Exploring the Relationship of Leisure Travel with Loneliness, Depression, and Cognitive Function in Older Adults.

Loneliness, depression, and cognitive decline are pressing concerns among older adults. This study examines the association between leisure travel participation and these health outcomes in older adults, aiming to provide further evidence of the benefits of leisure travel. Using nationally representative historical data from the 2006 household survey of the Health and Retirement Study, this study conducted a series of regression analyses to investigate the relationship between traveling and the three health outcomes, adjusting for age, sex, race, marital status, education, total wealth, annual income, and difficulty with daily activities. The results reveal that travel patterns in terms of distance are significantly associated with loneliness, depression, and cognitive function. Long-distance travel is positively related to higher cognitive function and a reduction in depressive symptoms, along with lower levels of loneliness, reinforcing the notion that leisure travel can potentially act as a catalyst for improved cognitive and mental health by offering opportunities for enhancing social connections and forming new relationships. The findings on the relationships between participation in leisure travel and mental and cognitive health contribute to the body of evidence supporting the therapeutic value of leisure travel in promoting healthy aging and enhancing the overall well-being in older adults.

Role of primary tumor volume and metastatic lymph node volume in response to curative effect of definitive radiotherapy for locally advanced head and neck cancer.

BACKGROUND: Studies have shown mixed results concerning the role of primary tumor volume (TV) and metastatic lymph node (NV) volume in response to the curative effect of definitive radiotherapy for locally advanced head and neck squamous cell carcinoma (LAHNSCC). OBJECTIVE: We aimed to evaluate the impact of TV and NV on the efficacy of radical radiotherapy in LAHNSCC patients, with the goal of guiding individualized therapy. PATIENTS AND METHODS: Patients with LAHNSCC who received radical radiation therapy and were reexamined within 6 months post-therapy from January 2012 to December 2021 were selected. The volumes of the primary tumors and metastatic lymph nodes were calculated by software and then were divided into a large TV group vs small TV group and a large NV group vs small NV group according to the relationship with the median. Additionally, patients who received concurrent chemoradiotherapy (CCRT) or not were divided into the CCRT group and the radiotherapy (RT) group. Patients with lymph node metastasis were divided into node concurrent chemotherapy (N-CCRT) group and a node metastatic chemotherapy (N-RT) group according to whether they received concurrent chemotherapy or not. The volume shrinkage rate (VSR), objective response rate (ORR), local control rate (LCR) and overall survival (OS) were recorded and analyzed. RESULTS: 96 patients were included in the primary tumor volume group, and 73 patients were included in the metastatic lymph node group. Receiver operating characteristic (ROC) curves were constructed for objective remission (OR) endpoints, and a volume threshold was defined for TV and NV patients. The threshold primary tumor volume was 32.45 cm3, and the threshold metastatic lymph node volume was 6.05 cm3.The primary TV shrinkage rates of the small TV and the large TV groups were basically the same, P = 0.801. Similarly, the ORR and LCR were not significantly different between the small TV group and the large TV group (PORR = 0.118, PLCR = 0.315). Additionally, the TV shrinkage rate did not significantly differ between the CCRT group and the RT group, P = 0.133. Additionally, there was no significant difference in ORR or LCR in CCRT group (PORR = 0.057, PLCR = 0.088). However, the metastatic lymph node volume shrinkage rate in the small NV group was significantly greater than that in the large NV group (P = 0.001). The ORR and LCR of the small NV subgroup were significantly greater than those of the large NV subgroup (PORR = 0.002, PLCR = 0.037). Moreover, compared with that of the N-RT group, the NV shrinkage rate of the N-CCRT group was 84.10 ± s3.11%, and the shrinkage rate was 70.76 ± s5.77% (P = 0.047). For the ORR and LCR, the N-CCRT group and N-RT group were significantly different (PORR = 0.030, PLCR = 0.037). The median OS of the whole group was 26 months. However, neither TV/NV nor concurrent chemotherapy seemed to influence OS. CONCLUSION: Primary tumor volume is not a prognostic factor for the response to curative effect radiotherapy in LAHNSCC patients. Nevertheless, metastatic lymph nodes are a prognostic factor for the response to curative effect radiotherapy in LAHNSCC patients. Patients with smaller lymph nodes have better local control.

