Performance of an Abbreviated Lubben Social Network Scale (LSNS-6) in Three Ethnic Groups of Older Asian Americans.

BACKGROUND AND OBJECTIVES: The present study examined the measurement quality and performance of an abbreviated Lubben Social Network Scale (LSNS-6) in three ethnic groups (Chinese, Koreans, and Vietnamese) of older Asian Americans, addressing both within- and cross-group validations. RESEARCH DESIGN AND METHODS: We selected 605 participants aged 50 or older (242 Chinese, 150 Koreans, and 213 Vietnamese) from the 2015 Asian American Quality of Life survey, conducted with self-identified Asian Americans aged 18 or above living in central Texas. We analyzed LSNS-6 data on measurement qualities (internal consistency and corrected item-total correlation), dimensionality (exploratory and confirmatory factor analyses), and correlations with other indicators. RESULTS: LSNS-6 showed very good internal consistency in each ethnic group, and the two-factor structure of family and friends were invariant across the groups. The items on friends demonstrated greater homogeneity than those on family and emerged as a first factor. Both subscale and total scores of LSNS-6 were associated in expected directions with the social and health indicators considered. DISCUSSION AND IMPLICATIONS: The findings confirm the measurement qualities of LSNS-6 within each group and provide support for measurement invariance across the groups. While the observed difference in family and friend networks warrants further investigation, LSNS-6 serves as a viable option for the assessment of social networks. When using LSNS-6 with older Asian Americans, it is highly recommended to use the family/friend subscales in consideration of cultural and immigration contexts.

Impact of the COVID-19 Pandemic on Loneliness and Social Isolation: A Multi-Country Study.

The COVID-19 global pandemic and subsequent public health social measures have challenged our social and economic life, with increasing concerns around potentially rising levels of social isolation and loneliness. This paper is based on cross-sectional online survey data (available in 10 languages, from 2 June to 16 November 2020) with 20,398 respondents from 101 different countries. It aims to help increase our understanding of the global risk factors that are associated with social isolation and loneliness, irrespective of culture or country, to support evidence-based policy, services and public health interventions. We found the prevalence of severe loneliness was 21% during COVID-19 with 6% retrospectively reporting severe loneliness prior to the pandemic. A fifth were defined as isolated based on their usual connections, with 13% reporting a substantial increase in isolation during COVID-19. Personal finances and mental health were overarching and consistently cross-cutting predictors of loneliness and social isolation, both before and during the pandemic. With the likelihood of future waves of COVID-19 and related restrictions, it must be a public health priority to address the root causes of loneliness and social isolation and, in particular, address the needs of specific groups such as carers or those living alone.

A Pilot Randomized Trial of an Intervention to Enhance the Health-Promoting Effects of Older Adults' Activity Portfolios: The Engaged4Life Program.

The purpose of this study was to evaluate the feasibility and outcomes of the Engaged4Life program, an intervention to encourage inactive community-dwelling older adults to embed physical activity, cognitive activity, and social interaction into their everyday lives in contexts that are personally meaningful and natural for them. Fifteen participants were randomized to the intervention group (technology-assisted self-monitoring of daily activity via pedometers and daily tablet-based surveys; psychoeducation + goal-setting via a 3-hour workshop; and peer mentoring via phone 2×/week for 2.5 weeks) and 15 to the control (technology-assisted self-monitoring only). Recruitment was shown to be feasible and efficient, but not able to reach the target for men. Retention rate was 83% and participants manifested high adherence and engagement with the intervention. Though this pilot trial was not powered to demonstrate significant differences between groups, daily steps increased by 431 (11% increase) from baseline to Week 4 for the intervention (p < .05), but decreased by 458 for the control, for a net difference of 889 steps (p < .05). Findings were sustained at Week 8 (p < .01). In a future trial, difficulties in recruiting men, barriers due to the technology-intensive design, and the optimization of secondary outcome measures should be addressed.

When Adults Don't Exercise: Behavioral Strategies to Increase Physical Activity in Sedentary Middle-Aged and Older Adults.

