A mixed methods feasibility study of a virtual group-based social support program for older adults in residential care.

OBJECTIVES: In response to calls for inventive ways to mitigate risks of physical distancing due to the COVID-19 pandemic for older adults living in residential care, the JAVA Music Club-Digital (JMC-D) was developed. The current feasibility study investigated benefits, usability, and implementation of weekly JMC-D sessions over 6 months. METHOD: Employing a pre-post mixed methods study, depressive symptoms, loneliness, social isolation, and quality of life were measured at baseline, 3 and 6 months. Qualitative interviews were conducted at 3 months. RESULTS: Twenty-one residents were recruited. Across the three time points there was a large effect for depressive symptoms, social isolation, and quality of life, though not statistically significant. There was a significant immediate increase in happiness following engagement in the JMC-D sessions. Thematic analysis of semi-structured interviews generated two overarching themes: Experiencing the JMC-D (subthemes: Benefits, Navigating the virtual platform, Feedback) and Considerations for Implementation (subthemes: Perceived purpose, Characteristics that impact the experience, and Infrastructure and resources). CONCLUSION: Findings are encouraging and suggest that the JMC-D may support emotional and other psychosocial indices of wellness in residential care during times of physical distancing. Appropriate staffing, resources, and internet accessibility are important for implementation and uptake.

Examining a Healthy Lifestyle as a Moderator of the Relationship between Psychological Distress and Cognitive Decline among Older Adults in the NuAge Study.

INTRODUCTION: The objective of this study was to examine whether a healthy lifestyle composite score of social engagement, physical activity, and Mediterranean diet adherence moderates the association between psychological distress and global cognitive decline among cognitively healthy older adults (67+ years of age at baseline). METHODS: A total of 1,272 cognitively intact older adults (Mage = 74.1 ± 4.1 years, 51.9% female) in the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge) completed a series of self-reported questionnaires to measure psychological distress and lifestyle behaviors, and the Modified Mini-Mental Examination (3MS) to assess cognitive performance at baseline and annually over 3 years. RESULTS: Controlling for sociodemographic and health-related characteristics, greater psychological distress was associated with steeper cognitive decline over time among males (B = -0.07, 95% CI: [-0.12, -0.02]), but not females (B = 0.008, 95% CI: [0.03, 0.04]). Although a healthy lifestyle composite score did not statistically significantly moderate the distress-cognition relationship (B = -0.005, 95% CI: [-0.02, 0.01]), there was an association between higher psychological distress and greater cognitive decline at low levels of social engagement (B = -0.05, 95% CI: [-0.09, -0.006]), but not at high levels of social engagement (B = 0.02, 95% CI: [-0.03, 0.07]). CONCLUSION: This study suggests that the potentially harmful impact of stress on cognitive function may be malleable through specific healthy lifestyle behaviors and emphasizes the importance of taking a sex-based approach to cognitive aging research.

Psychological Stress across the Lifespan and Cognitive Function among Older Adults: The Moderating Role of a Healthy Lifestyle.

This study aimed to (a) investigate the associations between indices of stress severity across the lifespan (early, middle, late life) and cognitive function among community-dwelling older adults, and (b) examine whether a healthy lifestyle composite score comprised of physical activity, healthy diet adherence, social engagement, sleep quality, and mindful relaxation moderates the associations between lifespan stress severity and cognitive function. Participants (n = 226, Mage = 68.2 ± 6.5, 68.1% female) completed questionnaires to measure stress and lifestyle behaviours, and three online neurocognitive tasks. No direct associations between stress severity and cognition were found. The healthy lifestyle composite score moderated the associations between early, midlife, and late-life stress severity and inhibitory control. Exploratory analyses suggest that this moderating effect may be sex-dependent. Despite study limitations and the need for additional research, findings provide preliminary support for the role of lifestyle behaviours in enhancing older adults' resilience to the effects of stress on cognitive health in a sex-specific manner.

Understanding the social and leisure needs of lonely and socially isolated older adults living in residential care: a qualitative study.

