Social factors and the prevalence of social isolation in a population-based adult cohort.

PURPOSE: Social isolation has negative effects on physical and brain health across the lifespan. However, the prevalence of social isolation, specifically with regard to sociodemographic and socioeconomic factors, is not well known. METHODS: Database was the Leipzig population-based study of adults (LIFE-Adult Study, n = 10,000). The short form of the Lubben Social Network Scale (LSNS-6) was used to assess social isolation (cutoff < 12 points). Sampling weights were applied to account for differences in sampling fractions. RESULTS: Data were available for 9392 study participants; 51.6% were women, the mean age was 45.2 years (SD = 17.3). The prevalence of social isolation was 12.3% (95% CI 11.6-13.0) across ages 18-79 years. Social isolation was more prevalent in men (13.8%, 95% CI 12.8-14.8) compared to women (10.9%, 95% CI 10.0-11.8; [Formula: see text] (1) = 18.83, p < .001), and it showed an increase with increasing age from 5.4% (95% CI 4.7-6.0) in the youngest age group (18-39 years) to 21.7% (95% CI 19.5-24.0) in the oldest age group (70-79 years; [Formula: see text] (4) = 389.51, p < .001). Prevalence differed largely with regard to socioeconomic status (SES); showing lower prevalence in high SES (7.2%, 95% CI 6.0-8.4) and higher prevalence in low SES (18.6%, 95% CI 16.9-20.3; [Formula: see text] (2) = 115.78; p < .001). CONCLUSION: More than one in ten individuals in the adult population reported social isolation, and prevalence varied strongly with regard to sociodemographic and socioeconomic factors. Social isolation was particularly frequent in disadvantaged socioeconomic groups. From a public health perspective, effective prevention of and intervention against social isolation should be a desired target as social isolation leads to poor health. Countermeasures should especially take into account the socioeconomic determinants of social isolation, applying a life-course perspective.

[Strategies to Recruit Refugees for Intervention Studies: Lessons Learned from the "Sanadak" Trial]. / Strategien zur Rekrutierung von Geflüchteten für Interventionsstudien: Erkenntnisse aus dem "Sanadak"-Trial.

OBJECTIVE: Recruitment of so called rare populations, including refugees, for participation in research studies is challenging. We aim to share our lessons learned regarding recruitment strategies used in the "Sanadak" trial, a randomized controlled trial for the evaluation of a self-help app for Syrian refugees with posttraumatic stress. METHODS: We conducted an interim evaluation of our recruitment strategies. A quantitative analysis addressed how potential study participants first learned about "Sanadak" and in which way they made first contact with us. A qualitative part included problem-centered interviews with our Syrian study nurses (n=3) regarding the success of various recruitment strategies and perceived barriers. RESULTS: Data were available for the recruitment of 140 Syrian refugees. Almost half of the sample (44%) was recruited via personal contact, about another third (36%) by means of study promotion (e. g. Facebook ads), and about a fifth (19%) through multipliers. Typical barriers were concerns regarding data protection, anonymity and stigmatization. DISCUSSION: Snowball sampling was an effective recruitment strategy in our trial. This is also the most acknowledged recruitment strategy for rare populations. In addition, other strategies were useful to increase sample variance. The interim evaluation helped to direct efforts towards effective recruitment strategies and to identify and address barriers. CONCLUSION: Multi-strategic recruitment with a focus on snowball sampling, multiple options to make contact with the study team, and having culturally sensitive members in the study team contributed towards successful recruitment in the "Sanadak"-trial.

Effects of low-volume high-intensity interval training in a community setting: a pilot study.