Physical activity is one of the most promising nonpharmacological, noninvasive, and cost-effective methods of health-promotion, yet statistics show that only a small percentage of middle-aged and older adults engage in the recommended amount of regular exercise. This state of affairs is less likely due to a lack of knowledge about the benefits of exercise than to failures of motivation and self-regulatory mechanisms. Many types of intervention programs target exercise in later life, but they typically do not achieve sustained behavior change, and there has been very little increase in the exercise rate in the population over the last decade. The goal of this paper is to consider the use of effective low-cost motivational and behavioral strategies for increasing physical activity, which could have far-reaching benefits at the individual and population levels. We present a multicomponent framework to guide development of behavior change interventions to increase and maintain physical activity among sedentary adults and others at risk for health problems. This involves a personalized approach to motivation and behavior change, which includes social support, goal setting, and positive affect coupled with cognitive restructuring of negative and self-defeating attitudes and misconceptions. These strategies can lead to increases in exercise self-efficacy and control beliefs as well as self- management skills such as self-regulation and action planning, which in turn are expected to lead to long-term increases in activity. These changes in activity frequency and intensity can ultimately lead to improvements in physical and psychological well-being among middle-aged and older adults, including those from underserved, vulnerable populations. Even a modest increase in physical activity can have a significant impact on health and quality of life. Recommendations for future interventions include a focus on ways to achieve personalized approaches, broad outreach, and maintenance of behavior changes.

Validation Study of the Abbreviated Version of the Lubben Social Network Scale Spanish Translation among Mexican and Mexican-American Older Adults.

PURPOSE: To perform a face validity study of the Spanish version of the Lubben Social Network Scale (LSNS-6) among Mexican and Mexican-American older adults. DESIGN AND METHODS: A cross-national qualitative descriptive approach, based on cognitive survey testing and cross-cultural equivalence analysis, was followed to assess the face validity of the Spanish version of the LSNS-6. Data were collected through 2 focus groups in Los Angeles (LA) and 4 in Mexico City (CDMX). Focus groups followed a semi-structured guide. Eligibility criteria included being 60 years and older, native Spanish speaking, and not suffering from significant cognitive impairments. Four initial focus groups were targeted at conducting a face validity assessment of the initial scale, which led to some modifications. The two remaining focus groups reassessed the face validity of the modified version of the Spanish LSNS-6. RESULTS: 56 older adults participated in the focus groups yielding 152 pages of verbatim transcripts. Analysis of the transcripts identified relevant themes affecting how Mexican and Mexican American older adults understood the items from the LSNS-6 Spanish version, among them: labelling of family members and friends, notions of neighborhood, identifying and counting people, and understanding of "private matters". This led to propose a modified Spanish version of the LSNS-6 following a name generating approach, as well as some language and instruction modifications. The face validity of the modified version suggested a better understanding. IMPLICATIONS: The study proposes that the LSNS-6 Spanish version needs to be adapted for its use among Mexican and Mexican American older adults, and we suggest a modified version. This potentially implies that social isolation may be more accurately measured in a vulnerable group of older adults. Further research is needed to ascertain the construct validity and psychometric properties of the modified version.

The Influence of Social Networks and Supports on Depression Symptoms: Differential Pathways for Older Korean Immigrants and Non-Hispanic White Americans.

OBJECTIVES: The current cross-cultural study examines the pathways underlying different formations of social networks and social support systems, which affect depression symptoms among older Korean immigrants and non-Hispanic Whites in the United States. METHOD: Data for this study came from a panel survey of 223 older Korean American immigrants and 201 non-Hispanic White older adults 65 years of age and older living in Los Angeles. Structural equation modeling (SEM) is used to test the proposed conceptual model designed to explain the direct and indirect relationships between social networks and social support on depression symptoms. RESULTS: Empirical evidence from this study indicated different effect of one's social networks and social support on depression by race/ethnicity. DISCUSSION: The work discussed in this article pointed to the need to recognize the role of culture in assessing the relationships between social networks, social support, and health among older adults.

