Assessment of a digital intervention program with Holocaust survivors.

OBJECTIVE: This study evaluated a digital intervention program with aging Holocaust survivors. Participants received a tablet device and were coupled with a volunteer who assisted them to use the tablet. The study aimed to assess which characteristics of the Holocaust survivors are linked with more frequent use of digital communication at the end of the program. METHODS: Information was collected by telephone interviews with 91 survivors before and 54 after participating in the program. We combined this data with digital usage data from the tablets. Regression models examined the characteristics of Holocaust survivors that were related to higher frequency of using digital communication technologies during the intervention. RESULTS: The Holocaust survivors expressed high satisfaction with the program. They increased their frequency of using digital communication technologies-text correspondence and video chats with friends and family. Regressions showed that Holocaust survivors who reported increased digital communication were characterized at the start of the intervention by having fewer post-traumatic stress symptoms, higher levels of flourishing (reflecting a more meaningful life and higher well-being), being lonelier, and were also more satisfied with the program at follow-up. CONCLUSION: The pilot program benefited the aging Holocaust survivors. Further programs should be developed to increase the digital communication of vulnerable older populations, such as trauma survivors.

A prospective association between social isolation and cognitive performance among older adults in Europe: the role of loneliness and poor oral health.

OBJECTIVES: The relationship between social isolation, loneliness, and tooth loss and cognition in older people is poorly understood. We examine how social isolation and cognitive performance are associated prospectively among older adults, as well as how tooth loss and loneliness are related to this association. METHODS: Using data from 26,168 participants aged ≥50 from the Survey of Health, Ageing and Retirement in Europe (SHARE), we explored the association between social isolation, loneliness, tooth loss and cognition. We used bootstrapping with resampling strategies for testing a moderated mediating model. RESULTS: Higher social isolation was associated with poorer cognitive performance (B = -0.20, 95% CI = -0.03, -0.01; R2 =0.60), an association mediated by the respondent's number of missing teeth (B = -0.001, 95% CI = -0.002, -0.001). Higher levels of social isolation were associated with a greater number of missing teeth, and a higher number of missing teeth was linked with poorer cognition. We also found that loneliness moderated the relationship between social isolation and both the number of missing teeth (B = -0.11, p = 0.047) and cognitive performance. CONCLUSION: In later life, social isolation and loneliness are associated with shoddy oral health and poor cognitive status. Clinicians and policymakers should be aware of both the association between social isolation and feelings of loneliness on dentition and oral health and their relationship to the cognitive status of older adults.

Employment over the life course and post-retirement social networks: a gendered perspective.

OBJECTIVES: The present study examines how different lifelong employment patterns are related to social relationships in old age, and whether there are gender differences in the impact of lifelong employment patterns. DESIGNS AND PARTICIPANTS: The study was based on data collected among European adults as part of the Health, Aging and Retirement Survey in Europe (SHARE) and focuses on retired adults. MEASUREMENTS: The study combines data on social relationships, collected in 2015, with retrospective data on employment history (number of jobs and years of employment) collected in 2017. RESULTS: The findings show that adults who worked in more jobs had overall better structural characteristics of their later life networks - they had larger social networks and were more likely to include children and friends within those networks but less likely to include their spouse. On the other hand, working in more jobs was related to less emotional closeness with the network. These results varied between men and women; women who were involved in the labor market over their life had larger social networks and tended to include friends as confidants. Among men, working for more years was related to higher emotional closeness with the social network. CONCLUSIONS: The study may indicate a gendered pattern of social advantages and disadvantages to involvement in the labor market over the work course. Practitioners should consider the lifelong employment of adults to identify those who might be at risk of social isolation.

Physical distancing is related to fewer electronic and in-person contacts and to increased loneliness during the COVID-19 pandemic among older Europeans.

