Community-embedded follow-up management intervention for geriatric primary care: a mixed-methods study of an integrated health services model.

BACKGROUND: To propose a community-embedded follow-up management model to provide health services for elderly patients with osteoporosis who live alone. METHODS: Researchers randomly selected 396 people with osteoporosis living alone from five communities in Nantong, China, for the study. These participants were randomly assigned to control and intervention groups. Twenty-four community physicians in five communities provided professional support based on a community-embedded follow-up management model. Participants completed quantitative questionnaires at baseline and after the 6-month follow-up intervention, and some participants underwent semi-structured face-to-face interviews. The primary outcome is the effectiveness of the community-embedded follow-up management model in improving the quality of life of elderly patients with osteoporosis living alone. Based on an objective quantitative assessment, the qualitative study explains and adds essential components of this community-based follow-up management model. RESULTS: The quantitative study showed that scores in physical functioning, ability to perform daily activities, self-efficacy, and mental status were significantly improved in the intervention group compared to the control group (p < 0.05). The most significant improvements were found in "mental status" (p = 0.012) and "self-care skills" (p = 0.003). The qualitative study reported the essential elements of a community healthcare model for older people living alone with osteoporosis, including professional support, personalized services, social support, and empowerment. CONCLUSIONS: Community-embedded follow-up management meets the need for elderly patients with osteoporosis living alone. It helps to improve health perception, promote physical and mental health, and optimize the quality of life in this population. Personalized services and professional support are two major contributing factors to effective embedded follow-up management in the community.

Factors associated with health behaviors in preventing non-communicable diseases among older adults living alone in poverty in Japan.

Introduction: Older adults who live alone in poverty are highly susceptible to non-communicable diseases and other adverse conditions owing to health disparities resulting from social structures. However, the factors associated with health behavior to prevent non-communicable diseases in this population are rarely explored. The purpose of this study was to identify factors associated with health behavior to prevent non-communicable diseases among older adults living alone in poverty. Methods: We conducted a self-administered mail survey covering 2,818 older adults living alone who were receiving public assistance, randomly selected from lists of individuals receiving national public assistance in all 1,250 local social welfare offices across Japan. A total of 1,608 individuals completed the questionnaire, a valid response rate of 57.1%. Respondents' mean age was 74.5 years (standard deviation = 6.7), and 52.9% were women. The study variables included demographic characteristics, scores on a health behavior scale for older adults living alone and receiving public assistance (HBSO), and individual and community-related factors. Results: Logistic regression analysis revealed that the individual factor of having a health check-up in the past 12 months [odds ratio (OR): 1.45, 95% confidence interval (CI): 1.10-1.91] and the community-related factors Lubben social network scale score (OR 1.15, 95% CI: 1.12-1.18) and Community Commitment Scale score (OR: 1.04, 95% CI: 1.00-1.08) were significantly associated with HBSO scores. Conclusion: To improve health behavior among older adults living alone in poverty in Japan, social structures, such as lowering mental barriers to the detection, treatment, and management of non-communicable diseases and developing human resources, should be changed to provide social support, such that these individuals are not only dependent on family and friends.

Associations between cooking self-efficacy, attitude, and behaviors among people living alone: A cross-sectional survey analysis.

Cooking-related literacy and attitudes may play important roles in preventing and reducing diet-related chronic diseases and nutrition disparities. People living alone are an under-researched but growing population who face above average food insecurity rates. This study's objectives were to 1) test how cooking self-efficacy and attitude are stratified demographically among a sample of people living alone, focusing on variations across gender, age, and food security, and 2) examine how cooking self-efficacy and attitude are associated with two indicators of cooking behavior - cooking frequency and convenience orientation. We draw from a cross-sectional survey analysis of 493 adults living alone in Illinois, USA with validated measures for cooking self-efficacy, attitude, frequency, convenience orientation, and demographic characteristics. Hierarchical linear regression models were used to examine demographic factors explaining variation in self-efficacy and attitude, with attention to interactions between gender, food insecurity, and age. Poisson and OLS linear regression models were used to examine associations between self-efficacy and attitude and cooking frequency and convenience orientation. We find cooking-related self-efficacy and attitude showed strong but distinct associations with cooking frequency and convenience orientation. Overall, food insecure groups had lower self-efficacy than those who were food secure; however, food insecure women had higher self-efficacy than men in similar positions, apart from older-adult women who held particularly low efficacy. Cooking attitudes varied in small ways, notably with food insecure younger and older women possessing more negative cooking attitudes than middle-aged women. This research highlights the importance of understanding the cooking-related orientations of single-living people, while demonstrating that this group's ability to prevent and manage food insecurity is not uniform. These results can inform targeted interventions around food and nutrition insecurity, cooking attitudes, and self-efficacy among single-living populations.