Social engagement across the retirement transition among "young-old" adults in the French GAZEL cohort.

The objective of this study was to test predictors of change in social engagement across the retirement transition in a cohort of 10,692 French utility workers retiring between 1992 and 2004, aged 51-65 in 2004. Three measures of social engagement (organizational activity participation, number of close family members, and number of close friends) were collected in 1991 and 2004; 1991 scores were subtracted from 2004 scores to determine change. We used ordered logistic regression to model predictors of change. Compared with those retiring just before the follow-up measure, those retiring 2-5 years earlier had greater positive change in organizational activity participation (OR 1.22, 95 % CI 1.07, 1.39) and greater positive change in number of close friends (OR 1.19, 95 % CI 1.04, 1.37) after retirement compared with before, but no difference in family contact, and no clear linear trend by retirement timing relative to the follow-up measure. Women were less likely than men to increase organizational activities and contact with close family ties. Poor self-rated health at follow-up consistently predicted decreased engagement. For specific activities, those retired longest had not only the greatest odds of increased political/religious organizational involvement and sports/hobby/leisure involvement but also the greatest odds of decreased volunteering. Those of low midlife socioeconomic status (SES) were more likely to decrease levels of formal engagement from before retirement to after, compared to those of higher SES. Overall, certain changes in social engagement emerged with increasing time in retirement. However, retirement timing was a weaker predictor of change in engagement than factors such as low midlife SES or poor health. Findings suggest that disparities in social engagement may emerge during retirement.

Social network assessment in community-dwelling older persons: results from a study of three European populations.

BACKGROUND AND AIMS: In clinical practice, the status of living alone is often used as the only measure describing an older person's social network. We evaluated whether additional use of a brief social network measure provides relevant additional information in relation to social support and engagement. METHODS: Cross-sectional survey of 6982 community- dwelling adults 65 years or older living in London, UK; Hamburg, Germany; and Solothurn, Switzerland. Data were collected using the self-administered multidimensional Health Risk Appraisal Questionnaire. Multivariate models were used to analyse adjusted correlations between the two measures of social network (living alone status, risk for social isolation with marginal family and friend network subscales) and potential consequences of inadequate social network (marginal emotional or instrumental support, lack of social engagement). RESULTS: Living alone status was more strongly associated with marginal instrumental support [OR=7.6 (95% CI 6.3, 9.1)] than with marginal emotional support [OR=4.2 (95% CI 3.4, 5.1)], and showed no statistically significant association with lack of social engagement [OR=0.9 (95% CI 0.8, 1.0)]. Risk of social isolation was more strongly related to marginal emotional support [OR=6.6 (95% CI 5.4, 8.0)] than to marginal instrumental support [OR=3.3 (95% CI 2.8, 4.0)], and was moderately related to lack of social engagement [OR=2.9 (95% CI 2.5, 3.4]. Marginal family and friend network subscales showed consistent and unique associations with social support and social engagement. CONCLUSION: Findings suggest that living alone status and a brief measure of social network identifies distinctive at-risk groups and potential pathways for intervention. Geriatric assessment programs including both social network measures may provide useful information about potentially modifiable social network risks in older persons.

Social network, cognitive function, and dementia incidence among elderly women.

OBJECTIVES: We examined whether social networks had a protective association with incidence of dementia among elderly women. METHODS: We prospectively studied 2249 members of a health maintenance organization who were 78 years or older, were classified as free of dementia in 2001, and had completed at least 1 follow-up interview in 2002 through 2005. We used the Telephone Interview for Cognitive Status-modified, the Telephone Dementia Questionnaire, and medical record review to assess cognitive status. We used the Lubben Social Network Scale-6 to assess social network. We estimated hazard ratios for incident dementia with Cox proportional hazards models, adjusting for age at entry, education, hormone use, cognitive status scores, and health conditions. RESULTS: We identified 268 incident cases of dementia during follow-up. Compared with women with smaller social networks, the adjusted hazard ratio for incident dementia in women with larger social networks was 0.74 (95% confidence interval=0.57, 0.97). CONCLUSIONS: Our findings suggest that larger social networks have a protective influence on cognitive function among elderly women. Future studies should explore which aspects of social networks are associated with dementia risk and maintenance of cognitive health.