PURPOSE: During the COVID-19 pandemic older adults are asked to maintain physical distancing, which can be linked to loneliness. While older people are encouraged to use electronic communication to stay socially connected, it remains an open question whether electronic contacts are related to lower loneliness during the pandemic. This study examined the associations of physical distancing during the pandemic with loneliness and the role of in-person and electronic contacts with children and non-kin as explaining these associations across European regions. METHODS: The study used data from Survey of Health, Ageing and Retirement in Europe (SHARE), collected during the COVID-19 pandemic in 2020. Mediation and moderation analyses tested the direct and indirect associations between physical distancing, contact frequency and loneliness, as well as the differences across European regions. RESULTS: The results indicate that adults who reported higher frequency of physical distancing also felt lonelier during the pandemic. This association was partly explained by social contacts-those who practiced physical distancing maintained less in-person contact with children and non-kin and less electronic contact with non-kin, which were related to feeling lonelier. Adults in Southern European countries felt lonelier and reported more frequent contacts. The moderation analyses showed that the link between physical distancing and loneliness was found in the northern region, but not in the southern and eastern regions of Europe. CONCLUSION: This study can indicate that attention should be paid to adults who may struggle to maintain social contacts in light of physical distancing guidelines.

Psychological reactions to the coronavirus pandemic: a comparative study of Holocaust survivors and other older adults in Israel.

BACKGROUND: The current study examines psychological reactions to the COVID-19 pandemic among older adults living in Israel. Based on the 'life events, stress, coping and health theory,' we hypothesized that due to their traumatic early life history and dearth of emotional and physical coping resources, Holocaust survivors would be more vulnerable than other older adults to the negative effects of this difficult and prolonged life event on their mental health. METHODS: Based on structured questionnaires with closed questions, we interviewed 306 Holocaust survivors and non-survivors aged 75 + during the COVID-19 pandemic. RESULTS: Univariate data analysis showed that Holocaust survivors had fewer coping resources in terms of health status and educational level than non-survivors. As expected, Holocaust survivors also reported a greater extent of COVID-19-related anxiety, and more depression, which worsened during the pandemic. However, both groups did not differ in their will to live, which is an indicator of general well-being and commitment to continue living. In multivariate analyses conducted to explain COVID-19 anxiety in the entire sample and separately on each of the two groups, the best explanatory variables were other psychological variables especially increased depression. CONCLUSIONS: It seems that Holocaust survivors are more emotionally vulnerable to the pandemic's negative effects than other older adults, in support of the 'life events, stress, coping and health theory,' but despite this, they show resilience in their will to continue living. Policy makers and practitioners are recommended to identify Holocaust survivors and other vulnerable older people and investigate their specific needs. Interventions should include practices for maintaining and boosting resilience and well-being by increasing appropriate emotional and cognitive internal and external coping resources, especially during prolonged periods of hardship.

Ageism from a cross-cultural perspective: results from a national survey of Israelis over the age of 50.

OBJECTIVES: We examined differences across three groups in Israel to test the double jeopardy versus the intersection escape hypotheses-which evaluate whether being older and belonging to an underrepresented group serves as a double burden, exposing older minorities to higher levels of perceived ageism or on the contrary, older age serves as a protective factor, especially for underrepresented groups. DESIGN: A cross-sectional, nationally representative sample, consisting of three groups: Veteran Israelis, Israeli Arabs and immigrants from the Former Soviet Union. The latter two groups represent underrepresented (minority) populations in Israel. SETTING: Community-dwelling Israelis over the age of 50. PARTICIPANTS: The sample was composed of 1570 participants. MEASUREMENT: To examine the double jeopardy versus the intersectional escape hypothesis, self-perceptions of aging (SPA) and perceived age-based discrimination in the healthcare system were examined as outcome variables. RESULTS: Among Israeli Arabs, being older was related to better SPA, whereas among the immigrants being older was related to worse SPA. As immigrants became older, they were more likely to report ageist experiences. Israeli Arabs reported higher levels of ageist experiences, regardless of their age. CONCLUSIONS: The findings point to certain groups that require education about ageism and the aging processes and might require further protection from the experiences of ageism. The findings also point to the relevance of different theoretical paradigms that advocate for the consideration of culture and group membership in the understanding of the experiences of ageism.

