-64 years with a chronic disease and those without, but participation in informal care giving did not. Individuals with a chronic disease are more likely to participate in volunteer activities than paid work. Future research should focus on differences in societal participation within heterogeneous group of individuals with a chronic disease, since differences may be present in subgroups with specific chronic diseases.

National and transnational belonging among Turkish and Moroccan older migrants in the Netherlands: protective against loneliness?

This research investigates how a sense of belonging functions as protective mechanism against loneliness. Inspired by the work of Berry (1980) on acculturation strategies (i.e. integration, assimilation, separation and marginalization), we distinguish migrants who feel a relatively strong or weak sense of belonging to larger society and those who feel a strong or weak belonging to the "own group." We expect that more national belonging contributes to less loneliness. We add a transnational perspective by arguing that feelings of belonging to the own group can take place in the country of settlement, but can also be transnational, i.e. a feeling of belonging to the country of origin. Transnational belonging can protect against loneliness, as it acknowledges the importance of place attachment. Using data from the Longitudinal Aging Study Amsterdam on older migrants aged 55-66, we employ latent class analysis and find five national belonging clusters, interpretable in terms of Berry's acculturation strategies. Further analyses reveal mixed evidence: some aspects of transnational belonging vary with belonging to the own group, but other aspects point to a third dimension of belonging. Regression analysis shows that those marginalized are loneliest and that a transnational sense of belonging contributes to more loneliness. We conclude that Berry's (1980) typology is useful for interpreting older migrants' national belonging and that a transnational sense of belonging is apparent among older migrants, but needs to be explored further.

Cohort Differences in Received Social Support in Later Life: The Role of Network Type.

OBJECTIVES: The objective is to assess cohort differences in received emotional and instrumental support in relation to network types. The main guiding hypothesis is that due to increased salience of non-kin with recent social change, those in friend-focused and diverse network types receive more support in later birth cohorts than earlier birth cohorts. METHOD: Data from the Longitudinal Aging Study Amsterdam are employed. We investigate cohort differences in total received emotional and instrumental support in a series of linear regression models comparing birth cohorts aged 55-64, 65-74, 75-84, and 85-94 across three time periods (1992, 2002, and 2012). RESULTS: Four network types (friend, family, restricted, and diverse) are identified. Friend-focused networks are more common in later birth cohorts, restrictive networks less common. Those in friend-focused networks in later cohorts report receiving more emotional and instrumental support. No differences in received support are evident upon diverse networks. DISCUSSION: The increased salience of non-kin is reflected in an increase in received emotional and instrumental support in friend-focused networks in later birth cohorts. The preponderance of non-kin in networks should not be perceived as a deficit model for social relationships as restrictive networks are declining across birth cohorts.

The Longitudinal Aging Study Amsterdam: cohort update 2016 and major findings.

The Longitudinal Aging Study Amsterdam (LASA) is an ongoing longitudinal study of older adults in the Netherlands, which started in 1992. LASA is focused on the determinants, trajectories and consequences of physical, cognitive, emotional and social functioning. The study is based on a nationally representative sample of older adults aged 55 years and over. The findings of the LASA study have been reported in over 450 publications so far (see www.lasa-vu.nl ). In this article we describe the background and the design of the LASA study, and provide an update of the methods. In addition, we provide a summary of the major findings from the period 2011-2015.

Adverse effects of frailty on social functioning in older adults: Results from the Longitudinal Aging Study Amsterdam.

