Feeling Alone Together: Loneliness in Older Adults with Cognitive Impairment and Their Family Caregivers with Low Mastery.

INTRODUCTION: Loneliness in older persons with cognitive impairment (PCI) may beget loneliness in their family caregivers, depending on buffering resources caregivers possess. This study examined the association between loneliness in older PCI and loneliness experienced by their family caregivers, and the moderating role of caregiver mastery in this association. METHODS: Dyadic data from 135 PCI and their family caregivers in Singapore were analyzed using multivariable regression. Loneliness was measured using a three-item UCLA loneliness scale. Mastery was assessed using a seven-item Pearlin instrument. RESULTS: Multivariable regression showed that PCI loneliness and caregiver loneliness were weakly associated, taking other covariates into account. Notably, a significant interaction between PCI loneliness and caregiver mastery was observed, indicating that PCI loneliness was associated with caregiver loneliness only when caregivers had low mastery. CONCLUSION: Lonely PCI may share their feelings of loneliness with their caregivers, and this can lead to loneliness among caregivers if they have low mastery. Promoting caregiver mastery may help reduce caregiver loneliness, directly and indirectly as a buffer against PCI loneliness.

Informal Caregiver Social Network Types and Mental Health: The Mediating Role of Psychological Resilience.

Little is known about whether and why social networks protect mental health among informal caregivers. This study examined the association between informal caregiver social network types and depressive symptoms and the mediatory mechanism of psychological resilience. Latent class analysis, applied to cross-sectional data on 278 Singaporean caregivers, identified four social network types: restricted (42%), friend (16%), family (21%), and diverse (21%). Path analysis showed that the diverse social network type, compared to the restricted social network type, was associated with a lower level of depressive symptoms, and psychological resilience fully mediated this association. Interventions should help caregivers to maintain social networks with their family and friends.

Informal caregiver social network typologies were explored using data from Singapore.Diverse, friend, family, and restricted social network types were identified.Diverse social network type was negatively associated with depressive symptoms.Psychological resilience fully mediated the association.

Engagement in Physical Activity and Quality of Life Among Informal Caregivers of Older Adults.

OBJECTIVES: This study examined (1) the association of caregiver engagement in physical activity (PA) with their quality of life (QoL) and (2) the moderating effect of caregiver engagement in PA on the relationship between several caregiving stressors and their QoL, among informal caregivers of older adults. METHODS: Multivariable regression was applied to data from 278 adult caregivers, aged 23-90 years, in Singapore. RESULTS: Engagement in PA by caregivers was positively associated with psychological, social relationships, and environment domains of their QoL. Caregiver engagement in PA also mitigated the negative association between care-recipient mood impairment and QoL of caregivers in the physical health and social relationships domains. DISCUSSION: QoL of caregivers may be improved or protected by their regular engagement in PA, especially when their care-recipients have mood impairment. Policymakers and practitioners should encourage caregivers to engage in PA and provide them with the necessary support to do so.

Older adult patient preferences for the content and format of prescription medication labels - A best-worst scaling and discrete choice experiment study.

BACKGROUND: Patient preferences for the content and format of prescription medication labels (PMLs, i.e., sticker labels placed on medication bottles/packets at dispensing) have been extensively studied. However, accommodating all preferences on PMLs is impractical due to space limitations. Understanding how patients prioritise the content and format attributes of PMLs can inform improvements while working within PML space constraints. OBJECTIVES: We aimed to (1) identify a ranking of medication-related content attributes to be prioritised on PMLs using best-worst scaling (BWS), and (2) determine the relative importance of format attributes when incorporated onto PMLs using discrete choice experiment (DCE), from the perspective of older adult patients in Singapore. METHODS: Attributes were informed by our prior qualitative study and PML best practice guidelines. For the BWS component, the assessed content attributes were indication, precautions, interaction or paired medicines, food instructions, side effects, expiry date, and missed dose action, all of which are currently not legally mandated on PMLs in Singapore. A BWS object case was used to rank the content attributes. For the DCE component, in a series of questions, participants were asked to choose between two PML options each time, that varied in the presentation of dosage-frequency instructions, font size, presentation of dosage, presentation of precautions, and font colour of precautions. A mixed logit model estimated the relative utilities of format attribute levels, enabling the calculation of importance scores of the format attributes. RESULTS: The study recruited 280 participants (mean age: 68.8 ± 5.4 years). The three most-preferred content attributes were indication, precautions and interaction or paired medicines. The top three format preferences were tabular style presentation of dosage-frequency instructions, large font size and precautions in red colour. CONCLUSIONS: Healthcare institutions should consider improving their PMLs based on the leading content and format preferences voiced by older adult patients. The methodology adopted in the study can also be used for aligning the content and format of other patient education materials with patient preferences.

