Seroprevalence trends of anti-SARS-CoV-2 antibodies and associated risk factors: a population-based study.

PURPOSE: We aimed to assess the seroprevalence trends of SARS-CoV-2 antibodies in several Swiss cantons between May 2020 and September 2021 and investigate risk factors for seropositivity and their changes over time. METHODS: We conducted repeated population-based serological studies in different Swiss regions using a common methodology. We defined three study periods: May-October 2020 (period 1, prior to vaccination), November 2020-mid-May 2021 (period 2, first months of the vaccination campaign), and mid-May-September 2021 (period 3, a large share of the population vaccinated). We measured anti-spike IgG. Participants provided information on sociodemographic and socioeconomic characteristics, health status, and adherence to preventive measures. We estimated seroprevalence with a Bayesian logistic regression model and the association between risk factors and seropositivity with Poisson models. RESULTS: We included 13,291 participants aged 20 and older from 11 Swiss cantons. Seroprevalence was 3.7% (95% CI 2.1-4.9) in period 1, 16.2% (95% CI 14.4-17.5) in period 2, and 72.0% (95% CI 70.3-73.8) in period 3, with regional variations. In period 1, younger age (20-64) was the only factor associated with higher seropositivity. In period 3, being aged ≥ 65 years, with a high income, retired, overweight or obese or with other comorbidities, was associated with higher seropositivity. These associations disappeared after adjusting for vaccination status. Seropositivity was lower in participants with lower adherence to preventive measures, due to a lower vaccination uptake. CONCLUSIONS: Seroprevalence sharply increased over time, also thanks to vaccination, with some regional variations. After the vaccination campaign, no differences between subgroups were observed.

Prevalence and association of frailty with SARS-CoV-2 infection in older adults in Southern Switzerland-Findings from the Corona Immunitas Ticino Study.

BACKGROUND: Frailty is an age-associated state of increased vulnerability to stressors that strongly predicts poor health outcomes. Epidemiological evidence on frailty is limited during the COVID-19 pandemic, and whether frailty is associated with the risk of infection is unknown. OBJECTIVES: We derived a robust Frailty Index (FI) to measure the prevalence of frailty and its risk factors in community-dwelling older adults in Southern Switzerland (Ticino), and we explored the association between frailty and serologically confirmed SARS-CoV-2 infection. METHODS: In September 2020, we recruited a random sample of community-dwelling older adults (65 +) in the Corona Immunitas Ticino prospective cohort study (CIT) and assessed a variety of lifestyle and health characteristics. We selected 30 health-related variables, computed the Rockwood FI, and applied standard thresholds for robust (FI < 0.1), pre-frail (0.1 ≤ FI < 0.21), and frail (FI ≥ 0.21). RESULTS: Complete data for the FI was available for 660 older adults. The FI score ranged between zero (no frailty) and 0.59. The prevalence of frailty and pre-frailty were 10.3% and 48.2% respectively. The log-transformed FI score increased by age similarly in males and females, on average by 2.8% (p < 0.001) per one-year increase in age. Out of 481 participants with a valid serological test, 11.2% were seropositive to either anti-SARS-CoV-2 IgA or IgG. The frailty status and seropositivity were not statistically associated (p = 0.236). CONCLUSION: Advanced age increases the risk of frailty. The risk of COVID-19 infection in older adults may not differ by frailty status.

Older adults' experiences of restrictive measures during the early stages of the COVID-19 pandemic in Southern Switzerland: Evidence from the Corona Immunitas Ticino study.

From the outset of the pandemic, Swiss federal authorities implemented numerous public health measures to contain the spread of SARS-CoV-2. In southern Switzerland, Canton Ticino legislated additional measures, some of which specifically targeted people aged 65 and over. We assessed how older adults perceived and experienced the introduction of these age-specific measures using data from a large, randomized sample of community-dwelling older adults aged 65+ collected between October 2020 and February 2021. We analyzed 788 open-ended responses on the experience of the introduction of the measures using a qualitative thematic analysis. At the individual level, 45% of the sample had a mostly positive experience, 29% had a mostly negative experience, 10% identified positive and negative aspects and 16% reported neither. We next assessed factors distinguishing the different types of experiences using bivariate and multivariate models. Older adults who were younger, unpartnered, had lower levels of education and higher levels of depressive symptoms and loneliness were more likely to report negative experiences. Our findings suggest the need to provide clear communication to older adults that accounts for the heterogeneity of this population, and to consider the potential for policies to have negative implications for those with fewer personal resources.