Self-perceptions of aging and depressive symptoms: the mediating role of loneliness.

Objectives: Depression is a major health concern for both individuals and societies. Hence, understanding the risk factors for depression is of importance. As individuals grow older, the way in which they perceive the aging process may have a significant influence on their physical and mental health. More negative perceptions of aging could put individuals at risk for social withdrawal, causing loneliness and resulting in higher levels of depressive symptoms.Methods: We use the Health and Retirement Survey, a large and longitudinal dataset spanning over a period of 8 years, to examine a model in which loneliness mediates the relationship between self-perceptions of aging and depressive symptoms.Results: Our findings suggest that loneliness indeed mediates the relationship between self-perceptions of aging and depressive symptoms.Conclusions: The results highlight to the importance of the way people view the aging process in shaping their social and mental well-being. Practitioners may want to address self-perceptions of aging when helping older adults cope with loneliness and depressive symptoms.

A prospective association between tooth status and cognitive performance among older adults in Europe.

OBJECTIVES: This study set out to examine both the longitudinal association between tooth status and cognitive performance among older adults in Europe, and the mediating effects of loneliness and quality of life on this association. METHODS: We conducted a prospective analysis using data from 38,614 participants aged 50 or older, taken from the Survey of Health, Ageing and Retirement in Europe (SHARE) of 2013 (baseline) and 2015 (follow up). Bootstrapping with resampling strategies was used for testing a multiple mediator model. RESULTS: The average age of participants was 66.9 (SD = 9.4). About 23% of the participants had full sets of their own teeth and 38.2% had missing teeth fully replaced by dental implants or dentures. Participants who had partially replaced teeth (B = 0.038, p < 0.001), and with fully replaced teeth (B = 0.041, p < 0.001), or had all their teeth in place (B = 0.055, p < 0.001), had better cognitive performance compared to those who did not replace their missing teeth. It was also found that quality of life and loneliness partially mediated these relationships - Having all teeth in place or replacing all or partially missing teeth was found to affect cognitive performance also via improved quality of life and through lower loneliness. CONCLUSION: In later life, poor tooth status can be directly associated with cognitive decline and indirectly linked to cognitive performance, in light of decreasing quality of life and increasing loneliness. Clinicians should be aware of both the impact of poor tooth status on cognitive status and the implications for the wellbeing of older adults.

Reciprocal Effects of Marital Idealization and Marital Satisfaction Between Long-Wed Spouses Over Time.

Marital idealization is defined as an interpersonal mode of self-deception whereby husbands and wives convey an exceedingly positive portrayal of their spouse and relationship (e.g., "My spouse has never made me angry"). For the Marriage and Health Study, we obtained responses from 119 long-wed couples at baseline, 1- and 2-years later (M = 34 years married). We first computed and compared contemporaneous actor-partner interdependence models (APIMs) suggesting that marital satisfaction predicts marital idealization within and between spouses; the reverse APIM was not supported (i.e., marital idealization did not predict marital satisfaction). Yet our analyses suggest the question should be answered with longitudinal data. When reported contemporaneously, husbands' marital satisfaction predicts marital idealization by their wives. The same cross-over effect is observed for wives-but not concomitantly, only in future. That is, marital satisfaction and idealization reported by wives predicts marital idealization reported by their husbands 2-years later.

Book-Oriented Environment in Childhood and Current Cognitive Performance among Old-Aged Europeans.