OBJECTIVES: The aim of this study was to examine the association between physical frailty and social functioning among older adults, cross-sectionally and prospectively over 3 years. STUDY DESIGN: The study sample consisted of 1115 older adults aged 65 and over from two waves of the Longitudinal Aging Study Amsterdam, a population based study. MAIN OUTCOME MEASURES: Frailty was measured at T1 (2005/2006) using the criteria of the frailty phenotype, which includes weight loss, weak grip strength, exhaustion, slow gait speed and low physical activity. Social functioning was assessed at T1 and T2 (2008/2009) and included social network size, instrumental support, emotional support, and loneliness. RESULTS: Cross-sectional linear regression analyses adjusted for covariates (age, sex, educational level and number of chronic diseases) showed that pre-frail and frail older adults had a smaller network size and higher levels of loneliness compared to their non-frail peers. Longitudinal linear regression analyses adjusted for covariates and baseline social functioning showed that frailty was associated with an increase in loneliness over 3 years. However, the network size and levels of social support of frail older adults did not further decline over time. CONCLUSIONS: Frailty is associated with poor social functioning, and with an increase in loneliness over time. The social vulnerability of physical frail older adults should be taken into account in the care provision for frail older adults.

Do predictors of volunteering in older age differ by health status?

It has been widely recognised that poor health is one of the main barriers to participation in volunteer activities in older age. Therefore, it is crucial to examine the participation of older people in volunteering, especially those in poor health. Based on the resource theory of volunteering, the aim of this study is to better understand the correlates of volunteering among older people with different health statuses, namely those without health problems (neither multimorbidity nor disability), those with mild health problems (multimorbidity or disability), and those with severe health problems (multimorbidity and disability). Data were drawn from the fourth wave (2011-2012, release 1.1.1) of the Survey of Health, Ageing and Retirement in Europe, which includes European people aged 50 years or older. The results showed that variables linked to volunteering were generally similar regardless of health status, but some differences were nevertheless identified. For older people with mild or severe health problems, for instance, depressive symptoms were negatively associated with their involvement in volunteer activities. We found a positive association of being widowed (rather than married) with volunteering in older people with particularly poor health, whereas high income was associated with volunteering in the case of mild health problems only. These results demonstrate that variables associated with volunteer participation partially differ between older people depending on their health status. These differences should be considered by policy makers in their attempts to promote volunteering in older people, as a means of preventing their social exclusion.

Nonkin in older adults' personal networks: more important among later cohorts?

OBJECTIVES: Research on age-related changes in personal networks has found compelling evidence for socioemotional selectivity theory and exchange theory holding that older adults experience a decline in less emotionally close nonkin relations as they age. However, recent societal developments are likely to have increased the salience of nonkin relations. We hypothesize that age-related decline in the proportion of nonkin in personal networks has been delayed or is slower in late birth cohorts of older adults compared with earlier cohorts. METHOD: Seven observations by the Longitudinal Aging Study Amsterdam covering a time span of 17 years since 1992 were analyzed using multilevel regression analysis. The sample had 12,949 person-year observations from 3,516 respondents born between 1908 and 1937. RESULTS: Age-related decline in the proportion of nonkin is absent for cohorts born after 1922 and large for cohorts born in 1922 and before. Mediating variables for health and other resources did not explain cohort differences in age-related change. DISCUSSION: The salience of nonkin relationships is likely to have increased due to societal changes, resulting in absence or delay of decline in later cohorts. The findings raise the need for a reevaluation of old age and the creation of new theoretical perspectives.

Changes in volunteering among young old in the Netherlands between 1992 and 2002: the impact of religion, age-norms, and intergenerational transmission.

The positive trend in volunteering among the Dutch young old may in part be due to a relatively favorable disposition to volunteer. Using data from the Longitudinal Aging Study Amsterdam, volunteering rates of 55-64 year olds in 1992 and 2002 were compared and associated with (among others) three types of dispositional factors: religious involvement, age-related engagement norms, and parental socialization. The recent cohort was less religiously involved, but more supportive of social engagement at older age, and more often had parents who volunteered, were religiously involved or higher educated. Multivariate analyses revealed that cohort differences were largely explained by cohort differences in educational level and religious involvement. It is concluded that their lower religious level suppresses the volunteering rate of the current young old. To compensate for the decline in religious young old, family and the broader society will become more important for stimulating volunteer work in the future.