Social Isolation, Physical Activity, and Subsequent Changes in Cognition Among Middle- and Older-Aged Adults: Results From the Canadian Longitudinal Study on Aging.

OBJECTIVE: The objectives of this study were to a) evaluate associations between social isolation and change in cognition over a 3-year period, and b) evaluate whether physical activity mediates the association between social isolation and cognition change. METHODS: Using baseline and follow-up 1 data from the Canadian Longitudinal Study on Aging, latent change score models, incorporating direct and indirect pathways, were constructed to estimate the indirect effect of social isolation on cognitive change through physical activity. Multigroup models were constructed based on age group (45-65 versus 65+ years) and sex to allow for varying estimates across age and sex. The final analytic sample included 51,338 participants. RESULTS: Indirect effects of social isolation on cognition through physical activity were evident in men and women 65+ years old for memory change ( = -0.005 [99.9% confidence interval = -0.007 to -0.002], p < .001 in both groups) and in male adults 65+ years old for executive function change ( = -0.01 [99.9% confidence interval = -0.02 to -0.006], p < .001). Statistically significant indirect effects were not observed for adults between 45 and 65 years old. CONCLUSIONS: Social isolation is associated with diminished physical activity, and in turn, diminished physical activity is associated with decline in memory in older women and men, with larger declines in executive function in older men. Public health initiatives to promote physical activity-perhaps incorporating social interaction-among older adults experiencing social isolation could be one way to mitigate the negative impact of social isolation on cognitive health.

Contributors to mental health resilience in middle-aged and older adults: an analysis of the Canadian Longitudinal Study on Aging.

OBJECTIVES: Identifying the correlates of mental health resilience (MHR)-defined as the discrepancy between one's reported current mental health and one's predicted mental health based on their physical performance-may lead to strategies to alleviate the burden of poor mental health in aging adults. Socioeconomic factors, such as income and education, may promote MHR via modifiable factors, such as physical activity and social networks. DESIGN: A cross-sectional study was conducted. Multivariable generalized additive models characterized the associations between socioeconomic and modifiable factors with MHR. SETTING: Data were taken from the population-based Canadian Longitudinal Study on Aging (CLSA), which collected data at various data collection sites across Canada. PARTICIPANTS: Approximately 31,000 women and men between the ages of 45 and 85 years from the comprehensive cohort of the CLSA. MEASUREMENTS: Depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale. Physical performance was measured objectively using a composite of grip strength, sit-to-stand, and balance performance. Socioeconomic and modifiable factors were measured by self-report questionnaires. RESULTS: Household income, and to a lesser extent, education were associated with greater MHR. Individuals reporting more physical activity and larger social networks had greater MHR. Physical activity accounted for 6% (95% CI: 4 to 11%) and social network accounted for 16% (95% CI: 11 to 23%) of the association between household income and MHR. CONCLUSIONS: The burden of poor mental health in aging adults may be alleviated through targeted interventions involving physical activity and social connectedness for individuals with lower socioeconomic resources.

Social isolation and loneliness among older adults living in rural areas during the COVID-19 pandemic: a scoping review.

BACKGROUND: The causes and consequences of social isolation and loneliness of older people living in rural contexts during the COVID-19 pandemic were systematically reviewed to describe patterns, causes and consequences. METHODS: Using the Arksey and O'Malley (2005) scoping review method, searches were conducted between March and December 2022, 1013 articles were screened and 29 were identified for data extraction. RESULTS: Findings were summarized using thematic analysis separated into four major themes: prevalence of social isolation and loneliness; rural-only research; comparative urban-rural research; and technological and other interventions. Core factors for each of these themes describe the experiences of older people during the COVID-19 pandemic and related lockdowns. We observed that there are interrelationships and some contradictory findings among the themes. CONCLUSIONS: Social isolation and loneliness are associated with a wide variety of health problems and challenges, highlighting the need for further research. This scoping review systematically identified several important insights into existing knowledge from the experiences of older people living in rural areas during the COVID-19 pandemic, while pointing to pressing knowledge and policy gaps that can be addressed in future research.

A Study of Social Isolation, Multimorbidity and Multiple Role Demands Among Middle-Age Adults Based on the Canadian Longitudinal Study on Aging.