Aging alone and financial insecurity predict depression: a path analysis of objective and subjective indices.

OBJECTIVES: This study draws on conservation of resources theory and transactional stress theory to guide our understanding of how social isolation, financial insecurity, and social support serve as a balance of both risk and protection for late-life depression. METHODS: Data were from the Leave-Behind Questionnaire in the 2016 (N = 4293) and 2018 (N = 4714) waves of the Health and Retirement Study. We conducted a cross-sectional path analysis via structural equation modeling, including objective and subjective perspectives. The same model was tested in both samples. RESULTS: Both social isolation and financial insecurity were associated with depression. We found several mediating risks and protective factors of these relationships. Objective financial status affected depression through both perceived financial insecurity and perceived social isolation, whereas objective isolation affected depression through perceived social support. This mediation model was -significant after adjusting for confounders. CONCLUSION: This study underscores the importance of investigating the balance between risk and protection for depression, in the rising number of older adults aging alone in society. Findings suggest that objective and perceived measures offer unique windows into psychological constructs. Considering both objective and subjective perspectives may provide alternative targets for subsequent interventions to improve mental health in later life.

A retrospective study on return to living alone of stroke patients who were living alone before stroke.

[Purpose] To identify factors that affect the return to solitary living of patients with stroke who had lived alone prior to stroke onset. [Participants and Methods] From January 2017 to March 2020, we enrolled a total of 103 patients with stroke who had lived alone prior to stroke onset and retrospectively analyzed their age, gender, length of hospital stay, outcome (return to living alone or not), functional independence measure at discharge, and social score at discharge. We also analyzed the relationship between the above factors and the outcome. [Results] Functional independence measure and social score at discharge were significantly associated with the outcome. The cutoff value of the functional independence measure at discharge was 91 (area under the curve: 0.91; sensitivity: 0.96; specificity: 0.72), while the rate of return to living alone was 23.5% when the social score was ≥3. The sensitivity and specificity for return to living alone were 0.91 and 0.88, respectively, when cutoff values of the functional independence measure and social score at discharge were 91 and 3, respectively. [Conclusion] Social factors and ability to perform activities of daily living are important for return to solitary living for patients with stroke who lived alone prior to stroke onset.

Exploratory study on the factors related with the early detection of missing older persons with dementia living alone in Japan.

AIM: To clarify the factors related to the early detection of missing older persons with dementia (PwD) who lived alone in Japan. METHODS: We carried out a multiple regression analysis with data from 88 missing PwD. RESULTS: The location of the discovery was within the municipality where the missing PwD lived. Furthermore, the use of long-term care insurance services was significantly associated with early detection. CONCLUSION: Missing PwD were located within the municipality in which they lived, which meant that the individual was found before they went far. In addition, with the long-term care insurance services, professionals should regularly visit the home of PwD according to a care plan. Planned regular visits might trigger the early recognition of a missing person with dementia and enable early search activities. Therefore, use of long-term care insurance services might lead to the early detection of missing PwD living alone. Geriatr Gerontol Int 2023; 23: 362-365.

Mental health service needs and mental health of old adults living alone in urban and rural areas in China: The role of coping styles.