Associations Between Social Network Characteristics and Brain Structure Among Older Adults.

INTRODUCTION: Social connectedness is associated with slower cognitive decline among older adults. Recent research suggests that distinct aspects of social networks may have differential effects on cognitive resilience, but few studies analyze brain structure. METHODS: This study includes 117 cognitively impaired and 59 unimpaired older adults. The effects of social network characteristics (bridging/bonding) on brain regions of interests were analyzed using linear regressions and voxel-wise multiple linear regressions of gray matter density. RESULTS: Increased social bridging was associated with greater bilateral amygdala volume and insular thickness, and left frontal lobe thickness, putamen, and thalamic volumes. Increased social bonding was associated with greater bilateral medial orbitofrontal and caudal anterior cingulate thickness, as well as right frontal lobe thickness, putamen, and amygdala volumes. DISCUSSION: The associations between social connectedness and brain structure vary depending on the types of social enrichment accessible through social networks, suggesting that psychosocial interventions could mitigate neurodegeneration. HIGHLIGHTS: Distinct forms of social capital are uniquely linked to gray matter density (GMD). Bridging is associated with preserved GMD in limbic system structures. Bonding is associated with preserved GMD in frontal lobe regions. Bridging is associated with increased brain reserve in sensory processing regions. Bonding is associated with increased brain reserve in regions of stress modulation.

Social enrichment on the job: Complex work with people improves episodic memory, promotes brain reserve, and reduces the risk of dementia.

Individuals with more complex jobs experience better cognitive function in old age and a lower risk of dementia, yet complexity has multiple dimensions. Drawing on the Social Networks in Alzheimer Disease study, we examine the association between occupational complexity and cognition in a sample of older adults (N = 355). A standard deviation (SD) increase in complex work with people is associated with a 9% to 12% reduction in the probability of mild cognitive impairment or dementia, a 0.14-0.19 SD increase in episodic memory, and a 0.18-0.25 SD increase in brain reserve, defined as the gap (residual) between global cognitive function and magnetic resonance imaging (MRI) indicators of brain atrophy. In contrast, complexity with data or things is rarely associated with cognitive outcomes. We discuss the clinical and methodological implications of these findings, including the need to complement data-centered activities (e.g., Sudoku puzzles) with person-centered interventions that increase social complexity.

Random sampling of alters from networks: A promising direction in egocentric network research.

The social network perspective has great potential for advancing knowledge of social mechanisms in many fields. However, collecting egocentric (i.e., personal) network data is costly and places a heavy burden on respondents. This is especially true of the task used to elicit information on ties between network members (i.e., alter-alter ties or density matrix), which grows exponentially in length as network size increases. While most existing national surveys circumvent this problem by capping the number of network members that can be named, this strategy has major limitations. Here, we apply random sampling of network members to reduce cost, respondent burden, and error in network studies. We examine the effectiveness and reliability of random sampling in simulated and real-world egocentric network data. We find that in estimating sample/population means of network measures, randomly selecting a small number of network members produces only minor errors, regardless of true network size. For studies that use network measures in regressions, randomly selecting the mean number of network members (e.g., randomly selecting 10 alters when mean network size is 10) is enough to recover estimates of network measures that correlate close to 1 with those of the full sample. We conclude with recommendations for best practices that will make this versatile but resource intensive methodology accessible to a wider group of researchers without sacrificing data quality.

What kinds of social networks protect older adults' health during a pandemic? The tradeoff between preventing infection and promoting mental health.

When the coronavirus emerged in early 2020, older adults were at heightened risk of contracting the virus, and of suffering mental health consequences from the pandemic and from the precautions designed to mitigate it. In this paper, we examine how social networks prior to the pandemic helped to shape health beliefs, behaviors, and outcomes among older adults during its onset, focusing on (1) perceived risk of COVID-19, (2) preventative health behaviors, and (3) mental health, including loneliness, perceived stress, depression, and anxiety. Drawing on the longitudinal Social Networks in Alzheimer Disease study, we find that networks high in bridging social capital predict greater perceived risk and more precautions taken, but worse mental health. In contrast, networks high in bonding social capital predict less perceived risk and fewer precautions taken, but better mental health. We discuss this apparent tradeoff between physical and mental health.