Lifetime employment histories and their relationship with 10-year health trajectories in later life: evidence from England.

BACKGROUND: Employment histories influence health. However, most studies have so far investigated cross-sectional associations between employment histories and health, failing to recognize health as a dynamic process in later life. METHODS: We use Waves 3-8 of the English Longitudinal Study of Ageing, including retrospective information on respondents' employment activities. We used dynamic hamming distances to summarize lifetime employment histories up to state pension age (64 for men and 59 for women). Multilevel growth curve models were then used to estimate the influence of lifetime employment histories on later life health trajectories over a 10-year period using quality of life (QoL), somatic health, and depression. RESULTS: Net of selection effect and a host of contemporaneous material and social resources, men who exited early started off with poorer health than those with continuous attachment to the labour market but had a very similar health profile by the end of the 10-year period considered. Among women, better somatic health and higher QoL were observed among those who had employment breaks for family care, and this health advantage was maintained over time. Lifetime employment histories are not related to depression for either men or women. CONCLUSION: Overall, differences in health by employment histories level off only among men who left earlier and those continuously employed. Flexible arrangements for men in poor health who benefit from leaving the labour market early and supporting women who wish to take breaks for family care may help reduce health inequalities in later life.

The decision to work after state pension age and how it affects quality of life: evidence from a 6-year English panel study.

Background: despite an increasing proportion of older people working beyond State Pension Age (SPA), little is known about neither the motivations for this decision nor whether, and to what extent, working beyond SPA affects quality of life (QoL). Methods: QoL was measured using the CASP-19 scale. Respondents in paid work beyond SPA were distinguished based on whether they reported financial constraints as the main reason for continuing in work. Linear regression models were used to assess the associations between paid work beyond SPA and CASP-19 scores among men aged 65-74 and women aged 60-69 (n = 2,502) cross-sectionally and over time using Wave 4 and Wave 7 of the English Longitudinal Study of Ageing. Results: approximately, one in five respondents were in paid work beyond SPA, one-third of whom reported financial issues as the main reason. These individuals reported significantly lower CASP-19 scores (ß = -1.21) compared with those who retired at the expected/usual age. Respondents who declared being in paid work beyond SPA because they enjoyed their work or wanted to remain active, reported significantly higher QoL (ß = 1.62). Longitudinal analyses suggest that those who were working post-SPA by choice, but who had stopped working at follow-up, also reported marginally (P < 0.10) higher CASP-19 scores. Conclusions: potential QoL benefits of working beyond SPA need to be considered in light of individual motivations for extending working life. Given the trend towards working longer and the abolishment of mandatory retirement ages, it is important that older people maintain control over their decision to work in later life.

Do work and family care histories predict health in older women?

Background: Social and policy changes in the last several decades have increased women's options for combining paid work with family care. We explored whether specific combinations of work and family care over the lifecourse are associated with variations in women's later life health. Methods: We used sequence analysis to group women in the English Longitudinal Study of Ageing according to their work histories and fertility. Using logistic regression, we tested for group differences in later life disability, depressive symptomology and mortality, while controlling for childhood health and socioeconomic position and a range of adult socio-economic circumstances and health behaviours. Results: Women who transitioned from family care to either part-time work after a short break from the labour force, or to full-time work, reported lower odds of having a disability compared with the reference group of women with children who were mostly employed full-time throughout. Women who shifted from family care to part-time work after a long career break had lower odds of mortality than the reference group. Depressive symptoms were not associated with women's work and family care histories. Conclusion: Women's work histories are predictive of their later life disability and mortality. This relationship may be useful in targeting interventions aimed at improving later life health. Further research is necessary to explore the mechanisms linking certain work histories to poorer later life health and to design interventions for those affected.

SARS-CoV-2 infection and cognition in community-dwelling and nursing home residents in southern Switzerland.