Network composition and health behaviors among older Samoan women.

PURPOSE: The purpose of this article is to explore how kin and nonkin social support networks influence health behaviors among older Samoan women. METHOD: Using a cross-sectional survey design, 290 Samoan women who were age 50 years and older were interviewed. Using separate logistic regressions, each health behavior was regressed on age and kin and nonkin social support networks after controlling for background characteristics and health status. RESULTS: In multivariate analyses, higher scores on kin increased the likelihood of never salting food, getting screened for diabetes in the past year, and having had a mammogram in the past 2 years, whereas higher scores on nonkin increased the likelihood of exercising at all and ever trying to lose weight. DISCUSSION: Kin networks positively affect mostly chronic disease-related health behaviors, whereas nonkin networks positively affect mostly lifestyle-related health behaviors.

Performance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations.

PURPOSE: There is a need for valid and reliable short scales that can be used to assess social networks and social supports and to screen for social isolation in older persons. DESIGN AND METHODS: The present study is a cross-national and cross-cultural evaluation of the performance of an abbreviated version of the Lubben Social Network Scale (LSNS-6), which was used to screen for social isolation among community-dwelling older adult populations in three European countries. Based on the concept of lack of redundancy of social ties we defined clinical cut-points of the LSNS-6 for identifying persons deemed at risk for social isolation. RESULTS: Among all three samples, the LSNS-6 and two subscales (Family and Friends) demonstrated high levels of internal consistency, stable factor structures, and high correlations with criterion variables. The proposed clinical cut-points showed good convergent validity, and classified 20% of the respondents in Hamburg, 11% of those in Solothurn (Switzerland), and 15% of those in London as at risk for social isolation. IMPLICATIONS: We conclude that abbreviated scales such as the LSNS-6 should be considered for inclusion in practice protocols of gerontological practitioners. Screening older persons based on the LSNS-6 provides quantitative information on their family and friendship ties, and identifies persons at increased risk for social isolation who might benefit from in-depth assessment and targeted interventions.

An international approach to community health care for older adults.

Worldwide population ageing, concomitant increases in disability rates, and changes in family health care systems require an examination of current service delivery to optimize use of societal resources in the future. This article examines a community health care approach suggested by research conducted by the World Health Organization Kobe Centre for Health Development (WKC). The WKC approach, which uses a cross-national perspective, envisions a community health care system that integrates health and social services and spans health promotion, primary care, and long-term care. Prototypical approaches for organizing community health care include communal, marketplace, case management, and managed care. The ramifications of these approaches are examined from the perspectives of the older adult, the family, and formal service providers.

A National Survey of Aging Curriculum in Schools of Social Work.

The present studv reports the results of a nationwide survey which examined the current status of gerontological education in B.S.W. and M.S.W. proprams. The survey findings register a decline in gerontological curricula but an increase in student intrest in aging. The survey also notes that lack of trained faculty and a full curriculum are most often mentioned as major barriers to further gerontological curricula development. The paper considers implications of these findings along with recommendations for expanding aging content at both the undergraduate and graduate level of social work education.

A Geriatric Education Center Faculty Development Program Dedicated to Social Work to Social Work.

This paper describes the effort of the California Geriatric Education Center (CGEC) at the University of California, Los Angeles (UCLA) to rectify the severe shortage of social work faculty trained in aging as reported in a recent national survey of schools of social work. The lack of gerontological social work faculty is a major barrier to the development of aging curricula in BSW and MSW programs. The CGEC Social Work Faculty Development Program (SWFDP) presents a model for faculty development in gerontology which addresses major issues in social work education.