Do subjective or objective cognitive measures better predict social network type among older adults?

A large literature highlights the link between cognitive function and social networks in later life. Yet there remains uncertainty about the factors driving this relationship. In the present study, we use measures of subjective cognitive decline and clinical cognitive assessments on a sample of older adults to investigate whether the relationship between cognitive function and social networks is driven by psychosocial factors. We found a consistent link between clinical cognitive assessments and social network type, but no association between subjective concerns of cognitive decline and networks. Participants who exhibited signs of clinical cognitive impairment were more likely to have restricted networks (i.e., smaller networks consisting of fewer contacts, more interconnectivity, and less social diversity) compared to their cognitively normal counterparts, regardless of subjective measures of cognitive decline - both from the participant's perspective and study partner's perspective. These findings suggest that neither cognitively impaired older adults nor their network members appear to consciously dissolve social ties on the basis of perceived cognitive decline. However, it remains unclear whether the association between clinical cognitive impairment and social network type indicates the protective nature of social networks against cognitive decline or a subconscious process leading to social contraction.

Cognitively stimulating environments and cognitive reserve: the case of personal social networks.

Cognitively stimulating environments are thought to be protective of cognitive decline and onset of Alzheimer's disease and related dementias (ADRD) through the development of cognitive reserve (CR). CR refers to cognitive adaptability that buffers the impact of brain pathology on cognitive function. Despite the critical need to identify cognitively stimulating environments to build CR, there is no consensus regarding which environmental determinants are most effective. Rather, most studies use education as proxies for CR and little is known about the association between older adults' personal social networks and CR. Using neuroimaging data from 135 older adults participating in the Social Networks in Alzheimer Disease (SNAD) study, this article adopted a residual method for measuring CR and found that large network size, high network diversity, and loosely connected networks were positively associated with greater CR. These results suggest that expansive social networks in later life may constitute cognitively stimulating environments which can be leveraged to build CR and reduce the burden of ADRD.

Role of adjuvant chemotherapy after concurrent chemoradiotherapy in patients with locally advanced cervical cancer.

Aims: With the use of concurrent chemoradiotherapy (CCRT) for locally advanced cervical cancer (LACC), survival outcomes are still not optimal. This study was designed to evaluate the efficacy and safety of adjuvant chemotherapy (ACT) for patients with LACC after treatment with CCRT. Methods: Patients diagnosed with stage IIA-IIIB LACC, were retrospectively analyzed. All patients received cisplatin-based CCRT and were divided into two groups: ACT after CCRT (CCRT + ACT group) and observation after CCRT (CCRT group). Overall survival (OS), progression-free survival (PFS) and adverse effects were recorded and analyzed. Results: In total, 375 patients were included; 262 patients accepted ACT after CCRT while the remaining 113 patients chose observation. With a median follow-up of 40 months, no significant differences were found in the OS rates for patients in the CCRT + ACT and CCRT groups at 1 year, 3 years and the end of follow-up. There was also no significant discrepancy in PFS between groups. Subgroup analysis showed the International Federation of Gynecology and Obstetrics (FIGO) stage and age had negligible influence on both OS and PFS. Acute adverse events (grades 3-4) happened more frequently in CCRT + ACT group than in the CCRT group, with significant differences in neutropenia, anemia and creatinine. Conclusion: ACT after CCRT did not show benefit in survival but did induce some adverse effects. Therefore, this regimen is not recommended unless further large-scale randomized controlled trials are executed.

How Widowhood and Gender Shape the Impact of Maternal Favoritism on Adult Children's Psychological Well-Being.