Background: COVID-19 patients can report 'brain fog' and may exhibit cognitive symptoms for months after recovery (Cognitive COVID). However, evidence on whether and the extent to which SARS-CoV-2 infection impacts cognition irrespective of COVID-19 course and severity is limited to clinical samples and mainly comes from prognostic studies. We aimed to explore the association between serologically confirmed SARS-CoV-2 infection and cognitive functioning in community-based and institutionalized older adults, irrespective of COVID-19 symptoms. Methods: We conducted a case-control study nested into two cohorts in Southern Switzerland. Eligible subjects were Italian speaking older adults, without a previous diagnosis of dementia, who underwent serological testing for anti-SARS-CoV-2 antibodies between November 2020 and July 2021. We manually selected age-, sex- and education-matched cases (i.e., individuals with a serologically confirmed SARS-CoV-2 infection), with seronegative controls, and we conducted in-person neuropsychological assessments using validated, highly sensitive cognitive tests. Results: We completed 38 neuropsychological assessments in a mostly female sample of older adults (Mean age: 83.13 ± 8.95; 86.8% women). 17 were community dwelling individuals while 21 lived in a nursing home. As expected, socio-demographic characteristics of age, gender and educational level were similarly distributed between cases (n = 14) and controls (n = 24). In linear regression models, cases had significantly lower scores in cognitive tasks of memory (ß = -0.367, p = 0.023), attention (ß = 0.428, p = 0.008) and executive functions (ß = 0.326, p = 0.046). We found no significant difference in tests of language and spatial-temporal orientation (all p values > 0.05). Conclusions: SARS-CoV-2 infection was associated with cognitive impairment in memory, attention, and executive functions in older adults. Our findings are consistent with mechanistic evidence of the neurotropism of the virus and provide empirical support for the "Cognitive COVID" construct also in non-clinical samples. With nearly 800 million COVID-19 cases (in April 2023), and many more infections worldwide, the clinical and public health implications of Cognitive COVID due to SARS-CoV-2 infection may be massive and warrant further epidemiological investigations.

Socioeconomic Status and Adherence to Preventive Measures During the COVID-19 Pandemic in Switzerland: A Population Based Digital Cohort Analysis.

Objectives: To assess the association between socioeconomic status (SES) and self-reported adherence to preventive measures in Switzerland during the COVID-19 pandemic. Methods: 4,299 participants from a digital cohort were followed between September 2020 and November 2021. Baseline equivalised disposable income and education were used as SES proxies. Adherence was assessed over time. We investigated the association between SES and adherence using multivariable mixed logistic regression, stratifying by age (below/above 65 years) and two periods (before/after June 2021, to account for changes in vaccine coverage and epidemiological situation). Results: Adherence was high across all SES strata before June 2021. After, participants with higher equivalised disposable income were less likely to adhere to preventive measures compared to participants in the first (low) quartile [second (Adj.OR, 95% CI) (0.56, 0.37-0.85), third (0.38, 0.23-0.64), fourth (0.60, 0.36-0.98)]. We observed similar results for education. Conclusion: No differences by SES were found during the period with high SARS-CoV-2 incidence rates and stringent measures. Following the broad availability of vaccines, lower incidence, and eased measures, differences by SES started to emerge. Our study highlights the need for contextual interpretation when assessing SES impact on adherence to preventive measures.

Trajectories of Seroprevalence and Neutralizing Activity of Antibodies against SARS-CoV-2 in Southern Switzerland between July 2020 and July 2021: An Ongoing, Prospective Population-Based Cohort Study.

OBJECTIVES: The COVID-19 pandemic continues, and evidence on infection- and vaccine-induced immunity is key. We assessed COVID-19 immunity and the neutralizing antibody response to virus variants across age groups in the Swiss population. STUDY DESIGN: We conducted a cohort study in representative community-dwelling residents aged five years or older in southern Switzerland (total population 353,343), and we collected blood samples in July 2020 (in adults only, N = 646), November-December 2020 (N = 1457), and June-July 2021 (N = 885). METHODS: We used a previously validated Luminex assay to measure antibodies targeting the spike (S) and the nucleocapsid (N) proteins of the virus and a high-throughput cell-free neutralization assay optimized for multiple spike protein variants. We calculated seroprevalence with a Bayesian logistic regression model accounting for the population's sociodemographic structure and the test performance, and we compared the neutralizing activity between vaccinated and convalescent participants across virus variants. RESULTS: The overall seroprevalence was 7.8% (95% CI: 5.4-10.4) by July 2020 and 20.2% (16.4-24.4) by December 2020. By July 2021, the overall seroprevalence increased substantially to 72.5% (69.1-76.4), with the highest estimates of 95.6% (92.8-97.8) among older adults, who developed up to 10.3 more antibodies via vaccination than after infection compared to 3.7 times more in adults. The neutralizing activity was significantly higher for vaccine-induced than infection-induced antibodies for all virus variants (all p values < 0.037). CONCLUSIONS: Vaccination chiefly contributed to the reduction in immunonaive individuals, particularly those in older age groups. Our findings on the greater neutralizing activity of vaccine-induced antibodies than infection-induced antibodies are greatly informative for future vaccination campaigns.