PURPOSE: High-intensity interval training (HIIT) is emerging as an effective and time-efficient exercise strategy for health promotion. However, most HIIT studies are conducted in laboratory settings and evidence regarding the efficacy of time-efficient "low-volume" HIIT is based mainly on demanding "all-out" protocols. Thus, the aim of this pilot study was to assess the feasibility and efficacy of two low-volume (≤ 30 min time-effort/week), non-all-out HIIT protocols, performed 2 ×/week over 8 weeks in a community-based fitness centre. METHODS: Thirty-four sedentary men and women were randomised to either 2 × 4-min HIIT (2 × 4-HIIT) or 5 × 1-min HIIT (5 × 1-HIIT) at 85-95% maximal heart rate (HRmax), or an active control group performing moderate-intensity continuous training (MICT, 76 min/week) at 65-75% HRmax. RESULTS: The exercise protocols were well tolerated and no adverse events occurred. 2 × 4-HIIT and 5 × 1-HIIT exhibited lower dropout rates (17 and 8 vs. 30%) than MICT. All training modes improved VO2max (2 × 4-HIIT: + 20%, P < 0.01; 5 × 1-HIIT: + 27%, P < 0.001; MICT: + 16%, P < 0.05), but the HIIT protocols required 60% less time commitment. Both HIIT protocols and MICT had positive impact on cholesterol profiles. Only 5 × 1-HIIT significantly improved waist circumference (P < 0.05) and subjective work ability (P < 0.05). CONCLUSIONS: The present study indicates that low-volume HIIT can be feasibly implemented in a community-based setting. Moreover, our data suggest that practical (non-all-out) HIIT that requires as little as 30 min/week, either performed as 2 × 4-HIIT or 5 × 1-HIIT, may induce significant improvements in VO2max and cardiometabolic risk markers.

Adherence to a lifestyle intervention - just a question of self-efficacy? Analysis of the AgeWell.de-intervention against cognitive decline.

BACKGROUND: Aim of this study was to detect predictors of better adherence to the AgeWell.de-intervention, a two-year randomized multi-domain lifestyle intervention against cognitive decline. METHODS: Data of 317 intervention group-participants comprising a risk group for dementia (Cardiovascular Risk Factors, Ageing and Dementia (CAIDE) score of ≥ 9; mean age 68.9 years, 49.5% women) from the AgeWell.de intervention study were analysed. Regression models with four blocks of predictors (sociodemographic, cognitive and psychosocial, lifestyle factors and chronic conditions) were run on adherence to the components of nutrition, enhancement of social and physical activity and cognitive training. Adherence to each component was operationalised by assessing the degree of goal achievement per component at up to seven time points during the intervention period, measured using a 5-point Likert scale (mean score of goal achievement). RESULTS: Increasing age was negatively associated with adherence, while higher education positively predicted adherence. Participants with better mental state (Montreal Cognitive Assessment (MoCA)-score > 25) at baseline and higher self-efficacy adhered better. Diabetes and cardiovascular conditions were not associated with adherence, whereas smoking negatively affected adherence. Highest education and quitting smoking in the past were the only predictors associated with all four intervention components. CONCLUSION: Results identified predictors for better and worse adherence. Particularly self-efficacy seems to be of considerable influence on adherence. This should be considered when designing future intervention trials. TRIAL REGISTRATION: German Clinical Trials Register (ref. number: DRKS00013555).

General practitioners' perspectives on lifestyle interventions for cognitive preservation in dementia prevention.

BACKGROUND: General practitioners (GPs) play a crucial role in identifying cognitive impairment and dementia and providing post-diagnostic care. This study investigates (1) how promising GP consider lifestyle changes to maintain cognitive performance in general, (2) GP beliefs about the power of modifiable health and lifestyle factors to maintain cognitive performance, and (3) whether those beliefs vary by GP age. METHODS: As part of the AgeWell.de trial, GPs (n = 72) completed a process evaluation questionnaire assessing their perspectives on lifestyle changes to preserve cognitive performance in elderly patients. In greater detail, their perceived efficacy of established risk and protective factors was investigated using a 5-point Likert scale. Descriptive statistical analyses were performed for research question (1) and (2). Spearman´s rank correlations and ordinal logistic regressions were used to answer research question (3). All results were interpreted exploratively. RESULTS: GPs rated the overall chance of lifestyle changes maintaining cognitive performance quite neutral with a median score of 3.0 (IQR = 2.0). They rated the efficacy of all the modifiable health and lifestyle factors high, with increase in physical and social activity ((Mdn = 5.0, IQR = 1.0) receiving the highest ratings with the narrowest range. Spearman's rank correlation indicated a significant positive relationship between age and the belief in "Optimization of nutrition" for preventing cognitive decline and dementia (ρ = .255, p = .041). However, ordinal logistic regressions showed no significant relationships between age and GP ratings of lifestyle change efficacy. CONCLUSION: These findings highlight the positive perception of GPs on the efficacy of modifiable health and lifestyle factors for preventing cognitive decline and dementia. TRIAL REGISTRATION: The AgeWell.de trial is registered in the German Clinical Trials Register (DRKS; trial identifier: DRKS00013555, Registration Date 07 December 2017).