Health Profiles among Community-Dwelling Older Adults with Cognitive Impairment and Their Implications for Caregiving Experience.

INTRODUCTION: Identifying health conditions of persons with cognitive impairment (PCI) in the community and exploring their implications for caregiving experience are vital for effective allocation of healthcare resources. This study examined distinct PCI health profiles among community-dwelling PCI and their association with caregiving burden and benefits. METHODS: Latent profile analysis and multivariable regression were applied to dyadic data from 266 PCI and their caregivers in Singapore. RESULTS: Three PCI health profiles were identified: less impaired (40% of PCI), moderately impaired (30%), and severely impaired (30%). Caregivers for severely impaired PCI were more likely to report a higher level of caregiving burden, and caregivers for moderately impaired PCI were more likely to report a higher level of caregiving benefits, compared to caregivers for less impaired PCI. CONCLUSION: The findings captured heterogeneity in health status among PCI in the community. Tailored interventions, based on PCI health profiles, should be designed to reduce caregiving burden and increase caregiving benefits.

Reciprocal Relationship Between Lifelong Learning and Volunteering Among Older Adults.

OBJECTIVES: Lifelong learning and volunteering contribute to not only health and well-being, but also social inclusion and cohesion among older adults. However, less is known about whether lifelong learning and volunteering promote each other. This study examined the reciprocal relationship between older adults' lifelong learning and volunteering and whether the relationship varied by the purpose of lifelong learning. METHODS: Cross-lagged panel models were applied to data on 2,608 older adults, aged 60 years and older, from 2 waves of a national longitudinal study from Singapore. RESULTS: We found a bidirectional relationship between lifelong learning and volunteering. However, when job-related and nonjob-related lifelong learning were considered separately, only nonjob-related lifelong learning predicted volunteering. On the other hand, volunteering predicted both job-related and nonjob-related lifelong learning. DISCUSSION: Lifelong learning leads to volunteering, and vice versa, creating a virtuous circle of productive social engagement in later life. Programs or initiatives engaging older adults in either productive activity should promote and provide opportunities for participation in the other activity.

Does a reciprocal relationship exist between social engagement and depression in later life?

OBJECTIVES: We examine if reciprocal associations exist between formal and informal social engagement and depression in older adults. METHOD: We apply dynamic panel-data structural equation models accompanied with the maximum likelihood estimator (ML-SEM) to the seven waves of data of the Korean Longitudinal Study of Aging (KLoSA). RESULTS: Formal social engagement in and through various voluntary groups exerts both cross-lagged and proximal effects in lessening depressive symptoms. In contrast, informal social engagement with familiar persons exhibits only proximal association with depression. Conversely, depression does not reciprocate a cross-lagged effect on either type of social engagement. CONCLUSION: The study confirms that formal social engagement in and through various voluntary groups produces a protective effect against depression for older adults across time, supporting the mental health advantage of formal engagement.

The Reciprocal Relationship Between Social Engagement and Cognitive Function Among Older Adults in South Korea.

A greater number of studies have examined the impact of social engagement on cognitive function rather than the other way around, leaving their reciprocal association underexplored. Furthermore, formal and informal social engagement are not differentiated, although they may have independent relationships with cognitive function. This study aims to identify (1) whether informal and formal social engagements are effective in maintaining cognitive health and (2) if cognitive function has a bidirectional effect on social engagement. The study applies a dynamic panel data structural equation modeling with a maximum likelihood estimator (ML-SEM) to the Korean Longitudinal Study of Aging (KLoSA) data. The results confirm that frequent participation in organizational activities is more robustly associated with cognitive function than memberships or informal social contact. Concerning the bidirectional relationship, the cognitive function increases the degrees of informal and formal engagement. The study thus validates a reciprocal association between social engagement and cognitive function.