Why Vaccinate Against COVID-19? A Population-Based Survey in Switzerland.

Objectives: This study examined factors associated with COVID-19 vaccination intention at the very beginning of the vaccination campaign in a representative sample of the population in southern Switzerland. Methods: In March 2021, we measured vaccination intention, beliefs, attitudes, and trust in a sample of the Corona Immunitas Ticino study. Results: Of the 2681 participants, 1933 completed the questionnaire (response rate = 72%; 55% female; meanage = 41, SD = 24, rangeage = 5-91). Overall, 68% reported an intention to get vaccinated. Vaccination intention was higher in social/healthcare workers, and increased with age, trust in public health institutions, and confidence in the vaccine efficacy. Prior infection of a family member, predilection for waiting for more evidence on the safety and efficacy of the vaccine, and for alternative protective means were negatively associated with intention. Conclusion: In view of needs of COVID-19 vaccine boosters and of suboptimal vaccination coverage, our results have relevant public health implications and suggest that communication about vaccine safety and efficacy, and aims of vaccination programs, should be bi-directional, proportionate, and tailored to the concerns, expectations, and beliefs of different population subgroups.

The Corona Immunitas Digital Follow-Up eCohort to Monitor Impacts of the SARS-CoV-2 Pandemic in Switzerland: Study Protocol and First Results.

Objectives: To describe the rationale, organization, and procedures of the Corona Immunitas Digital Follow-Up (CI-DFU) eCohort and to characterize participants at baseline. Methods: Participants of Corona Immunitas, a population-based nationwide SARS-CoV-2 seroprevalence study in Switzerland, were invited to join the CI-DFU eCohort in 11 study centres. Weekly online questonnaires cover health status changes, prevention measures adherence, and social impacts. Monthly questionnaires cover additional prevention adherence, contact tracing apps use, vaccination and vaccine hesitancy, and socio-economic changes. Results: We report data from the 5 centres that enrolled in the CI-DFU between June and October 2020 (covering Basel City/Land, Fribourg, Neuchâtel, Ticino, Zurich). As of February 2021, 4636 participants were enrolled and 85,693 weekly and 27,817 monthly questionnaires were collected. Design-based oversampling led to overrepresentation of individuals aged 65+ years. People with higher education and income were more likely to enroll and be retained. Conclusion: Broad enrolment and robust retention of participants enables scientifically sound monitoring of pandemic impacts, prevention, and vaccination progress. The CI-DFU eCohort demonstrates proof-of-principle for large-scale, federated eCohort study designs based on jointly agreed principles and transparent governance.

Mental health care use in later life: results from a national survey of Canadians.

OBJECTIVE: To estimate the proportion of older adults who have used mental health services in the past 12 months among those who meet the criteria for one or more Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, 12-month psychiatric disorders. We also examine the factors associated with mental health care use in this population. METHOD: We used secondary data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). We first estimated the proportion of adults aged 55 years and older who used a range of mental health services. Next, using logistic regression, we examined the relative contribution of predisposing, enabling, and need characteristics in predicting any service use in this population. RESULTS: Among the 12 792 adults aged 55 years and older in the CCHS 1.2, 513 (4.23%, 95% CI 3.89% to 4.95%) met the criteria for at least one 12-month DSM-IV disorder. Among these respondents, 37% (95% CI 31% to 43%) saw at least one type of mental health care provider in the past 12 months. Visits to a general health care provider for mental health reasons were most common, followed by specialist care. Only psychological distress was significantly and positively associated with using mental health care services. CONCLUSIONS: Over 60% of the older adults who met the criteria for a DSM-IV disorder were not using mental health care services. Social and demographic factors did not predict service use in this population.

Aging in Different Welfare Contexts: A Comparative Perspective on Later-Life Employment and Health.