INTRODUCTION: Identifying early-life factors that protect against compromised late-life cognition is of great public health interest. We aimed to explore the associations between book-oriented environment in childhood and late-life cognitive performance in the Survey of Health, Ageing and Retirement in Europe (SHARE). METHODS: The sample included 8,239 individuals aged ≥65 years (N = 8,239) free of stroke, Parkinson's disease, or Alzheimer's disease, who participated in both waves 4 (2011) and 5 (2013) of SHARE. Book-oriented environment was assessed by the self-reported home library size during childhood. Cognitive performance was assessed using tests of memory and verbal fluency. Covariates included education and measures of current health, lifestyle, and financial status. Additionally, interactions with age and education were assessed. RESULTS: After controlling for potential confounders, having large home libraries was related to better performance on the immediate and delayed memory (ß = 0.11 ± 0.02, p < 0.001; ß = 0.13 ± 0.02, p < 0.001) and the verbal fluency tests (ß = 0.14 ± 0.06, p < 0.001) and to a lesser decline in these domains (ß = 0.08 ± 0.01, p < 0.001; ß = 0.09 ± 0.02, p < 0.001; and ß = 0.09 ± 0.06, p < 0.001, respectively). Significant interactions were observed between library size and age such that larger home library was more strongly associated with improved immediate memory (p = 0.016), delayed memory (p < 0.001), and verbal fluency (p = 0.003) and with less cognitive decline (p = 0.013, p < 0.001, and p = 0.095, respectively) among the younger-old (<80 years) compared to the oldest-old (≥80 years) participants. No effect modification by education was observed. CONCLUSIONS: These findings suggest that early-life book-oriented environment may be important in shaping cognitive aging.

Social network type and subsequent cognitive health among older Europeans.

OBJECTIVES: One's personal social network constitutes a contextual framing factor for late-life cognitive function. This study examined the association between network type at baseline and changes in three cognitive measures: immediate recall, delayed recall, and fluency, two years hence, among Europeans aged 50 and older. PARTICIPANTS: Data were taken from Waves four and five of the Survey of Health, Ageing, and Retirement in Europe of adults aged 50 and above (N = 50,071). MEASUREMENTS: The latent class analysis was applied to a set of criterion variables. The procedure yielded five distinct network types: multi-tie (6%), family-rich (23%), close-family (49%), family-poor (12%), and friend-enhanced (10%). The network types were then regressed on the cognition measures at follow-up, controlling for the respective baseline cognition scores, as well as for age, gender, education, self-rated health, mobility difficulty, and country. RESULTS: Respondents in family-poor network types had poorer cognition scores at follow-up, compared to those in the modal close-family network, while those in multi-tie networks had consistently better scores. The family-rich network and the friend-enhanced network also had a somewhat better cognitive function. CONCLUSIONS: Having varied sources of network ties, e.g. friendship ties and/or several types of family relationships, is beneficial to the cognitive health of older adults over time. Networks based mainly on ties with relatives other than spouse and children, on the other hand, have poorer cognitive outcomes. Older people in this latter group face an increased risk for cognitive decline and should receive assistance in enhancing their interpersonal environments.

The outcomes of treatment for homebound adults with complex medical conditions in a hospital-at-home unit in the southern district of Israel.

BACKGROUND: A model of hospital-at-home services called the Home Care Unit ("the unit") has been implemented in the southern region of the Clalit Healthcare Services in Israel. The aim of the present study was to characterize this service model. METHODS: A retrospective cross-over study. included homebound patients 65 years of age and above who were treated for at least one month in the framework of the unit, between 2013 and 2020. We compared the hospitalization rate, the number of hospital days, the number of emergency room visits, and the cost of hospitalization for the six-month period prior to admission to the unit, the period of treatment in the unit, and the six-month period following discharge from the unit. RESULTS: The study included 623 patients with a mean age of 83.7 ± 9.2 years with a mean Mini-mental State Examination (MMSE) score of 12.0 ± 10.2, a mean Charlson Comorbidity Index (CCI) of 3.7 ± 2.2 and a Barthel Index score of 23.9 ± 25.1. The main indications for admission to the unit were various geriatric syndromes (56.7%), acute functional decline (21.2%), and heart failure (12%). 22.8% died during the treatment period and 63.4% were discharged to ongoing treatment by their family doctor after their condition stabilized. Compared to the six months prior to admission to the unit there was a significant decrease (per patient per month) in the treatment period in the number of days of hospitalization (2.84 ± 4.35 vs. 1.7 ± 3.8 days, p < 0.001) and in the cost of hospitalization (1606 ± 2170 vs. 1066 ± 2082 USD, p < 0.001). CONCLUSIONS: Treatment of homebound adults with a high disease burden in the setting of a hospital-at-home unit can significantly reduce the number of hospital days and the cost of hospitalization. This model of service for homebound patients with multiple medical problems maintained a high level of care while reducing costs. The results support the widespread adoption of this service in the community to enable the healthcare system to respond to the growing population of elderly patients with medical complexity.