Lonely in a Crowd: Social Isolation Profiles and Caregiver Burden Among Family Caregivers of Community-Dwelling Older Adults With Cognitive Impairment.

OBJECTIVES: This study identified distinct social isolation profiles among caregivers, each formed by varied combinations of social disconnectedness and loneliness, and examined if and how the profiles were associated with caregiver burden. METHODS: Latent class analysis and multivariable regression were applied to data from 266 caregivers of community-dwelling older Singaporeans with cognitive impairment. RESULTS: Two caregiver social isolation profiles were identified: strongly connected, not lonely (86%), and moderately connected, lonely (14%). Moderately connected and lonely caregivers tended to perceive a higher level of burden than strongly connected and not lonely caregivers. Moderately connected and lonely caregivers were also more likely to be burdened by their care recipients' poor health than their connected and not lonely counterparts. DISCUSSION: Caregivers who feel "lonely in a crowd" are vulnerable to caregiving stress and burden. Tailored interventions, such as cognitive behavioral therapy, are needed to reduce the loneliness of moderately connected caregivers.

Met and Unmet Needs of Older Adults With Cognitive Impairment, and Burden and Benefits of Their Family Caregivers.

OBJECTIVES: This study examined the association between met and unmet needs of older adults with cognitive impairment living in the community and unique types of caregiving experience, each comprising different levels of caregiving burden and benefits. METHODS: Latent class analysis and multivariable regression were applied to data on 266 caregivers of community-dwelling Singaporean older adults, aged 60 years and above, with cognitive impairment who participated in a community-based dementia care study in 2018. RESULTS: Three unique types of caregiving experience were identified: satisfied (low burden and high benefits; 54% of caregivers), dissatisfied (low burden and low benefits; 35%), and intensive (high burden and high benefits; 11%). Met needs were positively associated with satisfied caregiving experience (vs. dissatisfied caregiving experience), and both met and unmet needs were positively associated with intensive caregiving experience (vs. dissatisfied caregiving experience). Specifically, caregivers tended to have satisfied caregiving experience if older adults' care needs in daytime activities or mobility were met. DISCUSSION: Fulfillment of unmet needs of older adults with cognitive impairment is associated with a satisfied caregiver experience characterized by lower caregiver burden and greater caregiver benefits. Identification of and tailored interventions for unmet care needs of older adults will likely promote satisfied caregiving experience.

Care Needs Profiles and Their Association with Caregiver Strain among Community-Dwelling Older Adults with Cognitive Impairment.

INTRODUCTION: This study examined distinct profiles of met and unmet care needs among community-dwelling older adults with cognitive impairment and their association with caregiver strain. METHODS: Latent class analysis and multivariable regression were applied to data from 266 caregivers of older Singaporeans, aged 60 years and above, with cognitive impairment. Care needs were evaluated by caregivers using the Camberwell Assessment of Need for the Elderly. Caregiver strain was measured by the Zarit Burden Interview. RESULTS: Four need profiles were identified: (1) no need (38% of caregivers), (2) met social and memory needs (29%), (3) no social and met memory needs (17%), and (4) unmet social and memory needs (16%). The unmet social and memory needs profile was associated with a higher level of caregiver strain, compared to the no need profile. DISCUSSION: A person-centered approach captured heterogeneity in the care needs of community-dwelling older adults with cognitive impairment. Policymakers should develop tailored interventions based on need profiles that may help reduce caregiver strain.

The Negative Impact of Adult Children's Marital Dissolution on Older Parents' Mental Health in South Korea.