Beneficial and Impeding Factors for the Implementation of Health-Promoting Lifestyle Interventions-A Gender-Specific Focus Group Study.

(1) Background: The prevalence of dementia increases and so does the number of interventions that address modifiable risk factors for dementia. Recent evidence suggests that there are gender differences in the prevalence of those lifestyle factors as well as in the effectiveness of interventions. This study aims to identify differences in factors that benefit or hinder the effectiveness of interventions since a target group's perspective gets more relevant. (2) Methods: Two focus groups, a female (n = 11) and a male (n = 8) group, were interviewed, audio recorded and transcribed. Qualitative analyses were performed and main- and subcategories were identified. (3) Results: Main differences were observed including aspects of lifestyle changes (e.g., respective diet and importance of an active lifestyle) and gender-typical behavior and perception by relevant healthcare actors. (4) Conclusions: Identified differences might help to address and raise the efficiency of lifestyle interventions. Further, the importance of social aspects and retirement as an auspicious moment to start interventions were identified as relevant by study participants.

COVID-19 government measures and their impact on mental health: a cross-sectional study of older primary care patients in Germany.

Background: With the outbreak of COVID-19, government measures including social distancing and restrictions of social contacts were imposed to slow the spread of the virus. Since older adults are at increased risk of severe disease, they were particularly affected by these restrictions. These may negatively affect mental health by loneliness and social isolation, which constitute risk factors for depressiveness. We aimed to analyse the impact of perceived restriction due to government measures on depressive symptoms and investigated stress as mediator in an at-risk-population in Germany. Methods: Data were collected in April 2020 from the population of the AgeWell.de-study, including individuals with a Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) score ≥9, using the depression subscale of the Brief Symptom Inventory (BSI-18) and the Perceived Stress Scale (PSS-4). Feeling restricted due to COVID-19 government measures was surveyed with a standardized questionnaire. Stepwise multivariate regressions using zero-inflated negative binomial models were applied to analyse depressive symptoms, followed by a general structural equation model to assess stress as mediator. Analysis were controlled for sociodemographic factors as well as social support. Results: We analysed data from 810 older adults (mean age = 69.9, SD = 5). Feeling restricted due to COVID-19 government measures was linked to increased depressiveness (b = 0.19; p < 0.001). The association was no longer significant when adding stress and covariates (b = 0.04; p = 0.43), while stress was linked to increased depressive symptoms (b = 0.22; p < 0.001). A final model confirms the assumption that the feeling of restriction is mediated by stress (total effect: b = 0.26; p < 0.001). Conclusion: We found evidence that feeling restricted due to COVID-19 government measures is associated with higher levels of depressive symptoms in older adults at increased risk for dementia. The association is mediated by perceived stress. Furthermore, social support was significantly associated with less depressive symptoms. Thus, it is of high relevance to consider possible adverse effects of government measures related to COVID-19 on mental health of older people.

Gender-specific design and effectiveness of non-pharmacological interventions against cognitive decline and dementia-protocol for a systematic review and meta-analysis.

INTRODUCTION: Dementia is a public health priority with projected increases in the number of people living with dementia worldwide. Prevention constitutes a promising strategy to counter the dementia epidemic, and an increasing number of lifestyle interventions has been launched aiming at reducing risk of cognitive decline and dementia. Gender differences regarding various modifiable risk factors for dementia have been reported, however, evidence on gender-specific design and effectiveness of lifestyle trials is lacking. Therefore, we aim to systematically review evidence on gender-specific design and effectiveness of trials targeting cognitive decline and dementia. METHODS AND ANALYSIS: We will conduct a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases MEDLINE (PubMed interface), PsycINFO, Web of Science Core Collection, Cochrane Central Register of Controlled Trials (CENTRAL) and ALOIS will be searched for eligible studies using a predefined strategy, complemented by searches in clinical trials registers and Google for grey literature. Studies assessing cognitive function (overall measure or specific subdomains) as outcome in dementia-free adults will be included, with analyses stratified by level of cognitive functioning at baseline: a) cognitively healthy b) subjective cognitive decline 3) mild cognitive impairment. Two reviewers will independently evaluate eligible studies, extract data and determine methodological quality using the Scottish Intercollegiate Guidelines Network (SIGN)-criteria. If sufficient data with regards to quality and quantity are available, a meta-analysis will be conducted. ETHICS AND DISSEMINATION: No ethical approval will be required as no primary data will be collected. PROSPERO REGISTRATION NUMBER: CRD42021235281.