The Associations of Loneliness and Social Support with Cognitive Impairment among Middle-Aged and Older Individuals with Diabetes.

Diabetes mellitus is a chronic disease with significant morbidity and mortality and it is associated with poor cognitive performance in later life. This study seeks to determine the relationship between social support and cognitive function among participants with type 2 diabetes mellitus (T2DM). We used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, including participants with T2DM aged 45 and older (n = 4821). We examined different aspects of perceived social support, measured as structural social support (e.g., marital status), functional social support (having a caregiver in case of sickness or disability), and loneliness. We examined cognitive functioning using a six-item screener. Our results indicate that adults who felt lonely for 5-7 days per week had almost double the odds of cognitive impairment compared to those who didn't feel lonely. These results suggest that among middle-aged and older individuals with T2DM, interventions targeting lonely adults and which aim to reduce loneliness may combat some of the risks of cognitive decline.

Social Support and Commitment to Life and Living: Bidirectional Associations in Late Life over Time.

OBJECTIVES: This study aims to enhance the understanding of longitudinal associations between two important facets of well-being in late life: social support and commitment to life and living (CTL). METHODS: Structured home interviews were conducted with 824 Israelis ≥75 years of age, with three annual data collection timepoints. We hypothesized and tested a cross-lagged, longitudinal structural equation model (SEM) in which CTL and social support were assumed to predict each other over time, covarying for previously reported CTL and social support. RESULTS: Social support has a positive, contemporaneous effect, predicting commitment to living at T1 and T3, while CTL predicts social support the following year (i.e., T1-T2 & T2-T3). Satisfaction with relationships significantly contributes to measurement of both latent constructs at each point of data collection. DISCUSSION: Commitment to life and living and social support are intertwined phenomena. Whereas social support has a concomitant effect on CTL, the effect of CTL on social support emerges over time. This suggests that greater social support fosters greater CTL, leading older adults to nurture social networks and relationships; the effect of which is greater social support in the future. The implications of these results warrant further research over longer periods and across cultures.

Contact With Older Adults Is Related to Positive Age Stereotypes and Self-Views of Aging: The Older You Are the More You Profit.

OBJECTIVES: Past studies showed that intergenerational contact is beneficial in improving attitudes toward older people. To date, however, research on the benefits of contact with older adults focused on younger adults (intergenerational contact), overlooking the effects for older adults (contact with same-age peers). In this study, we investigated the association between contact with older adults and views of the self in old age in a domain-specific way among younger and older adults. METHODS: The sample (n = 2,356) comprised younger (39-55 years) and older (65-90 years) adults who participated in the aging as future study and were from China (Hong Kong and Taiwan), the Czech Republic, Germany, and the United States. We used moderated mediation models for data analysis. RESULTS: Contact with older adults was related to more positive views of the self in old age and this effect was mediated by more positive stereotypes of older people. These relations were stronger for older adults. Beneficial effects of contact with older adults emerged mostly in the domains of friends and leisure, but less in the family domain. DISCUSSION: Having interactions with other older adults may help favorably shape how younger adults and particularly older adults view their own aging, especially in relation to friends and leisure activities. From the perspective of older adults, having regular contacts with other older adults may increase the heterogeneity of exposure to different aging experiences, thus encouraging the formation of more differentiated stereotypes of older people and of their views of themselves in old age.