Objectives: Rates of loneliness and social isolation increase following the transition to residential care and are associated with poor health outcomes. One way to mitigate these experiences is through meaningful recreation, however, there is research to suggest that currently available programming does not meet the needs of lonely and socially isolated residents. Therefore, the objectives of the current study were to investigate: (1) the lived experience of loneliness and social isolation in residential care, (2) engagement and use of available resources by these residents, and (3) insights as to how programming can further address their needs.Methods: Qualitative interviews were conducted with ten staff members and 14 residents. Interviews were transcribed and analysed using thematic analysis.Results: Three themes emerged from the data: (1) Feelings of loneliness and social isolation (subthemes: loneliness and social isolation differ, contributors, and coping strategies), (2) Recreation and social participation (subthemes: program engagement and barriers to participation), and (3) Supporting residents' needs (subthemes: suggestions for meaningful recreation and resources).Conclusion: Loneliness and social isolation are idiographic experiences. Contributors to loneliness and social isolation are also reported as barriers to attending programming. Recommendations are made, many of which rely on greater staffing resources and psychoeducation.

A Qualitative Study of the Usability and Likability of a Virtual Group-Based Social Support Program for Older Adults in Residential Care.

OBJECTIVES: Despite social engagement being a robust predictor of wellbeing for older adults living in residential care, social programming ceased during the COVID-19 pandemic to abide by social distancing guidelines. Consequently, a tablet-based program called the Java Music Club-Digital (JMC-D) was developed. The JMC-D enables residents to engage with peers through discussion and singing from the safety of their own rooms. This study investigated the likability and usability of the JMC-D for older adults living in residential care and recreation staff. METHODS: Data was collected through semi-structured interviews and focus groups with seven residents and three recreation coordinators. Interviews were analyzed using thematic analysis. RESULTS: Three themes emerged: 1) Addressing a need, 2) Factors that affect virtual social connection, and 3) Usability. Interest in future participation in the JMC-D program varied depending on certain personal characteristics including comfort with computers, openness to new experiences, and existing social network. CONCLUSION: Findings suggest that the JMC-D is likeable and usable for residents and recreation coordinators. CLINICAL IMPLICATIONS: Study findings can be applied by researchers and residential care staff who wish to increase the use of virtual social programs to improve the psychosocial health of residents. Constructive feedback was incorporated into the platform.

Associations between circulating cardiovascular disease risk factors and cognitive performance in cognitively healthy older adults from the NuAge study.

Introduction: Cardiovascular disease risk factors (CVRFs) contribute to the development of cognitive impairment and dementia. Methods: This study examined the associations between circulating CVRF biomarkers and cognition in 386 cognitively healthy older adults (mean age = 78 ± 4 years, 53% females) selected from the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge). Memory, executive function, and processing speed were assessed at baseline and 2-year follow-up. CVRF biomarkers included total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), triglycerides, glucose, insulin, high sensitivity C-reactive protein (hs-CRP), homocysteine, protein carbonyls, and cortisol. Linear mixed models were used to determine associations between individual CVRF biomarkers and cognition at both time points. Results: HDL-C was most consistently associated with cognition with higher values related to better performance across several domains. Overall, stronger and more consistent relationships between CVRF biomarkers and cognition were observed in females relative to males. Discussion: Findings suggest that increases in the majority of circulating CVRFs are not associated with worse cognition in cognitively healthy older adults.

Nutrition risk and cognitive performance in community-living older adults without cognitive impairment: a cross-sectional analysis of the Canadian Longitudinal Study on Aging.

Malnutrition is correlated with poor cognition; however, an understanding of the association between nutrition risk, which precedes malnutrition, and cognition is lacking. This study aimed to determine if nutrition risk measured with the SCREEN-8 tool is associated with cognitive performance among cognitively healthy adults aged 55+, after adjusting for demographic and lifestyle covariates. Sex- and age-stratified analyses were also explored. Baseline data from the Canadian Longitudinal Study on Aging was used. Cognition was determined using a 6-measure composite score based on four executive functions and two memory tasks, taking into account age, sex, and education. Multivariable linear regression was performed while adjusting for body mass index (BMI), lifestyle, and health covariates in the entire sample (n = 11 378) and then stratified by sex and age. Approximately half of participants were female (54.5%) aged 65+ (54.1%). Greater nutrition risk was associated with poorer cognitive performance in the entire sample (F[1, 11 368] = 5.36, p = 0.021) and among participants aged 55-64 (n = 5227; F[1, 5217] = 5.45, p = 0.020). Sex differences in lifestyle and health factors associated with cognition were apparent, but nutrition risk was not associated with cognition in sex-stratified models. Based on this analysis, there may be an association between nutrition risk and cognitive performance in older adults. When screening for either cognitive impairment or nutrition risk, complementary assessments for these conditions is warranted, as early intervention may provide benefit.

