Environment profiles, social participation patterns, depressive symptoms and quality of life of disabled older adults: a longitudinal investigation.

OBJECTIVES: This study used the World Health Organization's healthy ageing framework to explore longitudinal influences of environment profiles and social participation (SP) patterns on depressive symptoms (DSs) and on quality of life (QOL). METHODS: Data were collected from a sample of community-dwelling older adults in Taiwan in 2018 (T1; N = 1,314) and a follow-up survey in 2020 (T2; N = 831). Latent class analysis was conducted to obtain environment and SP profiles. Multilevel modeling was carried out to explicate the hypothesized associations. RESULTS: Three unique environment profiles, labeled as Highly- (Highly-FE), Moderately- (Moderately-FE) and Weakly-Facilitative Environment (Weakly-FE), were identified from T1 data. The three SP classes that were obtained from T1 and T2 data denoted High-, Moderate- and Low-SP. Participants in the 'Highly-FE' class were more likely to belong to the 'High-SP' and 'Moderate-SP' subgroups and exhibited significantly fewer DSs and better QOL. The associations were confirmed both cross-sectionally and longitudinally. CONCLUSION: Interventions should be developed to promote or maintain preferred SP to maximize the current and future mental health and subjective well-being of disabled older adults.

Effects of types and levels of social capital on emotional well-being for older people in Indonesia: A longitudinal study.

OBJECTIVES: The purpose of this study was to examine the effects of different types and levels of social capital and emotional well-being in older adults in Indonesia by a longitudinal data. METHODS: The fourth and the fifth waves of Indonesian Family Life Survey data were used for this study. The participants aged 60 years or older who participated in both waves were included for analysis (n = 1374). Depressive symptoms and happiness were used to assess emotional well-being. Cognitive social capital (neighborhood trust) and structural social capital (participating in arisan, community meetings, volunteers, village improvement programs, and religious activities) were the main independent variables. The generalized estimating equations model was used for analysis. RESULTS: Participation in arisan (B = -0.534) and attending religious activities (B = -0.591) were related to lower depressive symptoms, but the effect of religious activities would offset over time. Both a low or high social participation showed protective effects on depressive symptoms at the intercept and the time slope. Having higher neighborhood trust was related to more chance of feeling very happy (OR = 1.518). CONCLUSION: Structural social capital is protective from depressive symptoms, while cognitive social capital contributes to happiness. Facilitating social participation and improving neighborhood trust through policies and programs is suggested to promote emotional well-being for older people.

Longitudinal mediation effects of activity meaning on the association between activity performance and quality of life among older adults with disabilities.

BACKGROUND: Physical limitations may hinder older adults with physical disabilities' capability to perform various activities, which can affect their quality of life (QOL). Accomplishing meaningful activities may mitigate the impact of limited activity performance on their QOL. This longitudinal study aims to investigate how activity meaning mediates the relationship between activity performance and QOL among older adults with disabilities. METHODS: Data for this longitudinal study was collected from 813 community-dwelling older adults aged 60 and above who had physical disabilities, over a two year interval. Path analysis was used to examine the cross-sectional and longitudinal mediation effects from activity performance, through activity meaning, to QOL. RESULTS: At the same wave, high IADL performance or social activity performance, and high QOL was indirectly associated through high IADL meaning or social meaning. As for longitudinal association, high T1 IADL performance was associated with better T2 QOL through high T1 and T2 IADL meaning. Similarly, high T1 social activity performance also contributed to T2 QOL through high T1 and T2 social activity meaning. Additionally, social activity performance exhibited higher influence on QOL than that of IADL. CONCLUSIONS: Both IADL and social activities have distinct impacts on the QOL of older adults with disabilities. To improve the current and future QOL of older adults with disabilities, professionals must prioritize their involvement in the most meaningful activities while being sensitive to and supportive of their preferences and valued lifestyles.

Loneliness, loneliness literacy, and change in loneliness during the COVID-19 pandemic among older adults: a cross-sectional study.