This study aimed to explore the level and relationship between the mental health service needs (MHSN), coping styles (CS), and mental health (MH) of old adults living alone in urban and rural, and to explore the moderating effects of coping styles. A cross-sectional study was conducted with 717 older adults living alone. The survey measured MHSN, CS, and MH. Data were analyzed using a structural equation and bootstrapping method. There were significant differences in the MHSN, CS, and MH between urban and rural old adults living alone (P < 0.05). The model of the impact of MHSN on MH in urban and rural old adults living alone showed a good fit. These findings highlighted the importance of high MHSN and positive CS as potential protective factors of mental health in old adults living alone. This provides a theoretical basis for psychological nursing for old adults living alone in the community.

Association between multimorbidity patterns and catastrophic health expenditure among Chinese older adults living alone.

BACKGROUND: Multimorbidity is prevalent among older adults and may result in catastrophic health expenditures (CHEs) on older adults' households. However, whether older adults living alone suffer such a financial burden is unknown. We aimed to investigate the association between multimorbidity patterns and CHE in Chinese older adults living alone. METHODS: We included 884 participants aged 60 years and over and living alone from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS). Latent class analysis was performed to identify multimorbidity patterns based on 14 self-reported chronic diseases. The logit model and Tobit model were adopted to analyze the association of multimorbidity patterns with the incidence and intensity of CHE, respectively. RESULTS: Approximately 20.2% of the older adults living alone experienced CHE. Among the four multimorbidity groups (minimal disease, cardiovascular, lung and asthma, and multisystem), the multisystem group and cardiovascular group had significantly higher incidence and intensity of CHE than the minimal disease group. CONCLUSIONS: Older adults living alone had high risks of CHE, especially those belonging to the multisystem pattern and cardiovascular pattern. Integrated care should be adopted in the treatment of multimorbidity to reduce health costs. More elder services and social assistance should be provided to solitary older adults with certain patterns of multimorbidity.

Assessment of the relationship between living alone and the risk of depression based on longitudinal studies: A systematic review and meta-analysis.

Background: Living alone is one of the most common psychosocial factors that may have an impact on lifestyle management and health status. Although many previous cross-sectional studies have found that living alone increases the risk of depression. However, this risk has rarely been assessed on the basis of longitudinal studies. Therefore, we will explore this relationship on the basis of longitudinal studies. Methods: We systematically searched Pubmed, Embase, and Cochrane databases up to May 2022. Adjusted odds ratios (ORs), and 95% confidence intervals (CIs) were pooled by a random-effects model using an inverse variance method. Results: Seven studies (six cohort studies and one case-control study) were included in our study. A total of 123,859 without a history of psychosis individuals were included, and the proportion of females was 65.3%. We applied a random-effects model to minimize the heterogeneity. Overall, the pooled data suggest that people living alone are associated with an increased risk of depression compared to those who do not live alone (OR 1.42, 95%CI 1.19-1.70). Conclusion: Compared to people who live with others, living alone increases the risk of depression. Only cross-sectional studies and a few longitudinal studies currently support this association; more high-quality studies will be required in the future to confirm this causal association.

The effect of living alone on the mental health of the economically active floating population during the COVID-19 pandemic.

Background: The Coronavirus disease 2019 (COVID-19) pandemic broke out at the end of 2019 in China. Through a strict Zero-Tolerant strategy, the pandemic was nearly controlled in the first half of 2020, and production resumed in most regions of China. A survey was performed to explore the effect of living alone on the mental health of the economically active floating population (EAFP) in developed regions of China during the COVID-19 pandemic. Methods: The online cross-sectional survey was conducted in work resumed time in the first half of 2020 in several developed regions of China. The 12-item General Health Questionnaire (GHQ-12) is used to assess the mental health status. The Multi-level ordinary least squares regression was performed on a total of 4,405 samples to examine the relationships between living alone and the participants' mental health. Results: Many participants lived alone during the COVID 19 pandemic. Living alone is negatively associated with mental health (p < 0.01) for EAFP. The effect of living alone on mental health is stronger for females than males and for people with a lover than those without a lover. It is also stronger for the seniors (aged 56-70) than younger ones (aged 16-35), and has no significant influence on the middle-aged population (36-55). The effect is significant for self-employed people and employees, and is not significant for unemployed ones. Furthermore, the right amount of online entertainment can lower the effect of living alone on mental health. Conclusion: The results show that living alone strongly affected the mental health of EAFP during the COVID 19 pandemic. Moreover, this effect has generated new inequalities among different groups. In addition, to provide more public services to support people against the pandemic, the government should provide more psychological support to those who live alone and guide them to establish a correct view of marriage and love to reduce living alone negative effect and prevent them from mental health problems.