OBJECTIVES: Our goal was to extend research on within-family differences in mother-child relations in later life by focusing on 2 social structural characteristics of mothers and offspring that may play important roles in shaping the impact of maternal favoritism on adult children's depressive symptoms-mother's marital status and child's gender. METHODS: Mixed-methods data were collected as part of the Within-Family Differences Study from 641 adult children nested within 273 families in which: (a) there were at least 2 living adult siblings, and (b) mothers were married or widowed. RESULTS: Multilevel analyses indicated that perceiving oneself as the child to whom one's mother was most emotionally close was a strong predictor of higher depressive symptoms among daughters of widowed mothers; in contrast, perceptions of favoritism did not predict depressive symptoms among sons of either widowed or married mothers, or daughters of married mothers. Qualitative analyses revealed that daughters, but not sons, of widowed mothers tended to attribute their greater closeness with their mothers to their roles as their mothers' "emotional caregivers," particularly solo caregivers, during times when mothers faced negative life events that neither they nor their children could control or ameliorate. DISCUSSION: The quantitative and qualitative findings we present underscore how social structural positions-in this case, mother's marital status and child's gender-combine with social psychological processes to shape how parent-child relations affect children's well-being in adulthood.

Social Networks and Cognitive Reserve: Network Structure Moderates the Association Between Amygdalar Volume and Cognitive Outcomes.

OBJECTIVES: The cognitive reserve hypothesis has been proposed as a key mechanism explaining the link between social networks and cognitive function but has rarely been empirically tested using neuroimaging data. This study examines whether social network attributes moderate the association between amygdalar volume and cognitive function. METHODS: Data were from the Social Networks in Alzheimer Disease study (N = 154) and Indiana Alzheimer's Disease Research Center. Social networks were measured using the PhenX Social Network Battery. Regional data from magnetic resonance imaging (amygdalar volume [AV]) were analyzed using FreeSurfer software. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) and consensus diagnosis. Linear regression analyses were conducted to test the moderating role of social networks on the association between AV and cognitive function. RESULTS: Participants with greater ability to span multiple social roles and subgroups within their networks scored higher on the MoCA after adjusting for sociodemographic variables, depression, frequency of contact, and AV. Social networks moderated the association between AV and cognitive function. DISCUSSION: Among participants who engaged in diverse and loosely connected social networks, the expected adverse cognitive effects of brain volume in regions implicated in socioemotional processing were attenuated. These findings suggest that cognitive stimulation achieved through social interaction with a diverse array of social relationships across multiple contexts may help promote cognitive reserve.

Why the cognitive "fountain of youth" may be upstream: Pathways to dementia risk and resilience through social connectedness.

Research suggests social connectedness may help older adults with dementia maintain cognitive functionality and quality of life. However, little is known about its specific social and biological mechanisms. This paper proposes two pathways through social bridging (i.e., cognitive enrichment through expansive social networks) and bonding (i.e., neuroendocrine benefits of integration in cohesive social networks). We provide preliminary evidence for these pathways using neuroimaging, cognitive, and egocentric social network data from the Social Networks and Alzheimer's Disease (SNAD) study (N = 280). We found that network size, density, and presence of weak ties (i.e., social bridging) moderated the association between brain atrophy and cognitive function, while marriage/cohabitation (i.e., social bonding) moderated the association between perceived stress and cognitive function. We argue that social connectedness may have downstream implications for multiple pathophysiological processes in cognitive aging, even negating existing structural damage to the brain, making it a strong candidate for clinical or policy intervention.

Non-Spousal Support, Marital Status, and Mortality Risk.

OBJECTIVE: To investigate whether the association between non-spousal support and mortality risk differs by marital status. METHODS: Using data from the National Social Life, Health, and Aging Project (N = 2460), we estimate a series of logistic regression models to assess how non-spousal support moderates the relationship between marital status and mortality across a 5-year period. RESULTS: Never married respondents who had minimal perceived access to non-spousal support had a greater probability of death compared to married respondents with similar levels of non-spousal support. The disparity in mortality risk between these two groups disappeared when non-spousal support was high. DISCUSSION: Although family and friends play an important role in mortality risk in later life, these findings suggest that never married older adults exhibit a heightened dependence on support from non-spousal sources. Future research and policies should explore ways in which never married older adults can be integrated into a supportive social environment.

Social Networks and Cognitive Function: An Evaluation of Social Bridging and Bonding Mechanisms.