BACKGROUND: Loneliness has become a significant public health concern for older people. However, little is known about the association of loneliness, loneliness literacy, and changes in loneliness during the COVID-19 pandemic with mental well-being. The purpose of this study was to explore whether loneliness literacy is related to a lower risk of loneliness, increased loneliness during the COVID-19 pandemic, and improved mental well-being for community-based older adults. METHODS: A telephone survey was conducted to collect data from older adults aged 65 years or older in Taiwan (n = 804). Loneliness, change in loneliness during COVID-19, and loneliness literacy were the main variables. Mental well-being was assessed by depressive symptoms and life satisfaction. Related factors included personal level (demographics, health conditions, health behaviors, and problem-focused/ emotion-focused coping strategies), interpersonal level (marital status, living arrangements, social support, social participation, leisure activities, and social interactions during COVID-19), and societal level (areas and regions) factors. RESULTS: Four dimensions of loneliness literacy were identified by factor analysis: self-efficacy, social support, socialization, and in-home support. Self-efficacy and in-home support were related to lower loneliness. Lower self-efficacy, higher social support, and higher socialization were related to changes (increases) in loneliness during COVID-19. In-home support may prevent depressive symptoms, while self-efficacy was beneficial for better life satisfaction. In addition, emotion-focused coping may increase loneliness during COVID-19, while satisfaction with family support would be a protective factor against loneliness. CONCLUSION: Loneliness literacy is related to loneliness and increased loneliness during the COVID-19 pandemic. Building up an age-friendly community with embedded services/information and learning positive coping and mental resilience strategies are suggested.

Differences in determinants of intention to stay and retention between younger and older nursing assistants in long-term care facilities: A longitudinal perspective.

AIMS: This study examines differences in the determinants of intention to stay (Time 1) and actual retention behaviour at follow-up (Time 2) between younger and older nursing assistants in long-term care facilities. BACKGROUND: The shortage of nursing assistants in long-term care is increasing, and the nursing assistant workforce is also ageing. METHODS: Data were obtained from a stratified equal probability sample of 595 nursing assistants from 137 institutions over a two-year period in Taiwan. Multilevel modelling was utilized for analyses. RESULTS: High organisational support and low burnout were associated with high intention to stay at Time 1 for both older and younger nursing assistants. However, the retention of older nursing assistants at Time 2 was more strongly influenced by high work latitude, the use of an optimization strategy and less burnout at Time 1, while the retention of younger nursing assistants at Time 2 was more likely to be affected by personal factors such as gender and marital status at Time 1. CONCLUSION: Organisational factors, the use of selection, optimization, compensation strategies, and burnout were more strongly associated with retention of older nursing assistants than of younger nursing assistants. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing assistant managers should recognize the needs of nursing assistants vary by age and stage of life. Retention programs that are designed to account for age differences will be more effective at retaining nursing assistants.

Environment patterns and mental health of older adults in long-term care facilities: the role of activity profiles.

Objectives: This study adopts the International Classification of Functioning, Disability and Health (ICF) model to determine extent to which the clustered patterns of long-term care (LTC) environment and activity participation are associated with older residents' mental health. Method: This study enrolled a stratified equal probability sample of 634 older residents in 155 LTC institutions in Taiwan. Latent profile analysis and latent class analysis were conducted to explore the profiles for environment and activity participation. Multilevel modeling was performed to elucidate the hypothesized relationships. Results: Three environment profiles (Low-, Moderate-, and High-Support Environment) based on physical, social, and attitudinal environment domains and two activity profiles (Low- and High-Activity Participation) across seven activity domains were identified. Compared to the Low-Support class, older adults in the Moderate- and High-Support Environment classes had better mental health. Older residents in those two classes were more likely to be in the "High Activity Participation" class, which in turn, exhibited better mental health. Conclusion: Environment and activity participation directly relate to older residents' mental health. Activity participation also mediates the link between environment and mental health. A combination of enhanced physical, social, and attitudinal environments, and continual engagement in various activities may optimize older LTC residents' mental health.

Does geriatric nursing staff burnout predict well-being of LTC residents?

Nursing staff in residential settings are exposed to a large number of stressors. This study examined the relationship between geriatric nursing staff (GNS) burnout and the well-being of residents in long-term care (LTC) facilities. Data were obtained concerning 590 older residents who were served by 315 GNS in 172 LTC facilities in Taiwan, using multilevel modeling. The depersonalization (DP) dimension of burnout in GNS was consistently related to various resident well-being outcomes. Higher DP among GNS was associated with lower residential satisfaction and perceived quality-of-life, as well as more depressive symptoms among older LTC residents. The findings support the claim that DP among GNS has a greater role in determining LTC resident well-being than other dimensions of burnout. Efforts should be made to mitigate the emergence of DP among GNS. Support and education are also needed to enable GNS to foster positive interactions and relationships with LTC residents.

Outdoor activities and depressive symptoms in displaced older adults following natural disaster: community cohesion as mediator and moderator.