Catastrophic health expenditure among Chinese adults living alone with cognitive impairment: findings from the CHARLS.

BACKGROUND: The catastrophic health expenditure of older adults results in serious consequences; however, the issue of whether cognitive status and living situations contribute to such financial burdens is uncertain. Our aim was to compare the differences in catastrophic health expenditure between adults living alone with cognitive impairment and those adults living with others and with normal cognition. METHODS: We identified 909 observations of participants living alone with cognitive impairment (cases) and 37,432 observations of participants living with others and with normal cognition (comparators) from the 2011/2012, 2013, 2015 and 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS). We used propensity score matching (1:2) to create matched cases and comparators in a covariate-adjusted logistic regression analysis. Catastrophic health expenditure was defined as an out-of-pocket cost for health care ≥40% of a household's capacity to pay. RESULTS: In comparison with participants living with others and with normal cognition, those adults living alone with cognitive impairment reported a higher percentage of catastrophic health expenditure (19.5% vs. 11.8%, respectively, P < 0.001). When controlling for age, sex, education, marital status, residence areas, alcohol consumption, smoking status and disease counts, we found that this subpopulation had significantly higher odds of having catastrophic health expenditure (odds ratio [OR] = 1.89, 95% confidence interval [CI]: 1.40, 2.56). Additional analyses confirmed the robustness of the results. CONCLUSIONS: This study demonstrated that adults living alone with cognitive impairment in the CHARLS experienced a high burden of catastrophic health expenditure. Health care policies on social health insurance and medical assistance should consider these vulnerable adults.

Vaccine Resistance and Hesitancy among Older Adults Who Live Alone or Only with an Older Partner in Community in the Early Stage of the Fifth Wave of COVID-19 in Hong Kong.

Vaccination is an effective way in providing protection against COVID-19 infection and severe outcomes. However, vaccine resistance and hesitancy are a great concern among vulnerable populations including older adults who live alone or only with an older partner. This study examined their vaccination status and reasons and associated factors of vaccine resistance and hesitancy. A cross-sectional study was conducted among older adults living alone or only with an older partner in communities in Hong Kong. Participants were interviewed between October 2021 and February 2022. Logistic regression analyses were employed to examine factors associated with vaccine resistance and hesitancy. Of the 2109 included participants, the mean age was 79.3 years (SD 7.6), 1460 (69.2%) were female, 1334 (63.3%) lived alone, and 1621 (76.9%) were receiving social security support. The vaccine uptake, non-uptake (i.e., resistance), and hesitancy rates were 50.1%, 34.4%, and 15.5%, respectively. The top four reasons for vaccine resistance and hesitancy were "Not feeling in good health" (27%), "Worry about vaccine side effects" (18%), "Feeling no need" (10%), and "Lack of recommendation from doctors" (9%). Vaccine resistance and hesitancy was significantly associated with older age, living alone, more chronic conditions, fewer types of social media use, and lower self-rated health status. Similar associations can be observed in their separate analysis for vaccine resistance and vaccine hesitancy, and ever hospital admission over the past 6 months was additionally related to vaccine hesitancy. Older people who live alone or only with an older partner had a low vaccination rate. Poor health or worry about vaccine side effects were the most common reasons for their vaccine resistance and hesitancy. Actions are greatly needed to improve the uptake rate among this vulnerable population, especially those who were older, have poorer health, and use less social media.

Factors of Functional Disability in the Social Participation of Older Adults Living Alone With Fall Experience.