OBJECTIVE: Little is known about whether and the extent children's marital dissolution deteriorates older parents' mental health. This study examines the association of children's marital dissolution with parents' mental health, and whether children's gender and intergenerational contact and support moderate such an association in South Korea, where family lives are strongly linked under the Confucian collectivistic legacy. METHODS: We apply fixed-effects models on 15,584 parent-child dyads nested in 5,673 older parents (45-97 years in Wave 1) participating in the four waves of the Korean Longitudinal Study of Aging (KLoSA), conducted from 2006 to 2012. RESULTS: In South Korea, a son's transition to marital dissolution is associated with higher levels of parents' depressive symptoms. Frequent parent-son contacts of at least once a week, living with a son, and increasing financial transfers from parents to a son tend to reduce the negative association of the son's marital dissolution with parents' depressive symptoms. DISCUSSION: The findings imply that a son's transition to marital dissolution, as a later-life stressor, is detrimental to parents' mental health in a patrilineal Asian cultural context. The study also highlights the importance of intergenerational bonding in mitigating the negative impact of children's marital dissolution upwardly transmitted to their older parents.

Transitions in Social Network Types over Time among Older Adults.

OBJECTIVE: Network typology studies have identified heterogeneous types of older adults' social networks. However, little is known about stability and change in social network types over time. We investigate transitions in social network types among older adults, aged 60 years and older, and factors associated with such transitions. METHODS: We used data on 1,305 older adults, participating in 2 waves of a national, longitudinal survey, conducted in 2016-2017 and 2019, in Singapore. Latent transition analysis identified the distinct types of social networks and their transition patterns between the waves. Multinomial logistic regression examined the association of baseline and change in physical, functional, and mental health and baseline sociodemographic characteristics with network transitions into more diverse or less diverse types. RESULTS: We found 5 social network types at both waves, representing the most to the least diverse types - diverse, unmarried and diverse, extended family, immediate family, and restricted. Between waves, about 57% of respondents retained their social network type, whereas 24% transitioned into more diverse types and 19% into less diverse types. Those who were older and less educated and those with worsening functional and mental health were more likely to transition into less diverse types versus remaining in the same type. DISCUSSION: The findings capture the dynamics in social network composition among older adults in the contemporary aging society. We highlight sociodemographic and health disparities contributing to later life social network diversity.

Transitions between social network profiles and their relation with all-cause mortality among older adults.

BACKGROUND: The importance of social network in mortality among older adults has been acknowledged. However, existing studies typically overlook the interplay among social network indicators, and seldom consider the change in social network over time. We take a person-centered approach to identify transitions between social network profiles, and examine the linkage of such transitions with subsequent mortality risk. METHODS: Data came from 2738 older Singaporeans enrolled in a longitudinal study. Latent transition analysis examined nine social network indicators assessed at two time points, two years apart to reveal the corresponding transitions between social network profiles. Adjusted Cox regression then associated the identified transitions with all-cause mortality risk in the subsequent four years. RESULTS: We observed three diverse social network profiles (that featured diversified social interaction and involved both household and non-household members) and three relatively restricted social network profiles (that focused on household or non-household members). Compared to sustained diverse profiles over time, sustained restricted profiles or a transition from diverse to restricted profiles entailed increased mortality risk. The mortality risk following a restricted-to-diverse profile transition could be as low as that associated with sustained diverse profiles. CONCLUSIONS: Dynamics of social network profiles have implications for mortality risk in later life. To promote longevity, initiatives are needed to help older people to maintain or shift to diverse social network profiles.

Types of Caregiving Experience and Their Association With Caregiver Depressive Symptoms and Quality of Life.

ObjectiveThis study examines distinct types of caregiving experience, each formed by varied combinations of caregiving burden and benefits, and their association with caregiver depressive symptoms and quality of life. Methods: We apply latent profile analysis and multivariable regression to data on 278 caregivers participating in the Caregiving Transitions among Family Caregivers of Elderly Singaporeans (TraCE) study in 2019-2020. Results: We identify four caregiving experience types: (1) balanced (low burden and moderate benefits, 40% of caregivers), (2) satisfied (low burden and high benefits, 33%), (3) intensive (high burden and high benefits, 17%), and (4) dissatisfied (moderate burden and low benefits, 10%). Caregivers with dissatisfied and intensive caregiving experience tend to report higher depressive symptoms and lower quality of life compared to those with satisfied caregiving experience. Discussion: A person-centered approach helps capture the heterogeneity in caregiving experience. Policymakers should develop tailored interventions by caregiving experience types for promoting caregiver well-being.