OBJECTIVES: This investigation examined whether community cohesion mediates or moderates the relationship between outdoor activities and depressive symptoms in older adults displaced by Typhoon Morakot in Taiwan. METHOD: This cross-sectional study included 292 adults aged 65 years or older who were relocated to permanent houses after Typhoon Morakot damaged their homes on 8th August 2009. Multiple regression analysis was applied to test the role of community cohesion on the association between outdoor activities and depressive symptoms. RESULTS: The sample of displaced older adults displayed higher prevalence of depressive symptoms than the average for community dwelling older people in Taiwan. Community cohesion fully mediated the relationship between outdoor activities and depressive symptoms. Community cohesion also moderated the relationship between outdoor activities and depressive symptoms. CONCLUSION: Community cohesion occupies a key role on the link between outdoor activities and depressive symptoms. Participation in outdoor activities was associated positively with community cohesion, while high community cohesion was related negatively to depressive symptoms. Additionally, the benefit of outdoor activities to fewer depressive symptoms only manifested in older adults with high community cohesion. Programs and services should be designed to enhance community cohesion in order to maximize the benefit of outdoor activities to the mental health of displaced older adults after natural disasters.

Functional disability and depressive symptoms: longitudinal effects of activity restriction, perceived stress, and social support.

OBJECTIVES: This longitudinal study investigates how activity restriction, perceived stress, and social support affect the relationship between functional disability and depressive symptoms. METHOD: This longitudinal study of a Taiwan population analyzed a nationally representative sample of 1268 subjects aged 60 years and over. Path analysis was used to assess interrelations among functional disability, activity restriction, perceived stress, social support, and depressive symptoms over time. RESULTS: The analytical results supported the following relationships: (a) high functional disability were associated with high activity restriction, low social support, and high perceived stress over time, (b) high functional disability, high activity restriction, low social support, and high perceived stress were associated with high levels of depressive symptoms over time, (c) among the four factors, perceived stress exerted the strongest cross-sectional and longitudinal effect on depressive symptoms, and (d) the significant effect of prior functional disability on subsequent depressive symptoms substantially contributed to indirect changes in activity restriction, perceived stress, and social support between waves. CONCLUSION: The findings indicate that functional disability may contribute to subsequent depressive symptoms by reducing activities and social support. Decreased activities and social support increased perceptions of stress, which then increased depressive symptoms during the 8-year follow-up study.

Functional disability and psychological well-being in later life: does source of support matter?

OBJECTIVES: This study explored the buffering effects of instrumental and emotional support from different sources against the impact of increasing functional disability on depression and life satisfaction. METHODS: Random effects modeling was utilized with data from a nationwide longitudinal study in Taiwan. A total of 6722 observations from 2856 elders over a seven-year period served as subjects of this study. RESULTS: The results suggested that instrumental support from family members and formal organizations as well as emotional support from families, friends and formal organizations was significantly associated with better psychological well-being among the elderly in Taiwan. In addition, receiving instrumental support from family members and formal organizations can moderate the linkage between increasing functional disability and depression. CONCLUSION: The results emphasize the importance of encouraging a partnership between natural helpers and health care professionals. A good integration between formal and informal networks could more effectively meet the needs of the frail older adults and their families. This study also calls for more attention to the cultural competence of health care policy and service delivery.

COVID-19-related worries, social disruptions, and depressive symptoms among community-dwelling older adults with disabilities: What makes the difference?

OBJECTIVES: This study explores how home- and community-based services use, COVID-19-related worries and social disruptions are related to the depressive symptoms of community-dwelling older adults with disabilities, and whether the associations differ by month of interview. METHODS: Data on a sample of 593 older individuals in Taiwan were collected between April and July 2020. Multiple regression analyses were performed to test the hypothesized relationships. RESULTS: As the number of confirmed cases of COVID-19 in Taiwan continuously declined from April 2020, participants who were interviewed in May, June and July experienced significantly fewer COVID-19-related worries and social disruptions than those interviewed in April. The month interviewed, representing the pandemic development phase of COVID-19, moderated the relationships between home-based service (HBS) use and COVID-19 worries. Month interviewed also moderated the association between COVID-19-related social disruptions and depressive symptoms. DISCUSSION AND IMPLICATIONS: Differences in the level of COVID-19-related worries between HBS users and non-users were greatest in April, followed by May, and least in June and July, suggesting that the disparities between HBS users and non-users attenuated over time. Perceived high COVID-19-related social disruptions was weakly and negatively correlated with depressive symptoms in April, but the relationship became moderately positive in May, and strongly positive in June and July. These results supported the claim that the associations between COVID-19-related social disruptions and depressive symptoms can vary over time. Professionals who serve disabled older individuals in communities should be aware of their unstated needs and adopt strategies that are appropriate for the current stage of the COVID-19 pandemic to respond better to their needs and emotional state.