OBJECTIVE: We adopt a cross-national comparative perspective to assess the labor market experiences of older adults in the years leading up to and beyond the full pension age (FPA) and their association with health in diverse welfare state contexts. METHOD: We work with a harmonized pooled-country data set of 12 nations to model individuals' employment trajectories during the 10 years surrounding gender- and country-specific FPAs over the same chronological period (2004 to 2014/2015) using sequence analysis. We then analyze these trajectories' relationships with self-rated health and chronic conditions across different welfare state contexts. RESULTS: We find five types of later-life employment trajectories: early retirement, conventional retirement, predominantly part-time, not in the labor market, and partial retirement. Among other findings, our analyses indicate that early retirement is associated with positive health outcomes in social-democratic and corporatist countries but not in liberal and liberal-corporatist countries. For people in the not in the labor market trajectory, poor self-rated health is more frequent in liberal and southern, and less frequent in corporatist countries. DISCUSSION: The research findings illustrate the importance of both generous public benefits in old age and later-life employment trajectories for older individuals' health.

Corrected and uncorrected hearing impairment in older Canadians.

BACKGROUND: Hearing impairment (HI) is a common chronic condition in later life, but one that can often be improved with the use of a hearing aid. However, a distinction is not often made between corrected and uncorrected HI in the literature. OBJECTIVE: To estimate the prevalence of corrected and uncorrected HI, and assess whether there are differences in sociodemographic factors among older adults (age 50+) with corrected HI, uncorrected HI and no HI. METHOD: Secondary data came from two national data sources: the 1994 National Population Health Survey (n = 6,202) and the Canadian Community Health Survey 1.1 (n = 50,113). We use multinomial logistic regression to assess sociodemographic risk markers for both corrected and uncorrected HI. RESULTS: Both corrected and uncorrected HI was common in this age group: 6.5 and 4.0%, respectively, in the National Population Health Survey and 5.7 and 2.5% in the Canadian Community Health Survey. In both samples, the prevalence of corrected and uncorrected HI increased with age and was more common among men. Respondents with either corrected or uncorrected HI were less likely to be married and more likely to report other physical health problems compared to respondents with no HI. In the Canadian Community Health Survey, income was associated with lower odds of reporting uncorrected HI, while education was associated with reduced likelihood of reporting corrected HI. CONCLUSION: Our findings suggest that HI is prevalent in later life, and sociodemographic factors such as marital status, education, and income do not differ significantly between those with corrected and uncorrected HI compared with respondents with no HI. Further investigation into the factors associated with hearing aid use is necessary to better target older adults who might benefit from wearing a hearing aid.

Transitions in hearing impairment and psychological distress in older adults.

OBJECTIVE: Although previous research has demonstrated an association between hearing impairment (HI) and psychological distress, less work has explored the effect of transitions in hearing status on distress over time, or the explanatory pathways that may explain this association. METHOD: We use 2 waves of data from the Canadian National Population Health Survey to examine the effect of HI transitions on changes in distress during 6 years, and to test the potential mediating effects of psychosocial factors and chronic stressors. RESULTS: Experiencing a decline in hearing was associated with increased distress at Wave 4, net of Wave 1 distress, although the significance of the relation was reduced to trend level following adjustment for sociodemographic variables (P < 0.06). The introduction of mastery and self-esteem further reduced the size of the effect of reporting a decline in hearing in the full model. CONCLUSIONS: The association between declines in HI and psychological distress during a 6-year period did not reach a traditional level of statistical significance, and we discuss potential explanations for this finding. Mastery and self-esteem may be important explanatory variables in the HI-distress association and should be considered in future research.

General practitioner referral of older patients to Improving Access to Psychological Therapies (IAPT): an exploratory qualitative study.

Aims and methodTo understand general practitioner (GP) reticence to refer older patients to a local Improving Access to Psychological Therapies (IAPT) service providing mostly cognitive-behavioural therapy (CBT)-based interventions. Semi-structured, hour-long interviews were conducted with eight GPs and then analysed by modified grounded theory and thematic analysis. RESULTS: GP views regarding the treatability of older adults with CBT influenced their willingness to refer to a CBT-based IAPT service. Perceptions of local IAPT assessment processes being distressing and onerous to older patients also motivated referral inaction. GPs expressed a preference to treat depressed older patients themselves (with medication and psychological approaches such as watchful waiting).Clinical implicationsAny strategy to increase referral rates of older adults to CBT-based IAPT services should address local GP concerns regarding assessment processes and the effectiveness of offered treatments.Declaration of interestNone.