Given the increasing complexity and fluidity of parenting, caregiving, and paid work patterns, in tandem with an increased risk of multimorbidity in mid-life, this study examines the relationship between these three concurrent roles and social isolation among middle-aged persons across multimorbidity statuses. Drawing upon life course theory, we applied linear mixed models to analyze 29,847 middle-aged participants from two waves of the Canadian Longitudinal Study on Aging. Findings reveal that participants experience greater social isolation over time, albeit the difference is extremely small. Among participants without multimorbidity, holding multiple roles is associated with lower social isolation. For those with multimorbidity, being employed full-time and providing intensive care are associated with social isolation. The occurrence of multiple roles demonstrates unique associations with social isolation among those with and without multimorbidity over time. Future research should study multimorbidity as a salient contextual variable. Moreover, enhanced support is needed for multimorbid middle-aged individuals with different role demands.

Linking Lives in Ethnically Diverse Families: The Interconnectedness of Home Leaving and Retirement Transitions.

Drawing from a sociocultural life course perspective, this study examines the linkages between two age-related family transitions: young adult children leaving home and parental retirement. A sample of 580 ethnically diverse parents aged 50+ with at least one adult child aged 19-35 living in Metro Vancouver, British Columbia, Canada, was used in this study based on four cultural groups: British-, Chinese-, Persian/Iranian-, or South Asian-Canadian. Separate survival analyses are used to predict the timing of, and associations between children's leaving home and parents' retirement. Later timing of adult children's leaving home is associated with delays in retirement of parents and is influenced by a number of predictors. Main and interaction effects were supported for ethnicity, where belonging to the Persian/Iranian ethnic group (compared to British) delays home leaving, and belonging to Persian/Iranian and South Asian ethnic groups (compared to British) delays retirement timing.

Leisure Time Satisfaction and Activity Preferences Among Ethnically Diverse Aging Parents in Metro Vancouver.

It is well established that family and work-retirement transitions are increasingly becoming more complicated, extended, and reversible among aging parents. Combined with improved life expectancy, older parents are now confronted with new opportunities and challenges including their access to leisure activities. However, a paucity of research exists with regard to the extent to which older-aged parents are satisfied with their amount of leisure time as well as their ideal leisure preferences. Drawing upon socio-cultural life course theory, this paper examines how socio-demographic and ethnocultural variables (i.e., gender, ethnic identity), family-related factors (e.g., presence of children in the household), and socio-economic and work contexts (i.e., income satisfaction and retirement status) shape leisure time satisfaction and activity preferences. Data are drawn from the "Families and Retirement Project," a sample of 588 diverse (British-, Chinese-, Iranian/Persian-, South-Asian Canadians) aged 50 + (mean age = 59.6) residing in Metro Vancouver with at least one young adult child aged 19-35. Quantitative analyses reveal that leisure time satisfaction is higher among: those reporting lower levels of parental stress, the fully retired, those with less education, and among Chinese parents (compared to British). Moreover, strong variations by ethnic background are shown in preferred leisure activity, based on a thematic analysis of data. Results are discussed in terms of contributions to a socio-cultural family life course activity theory. Implications for community service provision (e.g., culturally sensitive and relevant recreational programs and services) are also highlighted, given the salience of participation in enjoyable leisure activities to healthy aging.

Development of a physical literacy model for older adults - a consensus process by the collaborative working group on physical literacy for older Canadians.

BACKGROUND: Arguably the uptake and usability of the physical activity (PA) guidelines for older adults has not been effective with only 12% of this population meeting the minimum guidelines to maintain health. Health promoters must consider innovative ways to increase PA adoption and long-term sustainability. Physical literacy (PL) is emerging as a promising strategy to increase lifelong PA participation in younger age-groups, yet there is relatively little evidence of PL being used to support older adults in achieving the PA guidelines. METHODS: An iterative and mixed-methods consensus development process was utilized over a series of six informed processes and meetings to develop a model of physical literacy for adults aged 65 years and older. RESULTS: A multi-disciplinary collaborative working group (n = 9) from diverse practice settings across Canada, and representative and reflective of the full range of key elements of PL, was assembled. Three consensus meetings and two Delphi surveys, using an international cohort of 65 expert researchers, practitioners, non-government organizations and older adults, was conducted. 45% responded on the first round and consensus was achieved; however, we elected to run a second survey to support our results. With 79% response rate, there was consensus to support the new PL model for older adults. CONCLUSION: Older adults are a unique group who have yet to be exposed to PL as a means to promote long-term PA participation. This new PL model uses an ecological approach to integrate PL into the lifestyles of most older adults. Understanding the interactions between components and elements that facilitate PL will ultimately provide a new and effective tool to target PA promotion and adherence for all older Canadians.