The fall experiences of older adults living alone lead to restrictions in their social participation. This study aimed to examine the factors that influence functional disability in social participation (FSP) among older adults who live alone and have experienced falls. This study used secondary data of 493 older adults living alone who experienced a fall, which were collected from the 2017 National Survey of Older Koreans. Multiple linear regression analyses were performed. Factors, such as old age, sex, economic status, frequency of drinking, and number of acquaintances, significantly related to functional disability in terms of social participation. In addition, poor muscle strength, depression, and cognitive decline comprised predictors of FSP. The findings of this study revealed that it is important to comprehensively evaluate the social participation of older adults who live alone and have experienced falls.

Does living alone increase the consumption of social resources?

China's living arrangement has changed as the economy grows and society makes progress. More and more people prefer to live alone. In 2018, a total of 240 million people chose to live alone in China, with an annual growth of 0.53% per year. How will the growing number of people living alone affect the resources consumption and the ecological environment? Based on the data from 1998 to 2017 at provincial level, this paper selects domestic water and electricity consumption to represent resources consumption, and household garbage generation to represent ecological environment, taking the proportion of single-person households in the total households as the explanatory variable and age, education, and household appliances as the control variables. This paper aims to apply dynamic panel models to analyze the impact of solitary population on resources consumption (water and electricity resources as representatives) and on waste generation. The results show that (1) people living alone consume more resources and generate more garbage, while household waste is influenced most, followed by household electricity consumption and household water consumption, (2) positive relations between age and resources consumption and waste generation have been identified, and (3) the energy-saving technology of home appliances is conducive to resources conservation and emission reduction.

Factors associated with inability to attend a follow-up assessment, mortality, and institutionalization among community-dwelling older people with cognitive impairment during a 5-year period: evidence from community-based participatory research.

BACKGROUND: The aim of the present study was to explore factors associated with (i) the inability to attend a follow-up assessment in the community-based participatory research (CBPR) framework; (ii) mortality; and (iii) institutionalization, across a 5-year period among older people with cognitive impairment identified via an epidemiological survey. METHODS: The participants were 198 older people whose score on the Mini-Mental State Examination was below 24, and who were living in our CBPR region in the Tokyo metropolitan area. Baseline data included sociodemographic factors, health-related factors, social factors, and assessments by healthcare professionals. Over the following 5 years we observed what happened to the subjects within the CBPR framework. Bivariate and stepwise multiple logistic regression analyses were performed to explore the factors associated with the inability to attend a follow-up assessment, 5-year mortality, and institutionalization. RESULTS: Participants who did not attend a follow-up assessment tended to live alone. Being older (>80), living with others, frailty, and the need for rights protection and daily living support were associated with increased mortality. Long-term care insurance certification was strongly associated with institutionalization as a natural consequence of the health-care system. Having dementia and low access to doctors were also positively associated with institutionalization. CONCLUSIONS: Older people with cognitive impairment who are living alone are at higher risk of being overlooked by society. To move toward more inclusive communities, the following are recommended: (i) more interventions focusing on older people living alone; (ii) social interventions to detect daily life collapse or rights violations; and (iii) more support to help people with dementia continue living in the community.

Educational Differences in Self-Rated Health Trends Among Middle-Aged and Older Adults Living Alone, 1972-2018.

Objectives: This study examines educational differences in living alone and in self-rated health trends among middle-aged and older adults. Methods: We used logistic regression to analyze data from the 1972-2018 National Health Interview Survey (n = 795,239 aged 40-64; n = 357,974 aged 65-84). Results: Between 1972-1974 and 2015-2018, living alone became more prevalent, particularly among men and at lower levels of education. Self-rated health trends varied by living arrangement and education. We found self-rated health declines among middle-aged adults having no college degree and living alone, but trends in self-rated health were mostly stable or even improved among middle-aged adults living with others. Among older adults, self-rated health improved over time, but for the least-educated older Americans living alone, the probability of reporting fair or poor health increased between 1972-1974 and 2015-2018. Discussion: The findings suggest growing disparities by social class, in living arrangements and in self-rated health.