Cumulative Stress Exposure and Cognitive Function Among Older Adults: The Moderating Role of a Healthy Lifestyle.

OBJECTIVES: Although chronic stress is a risk factor for poor age-related cognitive health, there is limited research that has examined how cumulative stress across the lifespan affects cognitive aging. There may also be resilience factors that minimize the effects of cumulative stress on cognitive health. Engaging in a healthy lifestyle is protective against cognitive decline and may therefore interact with cumulative stress to buffer the stress-cognition relationship. The objective of the current study was to examine the moderating role of a healthy lifestyle, comprised of physical activity, social engagement, and sleep quality, in the relationship between cumulative stress exposure (CSE) and baseline and change in cognitive performance (global cognition, episodic memory, executive function) over 9 years among 1,297 older adults in the Midlife in the United States cohort (Mage = 69.0 ± 6.4, 57.8% female). METHODS: CSE and healthy lifestyle behaviors were indexed using self-reported questionnaires at baseline, and cognitive function was assessed using a battery of standardized neuropsychological tests at baseline and follow-up. RESULTS: Controlling for age, sex, education, race, marital status, employment status, hypertension, diabetes, and depression, higher CSE was associated with poorer baseline performance and slower decline over time in global cognition and executive function, but not episodic memory. A healthy lifestyle did not significantly moderate the relationship between cumulative stress and cognitive function. Exploratory analyses showed a significant cumulative stress-cognition relationship among females only. DISCUSSION: This study lends support for a lifespan model of cognitive aging and suggests that the cognitive health consequences of stress extend beyond immediate timescales.

Neuroticism and Stress in Older Adults: The Buffering Role of Self-Esteem.

BACKGROUND: Chronic stress is associated with accelerated aging and poor health outcomes in older adults. According to the Transactional Model of Stress (TMS), distress is experienced when one perceives the stressor, or threat, to outweigh the ability to cope. The experience of distress is correlated with trait neuroticism, which is associated with greater perceptions of stress and stress reactivity, as well as a tendency to engage in maladaptive coping strategies. However, as individual personality traits do not act in isolation, this study aimed to investigate the moderating role of self-esteem in the relationship between neuroticism and distress using a TMS framework. METHODS: A total of 201 healthy older adults (Mage = 68.65 years) completed questionnaires measuring self-esteem, neuroticism, perceived stress, and positive coping. RESULTS: Greater neuroticism was significantly associated with less positive coping at low (b = -0.02, p < 0.001) and mean self-esteem levels (b = -0.01, p < 0.001), but not at high self-esteem levels (b = -0.01, p = 0.06). No moderating effect was found for perceived stress or overall distress. CONCLUSION: The results support the association between trait neuroticism and indices of stress and suggest a potential buffering effect of self-esteem in moderating the negative association between neuroticism and positive coping.

Stress across the Lifespan: From Risk to Management-Conference Report on the Inaugural Canadian Stress Research Summit.

In 2021, the Toronto Metropolitan University Institute for Stress and Wellbeing Research welcomed over 200 conference delegates across Canada to the inaugural Canadian Stress Research Summit (CSRS) to share ideas and foster collaboration among Canadian scholars. This conference was unique from existing international stress-related conferences as it bridged science and community. The objective of this conference report is to provide an overview of the 3-day virtual inaugural stress conference, offering a summary of the keynote addresses, themed symposia, spotlight presentations, graphical designs of selected presentations, and conference feedback. Overall, the CSRS highlighted important methodological considerations in understanding the relationship between stress exposure and various outcomes of interest that pertain to the mental health and wellbeing of Canadians. Furthermore, there is a need for continued work to understand stress across the lifespan from an inclusive and diverse Canadian lens.