Does greater frequency of contact with general physicians reduce feelings of mastery in older adults?

In this study, we test one aspect of Rodin's hypothesis concerning age-related decline in mastery: The effect of frequent contact with the health care sector on mastery. We conducted cross-sectional and longitudinal multiple regression analyses to examine the effect of general physician (GP) visits on mastery. In the cross-sectional analyses, a higher number of GP visits is associated with lower mastery, but this relationship is substantially weakened when physical health is entered into the analysis. These results are confirmed in the longitudinal analysis. The effect of GP visits on mastery thus appears to be significantly confounded by physical health problems. These findings direct attention away from the role of contact with the health care sector in influencing perceived mastery and toward the importance of physical health status as both a cause and potential consequence of changes in perceived control with age.

Is being in paid work beyond state pension age beneficial for health? Evidence from England using a life-course approach.

BACKGROUND: Given the current policy emphasis in many Western societies on extending working lives, we investigated the health effects of being in paid work beyond state pension age (SPA). Until now, work has largely focused on the health of those who exit the labour force early. METHODS: Our data come from waves 2-4 of the English Longitudinal Study of Ageing, including the life history interview at wave 3. Using logistic and linear regression models, we assessed the longitudinal associations between being in paid work beyond SPA and 3 measures of health (depression, a latent measure of somatic health and sleep disturbance) among men aged 65-74 and women aged 60-69. Our analyses controlled for baseline health and socioeconomic characteristics, as well as for work histories and health in adulthood and childhood. RESULTS: Approximately a quarter of women and 15% of men were in paid work beyond SPA. Descriptive bivariate analyses suggested that men and women in paid work were more likely to report better health at follow-up. However, once baseline socioeconomic characteristics as well as adulthood and baseline health and labour market histories were accounted for, the health benefits of working beyond SPA were no longer significant. CONCLUSIONS: Potential health benefits of working beyond SPA need to be considered in the light of the fact that those who report good health and are more socioeconomically advantaged are more likely to be working beyond SPA to begin with.

Relationship between employment histories and frailty trajectories in later life: evidence from the English Longitudinal Study of Ageing.

BACKGROUND: Given the acceleration of population ageing and policy changes to extend working lives, evidence is needed on the ability of older adults to work for longer. To understand more about the health impacts of work, this study examined the relationship between employment histories before retirement and trajectories of frailty thereafter. METHODS: The sample comprised 2765 women and 1621 men from the English Longitudinal Study of Ageing. We used gendered typologies of life-time employment and a frailty index (FI). Multilevel growth curve models were used to predict frailty trajectories by employment histories. RESULTS: Women who had a short break for family care, then did part-time work till 59 years had a lower FI after 60 years than those who undertook full-time work until 59 years. Women who were largely family carers or non-employed throughout adulthood, had higher levels of frailty at 60 years but experienced a slower decline with age. Men who worked full-time but early exited at either 49 or 60 years had a higher FI at 65 years than those who worked full-time up to 65 years. Interaction between employment histories and age indicated that men in full-time work who experienced an early exit at 49 tended to report slower declines. CONCLUSIONS: For women, experiencing distinct periods throughout the lifecourse of either work or family care may be advantageous for lessening frailty risk in later life. For men, leaving paid employment before 65 years seems to be beneficial for decelerating increases in frailty thereafter. Continuous full-time work until retirement age conferred no long-term health benefits.

The role of social support in the relationship between urinary incontinence and psychological distress in older adults.

While an association between UI and psychological distress among older adults has been established in the literature, the mechanisms underlying this relationship remain less clear. Using a sample of 4,689 older adults from the Canadian Community Health Survey (1.1), we test the potential mediating and moderating effects of four dimensions of social support on the UI-distress relationship. Incontinent older adults are significantly more likely to report higher levels of distress than continent adults. Although we do not find support for a mediating effect of any of the dimensions of social support, we do report a significant interaction between one dimension of social support (tangible support) and UI. A buffering effect of tangible support is evident for continent - but not incontinent - respondents. These findings emphasize the need to assess the types of social support and the context in which they operate.