BACKGROUND AND OBJECTIVES: Social connectedness has been linked prospectively to cognitive aging, but there is little agreement about the social mechanisms driving this relationship. This study evaluated 9 measures of social connectedness, focusing on 2 forms of social enrichment-access to an expansive and diverse set of loosely connected individuals (i.e., social bridging) and integration in a supportive network of close ties (i.e., social bonding). RESEARCH DESIGN AND METHODS: This study used egocentric network and cognitive data from 311 older adults in the Social Networks in Alzheimer Disease study. Linear regressions were used to estimate the association between social connectedness and global cognitive function, episodic memory, and executive function. RESULTS: Measures indicative of social bridging (larger network size, lower density, presence of weak ties, and proportion of non-kin) were consistently associated with better cognitive outcomes, while measures of social bonding (close ties, multiplex support, higher frequency of contact, better relationship quality, and being married) largely produced null effects. DISCUSSION AND IMPLICATIONS: These findings suggest that the protective benefits of social connectedness for cognitive function and memory may operate primarily through a cognitive reserve mechanism that is driven by irregular contact with a larger and more diverse group of peripheral others.

Personal Network Bridging Potential Across Geographic Context.

OBJECTIVES: Personal networks play a fundamental role in the daily lives of older adults. Although many studies examine how life course factors and personal preferences shape network formation, fewer consider how the places in which older adults live present opportunities and obstacles to cultivate social relationships. In the present study, we explore how geographic context is associated with the ability to bridge social ties within one's personal network. METHODS: We use data from the Person-to-Person Health Interview Survey (N = 709), a representative sample of Indiana residents. Personal network data were collected using 4 name-generating prompts. Logistic regression models and linear regression models were used to assess 2 measures of network bridging. RESULTS: A minority of respondents reported the ability to bridge ties within their networks. Respondents residing in rural and mixed counties were less likely than urban respondents to have at least one member of their network who was completely disconnected from all other members. DISCUSSION: These findings suggest that the communities in which older adults live condition opportunities for accessing unique network resources. Additional research adopting a network perspective is needed to provide insight into geographic disparities occurring among the older population.

Social Isolation and Loneliness Before and During the COVID-19 Pandemic: A Longitudinal Study of U.S. Adults Older Than 50.

OBJECTIVES: The potential impact of social distancing policies during the coronavirus disease 2019 (COVID-19) pandemic on social isolation and loneliness is of increasing global concern. Although many studies focus primarily on loneliness, patterns of social isolation-particularly physical and digital isolation-are understudied. We examined changes in social isolation, physical isolation, digital isolation, and loneliness in U.S. adults older than 50 before and during the lockdown. METHODS: Two waves of the Health and Retirement Study, a national panel sample of U.S. adults older than 50 years, were used. Fixed-effects regression models were fitted to identify within-person change from 2016 to 2020 to examine the impact of social distancing policies during the pandemic. RESULTS: There was an increase in physical isolation and social isolation among respondents during the COVID-19 social distancing policies. However, respondents experienced no change in digital isolation or loneliness. The increase in physical isolation was only present for people with high COVID-19 concern, whereas people with low concern experienced no change in physical isolation. DISCUSSION: Despite an increase in physical isolation due to the social distancing policies, U.S. adults aged older than 50 stayed connected through digital contact and were resilient in protecting themselves from loneliness.

New Structure, Traditional Essence: Patterns of Helping Non-Coresident Parents by Own and Sibling(s)' Gender in China.

As Chinese households are becoming smaller with increasing numbers of adult children and older parents living apart, the extent to which patterns of parental support reflect traditional gender dynamics is under debate. Integrating theories of sibling compensation with ceremonial giving, we tested whether helping non-coresident parents in China is affected by sibship size and how these patterns depend on own and sibling(s)' gender using a sample of 4,359 non-coresident parent-child dyads nesting within 3,285 focal adult children from China Health and Retirement Longitudinal Study 2013. Opposite to patterns in the United States and Europe, we found substitutions of daughters with sons-having more brothers was associated with daughters' reduced probabilities and hours of helping. Sons' patterns of helping were independent of number of brothers and sisters in the family, consistent with the theory of ceremonial giving. These findings reflect the dominance of traditional family dynamics despite changes in family structure.

Substitution of Nonpharmacologic Therapy With Opioid Prescribing for Pain During the COVID-19 Pandemic.