Development of the Houston-Apollo model for older people living in remote areas in Taiwan.

AIM: Senior healthcare is challenging in remote areas, particularly in an economically disadvantaged population. This study examined the benefits of a combined healthcare system (Houston-Apollo model) in improvements of physical performance and medical care utilization of local older people. METHODS: People aged ≥65 years who participated in congregate meal services were recruited. Using concepts of telemedicine and community health records, participants received consultation from local general physicians, who provided advice or arranged referrals to the National Taiwan University Hospital Yunlin Branch. Physical parameters including blood pressure, body mass index, grip strength, walking speed, and five times sit-to-stand test (FTSST) were transferred to the National Taiwan University Hospital Yunlin Branch and local doctors in a timely manner. Changes in physical parameters and utilization of healthcare facilities were measured at the beginning of recruitment and 1 year later. RESULTS: In the 470 registered participants, 66% had hypertension, 50% had weakness in grip strength, 58% were slow at FTSST and 78% had disability in 6-meter walking speed. In total, 97 participants were followed up at 1 year. The systolic and diastolic blood pressure (mmHg) decreased from 137.4 to 133.3 (P = 0.019) and from 76.9 to 74.4 (P = 0.008), respectively. The time of FTSST (s) decreased from 11.3 to 10.4 (P = 0.011). The walking speed (m/s) increased from 0.71 to 0.74 (P = 0.039). Medical and dental outpatient usage increased by 2 and 1.14 times, respectively. CONCLUSIONS: The Houston-Apollo model could provide benefits for the physical status of older adults, promote proactive and preventive healthcare utilization, and contribute to medical equality. Geriatr Gerontol Int 2021; ••: ••-••.

Social support, coping strategies and their correlations with older adults' relocation adjustments after natural disaster.

AIM: The present study examines the associations among social support, coping strategies and relocation adjustment outcomes, including community cohesion, residential satisfaction and depressive symptoms, for older persons in Taiwan displaced by Typhoon Morakot. METHODS: This study enrolled 372 adults aged 60 years or older who were relocated to permanent houses after Typhoon Morakot destroyed their homes on 8 August 2009. A path analysis simultaneously examined the hypothesized links among social support, coping strategies and relocation adjustment outcomes. RESULTS: The relationships between coping strategies and relocation outcomes varied. Problem-focused and support-seeking coping were positively related to perceived community cohesion, whereas emotion-focused coping was associated with a high number of depressive symptoms. Social support was positively related to residential satisfaction. Additionally, social support was also indirectly related to increased community cohesion and residential satisfaction through its positive relationship with support-seeking and problem-focused coping. CONCLUSIONS: More interventions should be implemented to enhance support within informal networks and a sense of belonging to the new resident community, thereby promoting more active coping strategies, enhancing the effectiveness of coping efforts and maximizing positive adjustment outcomes. Geriatr Gerontol Int 2017; 17: 1006-1014.

Changes in Leisure Activities and Dimensions of Depressive Symptoms in Later Life: A 12-Year Follow-Up.

PURPOSE OF STUDY: Although leisure activities benefit the mental health of the elderly population, the effect of changes in leisure activities on dimensions of depressive symptoms remains unclear. This investigation examined the influences of changes in intellectual, social, and physical activities between waves on four dimensions of depressive symptoms at follow-up. DESIGN AND METHODS: Random effects modeling was utilized with data from a nationwide longitudinal study conducted in Taiwan. The study data comprised 6,942 observations from 2,660 older adults over a 12-year period. RESULTS: The results suggested that changes in physical activities contributed to depressive symptoms which reflected positive affect in the later wave. Increased social activities between waves predicted higher positive affect and lower interpersonal difficulties scores at follow-up. Increased intellectual activities between waves did not substantially affect any domain of depressive symptoms. In contrast, declines in intellectual activities between waves predicted higher scores in three depressive symptoms domains, including depressed mood, somatic symptoms, and interpersonal difficulties. IMPLICATIONS: Engagement in a varied range of activities benefits mental health among elders more than participation in any single type of activity among elders. Reducing physical activities can lower positive affect, while the adverse effect may be balanced by increasing social activities. Also, the impact of decreasing intellectual activities on the interpersonal difficulties domain of depressive symptoms may be offset by increasing social activities.