The health and well-being of older women living alone in the United Kingdom and beyond: a scoping review.

In the United Kingdom (UK), women are more likely to live alone in later life. Social factors such as household composition have been shown to affect health and wellbeing as we age. The health and well-being of older women who live alone are of interest to researchers, care providers, health organizations, and policymakers. This article contributes to the literature by detailing a scoping review, establishing the current evidence in this field. The purpose and context of the review are given. The methodology and resulting data are described. Gaps in the literature and implications for practice and research are given.

Effects of healthcare access and financial status on self-rated health among adults living alone in South Korea.

Assessments of the overall health status of people living alone are important for developing health promotion programs and delivering appropriate health services. In the context of universal social health insurance system of South Korea, the relationship between failure to access health-care and self-rated health among adults living alone has given little attention. In addition, the influence of objective financial status on self-rated health in adults living alone has not explored so far. The sample of the present study comprised 4,852 adults who participated in the cross-sectional 2015 Korea National Health and Nutrition Examination Survey. The main finding was that the unmet health-care needs resulting from the inability to access health-care services during the previous 12 months was independently associated with fair or poor self-rated health, especially for women living alone. Having an income below the subsistence level was significantly associated with fair or poor self-rated health among women living alone. The findings of this study demonstrate the need for policies enabling appropriate delivery of health-care services, especially for women living alone. It is necessary to provide community-based monitoring programs related to general health for women living alone with a household income below the minimum cost-of-living.

Differences in assistive technology installed for people with dementia living at home who have wandering and safety risks.

BACKGROUND: Assistive Technology for people with dementia living at home is not meeting their care needs. Reasons for this may be due to limited understanding of variation in multiple characteristics of people with dementia including their safety and wandering risks, and how these affect their assistive technology requirements. This study therefore aimed to explore the possibility of grouping people with dementia according to data describing multiple person characteristics. Then to investigate the relationships between these groupings and installed Assistive Technology interventions. METHODS: Partitioning Around Medoids cluster analysis was used to determine participant groupings based upon secondary data which described the person characteristics of 451 people with dementia with Assistive Technology needs. Relationships between installed Assistive Technology and participant groupings were then examined. RESULTS: Two robust clustering solutions were identified within the person characteristics data. Relationships between the clustering solutions and installed Assistive Technology data indicate the utility of this method for exploring the impact of multiple characteristics on Assistive technology installations. Living situation and caregiver support influence installation of assistive technology more strongly than level of risk or cognitive impairment. People with dementia living alone received different AT from those living with others. CONCLUSIONS: Results suggest that caregiver support and the living situation of the person with dementia influence the type and frequency of installed Assistive Technology. Reasons for this include the needs of the caregiver themselves, the caregiver view of the participants' needs, caregiver response to alerts, and the caregiver contribution to the assistive technology assessment and selection process. Selection processes should be refined to account for the needs and views of both caregivers and people with dementia. This will require additional assessor training, and the development of validated assessments for people with dementia who have additional impairments. Policies should support the development of services which provide a wider range of AT to facilitate interventions which are focused on the needs of the person with dementia.

[Medical and social status of patients over 80 years old subject to single or joint residence.]

The study of the living conditions of the elderly living alone or together with other family relatives is relevant to the organization of medical and social care and the strengthening of coordination between medical and social services. We analysed information of 1 261 people aged 80 years and older in ambulatory care settings, of whom 40% lived alone and 60% lived in the family. The proportion of single residents increases with age. It was determined several socio-demographic characteristics of patients, including age, gender, and household composition, calculated the prevalence of senile asthenia syndrome and the main chronic non-infectious diseases for single and family patients, and identified gender differences. Single men in the «Age is not a hindrance¼ screening more often revealed senile asthenia and had more severe pain syndrome compared to men living in a family. In contrast to men, senile asthenia and pain summation were more frequently registered for women living in a family than for women living alone. For the organization of medical and social care, it is important to consider the relationship between gender and marital status, as well as how this relationship changes over time.