Importance: During the pandemic, access to medical care unrelated to COVID-19 was limited because of concerns about viral spread and corresponding policies. It is critical to assess how these conditions affected modes of pain treatment, given the addiction risks of prescription opioids. Objective: To assess the trends in opioid prescription and nonpharmacologic therapy (ie, physical therapy and complementary medicine) for pain management during the COVID-19 pandemic in 2020 compared with the patterns in 2019. Design, Setting, and Participants: This retrospective, cross-sectional study used weekly claims data from 24 million US patients in a nationwide commercial insurance database (Optum's deidentified Clinformatics Data Mart Database) from January 1, 2019, to September 31, 2020. Among patients with diagnoses of limb, extremity, or joint pain, back pain, and neck pain for each week, patterns of treatment use were identified and evaluated. Data analysis was performed from April 1, 2021, to September 31, 2021. Main Outcomes and Measures: The main outcomes of interest were weekly rates of opioid prescriptions, the strength and duration of related opioid prescriptions, and the use of nonpharmacologic therapy. Transition rates between different treatment options before the outbreak and during the early months of the pandemic were also assessed. Results: A total of 21 430 339 patients (mean [SD] age, 48.6 [24.0] years; 10 960 507 [51.1%] female; 909 061 [4.2%] Asian, 1 688 690 [7.9%] Black, 2 276 075 [10.6%] Hispanic, 11 192 789 [52.2%] White, and 5 363 724 [25.0%] unknown) were enrolled during the first 3 quarters in 2019 and 20 759 788 (mean [SD] age, 47.0 [23.8] years; 10 695 690 [51.5%] female; 798 037 [3.8%] Asian; 1 508 023 [7.3%] Black, 1 976 248 [9.5%] Hispanic, 10 059 597 [48.5%] White, and 6 417 883 [30.9%] unknown) in the first 3 quarters of 2020. During the COVID-19 pandemic, the proportion of patients receiving a pain diagnosis was smaller than that for the same period in 2019 (mean difference, -15.9%; 95% CI, -16.1% to -15.8%). Patients with pain were more likely to receive opioids (mean difference, 3.5%; 95% CI, 3.3%-3.7%) and less likely to receive nonpharmacologic therapy (mean difference, -6.0%; 95% CI, -6.3% to -5.8%), and opioid prescriptions were longer and more potent during the early pandemic in 2020 relative to 2019 (mean difference, 1.07 days; 95% CI, 1.02-1.17 days; mean difference, 0.96 morphine milligram equivalents; 95% CI, 0.76-1.20). Analysis of individuals' transitions between treatment options for pain found that patients were more likely to transition out of nonpharmacologic therapy, replacing it with opioid prescriptions for pain management during the COVID-19 pandemic than in the year before. Conclusions and Relevance: Nonpharmacologic therapy is a benign treatment for pain often recommended instead of opioid therapy. The decrease in nonpharmacologic therapy and increase in opioid prescription during the COVID-19 pandemic found in this cross-sectional study, especially given longer days of prescription and more potent doses, may exacerbate the US opioid epidemic. These findings suggest that it is imperative to investigate the implications of limited medical access on treatment substitution, which may increase patient risk, and implement policies and guidelines to prevent those substitutions.

A latent variable approach to measuring bridging social capital and examining its association to older adults' cognitive health.

Access to cognitive stimulation through social interactions is a key mechanism used to explain the association between personal networks, cognitive health, and brain structure in older adults. However, little research has assessed how best to operationalize access to novel or diverse social stimuli using social network measures, many of which were designed to study information diffusion within large whole networks (e.g., structural holes and bridging social capital). Using data from 277 adults in the Social Networks and Alzheimer Disease (SNAD) study, we aimed to evaluate such measures for use in research on cognitive aging using personal social networks. We found a positive association between individual measures of structural holes and cognitive health, but not with brain structure. Further, we extracted a latent measure of bridging social capital using multiple individual measures (i.e., structural holes, network diversity, weak ties, and network size) and found it was significantly associated with cognitive health and brain structure, supporting the utility of this concept and related measures in the study of cognitive aging. Finally, individual measures may underestimate the effects of multidimensional bridging social capital on cognitive health and brain structure compared to a latent measure that combines them.