Estimating multiple morbidity disease burden among older persons: a convergent construct validity study to discriminate among six chronic illness measures, CCHS 2008/09.

BACKGROUND: Since approximately two in three older adults (65+) report having two or more chronic diseases, causes and consequences of multimorbidity among older persons has important personal and societal issues. Indeed, having more than one chronic condition might involve synergetic effects, which can increase impact on disabilities and quality of life of older adults. Moreover, persons with multimorbidity require more health care treatments, implying burden for the person, her/his family and the health care system. METHODS: Using the 2008/09 Canadian Community Health Survey (CCHS), this paper assesses the convergent construct validity of six measures of multimorbidity for persons aged 65 and over. These measures include: 1) Multimorbidity Dichotomized (0, 1+ conditions); 2) Multimorbidity Dichotomized (0/1, 2+); 3) Multimorbidity Additive Scale; 4) Multimorbidity Weighted by the Health Utility (HUI3) Scale; 5) Multimorbidity Weighted by the OARS Activity of Daily Living (ADL) Scale; and 6) Multimorbidity Weighted by HUI3 (using beta coefficients). Convergent construct validity was assessed using correlations and OLS regression coefficients for each of the multimorbidity measures with the following social-psychological and health outcome variables: life satisfaction, perceived health, number of health professional visits, and medication use. RESULTS: Overall, the two dichotomies (scales #1 & #2) showed the weakest construct validity with the health outcome variables. The additive chronic illness scale (#3) and the multimorbidity weighted by ADLs (#5), performed better than the other two weighted scales using (HUI #4 & #6). Measurement errors apparent in the dichotomous multimorbidity measures were amplified for older women, especially for life satisfaction and perceived health, but decreased when using the scales, suggesting stronger validity of scales #3 through #6. CONCLUSIONS: To properly represent multimorbidity, using dichotomous measures should be used with caution. When only prevalence data are available for chronic conditions, such as in the CCHSs or CLSA, an additive multimorbidity scale can better measure total illness burden than simple dichotomous or other discrete measures.

A national comparison of spousal abuse in mid- and old age.

This exploratory study addresses whether there are similar or different risks and protective factors associated with spousal abuse among mid-age adults (persons aged 45-59) and old-age adults (persons aged 60 and over). The risk and protective factors of abuse are compared across these two age groups and situated within a life course framework. Cross-sectional data from the 1999 and 2004 General Social Surveys are merged to address the research questions. Overall, it was found that there are as many differences as there are similarities in risk/protective factors connected to individual, relationship, and community environments. The findings are discussed in terms of program development and future research.

Transition Into the Caregiver Role Among Older Adults: A Study of Social Participation and Social Support Based on the Canadian Longitudinal Study on Aging.

OBJECTIVES: Older adults (65 years and older) are increasingly providing care for their spouses, family members, and nonkin others (e.g., friends and neighbors). However, available knowledge of older caregivers is limited to spousal caregivers and their psychological outcomes. Other caregiver role types or social outcomes among older caregivers are less well studied. Thus, this study examines the social participation and social support among older caregivers by comparing 3 types of older caregivers, including spousal caregivers, nonspouse family caregivers, and nonkin caregivers. METHODS: Participants for this study were drawn from the Baseline and Follow-up 1 data from the Canadian Longitudinal Study on Aging. A total of 3,789 older adults became caregivers during the 2 data collection time points. Linear mixed models were applied to examine the change of social participation and social support among the three caregiver role types over the course of survey. RESULTS: The study finds that after transitioning into the caregiving role, spousal caregivers, and nonkin caregivers experienced a decline in social participation, and spousal caregivers also received less social support over time. When comparing the 3 caregiver role types, spousal caregivers reported the greatest decline in social participation and social support. DISCUSSION: This study adds to the relatively limited knowledge of older caregivers by presenting the changes in social participation and social support after transitioning into 3 types of caregiver roles. The results indicate the need to provide support for caregivers, particularly spousal and nonkin caregivers, to help them maintain social relationships and networks for participation and support.

Environmental Influences on Life Satisfaction and Depressive Symptoms Among Older Adults With Multimorbidity: Path Analysis Through Loneliness in the Canadian Longitudinal Study on Aging.

BACKGROUND AND OBJECTIVES: More older adults with multimorbidity are aging in place than ever before. Knowing how the environment affects their mental well-being could enhance the efficacy of age-friendly interventions for multimorbidity resilience. With reference to the Transdisciplinary Neighborhood Health Framework, we construct and examine a priori models of environmental influences on life satisfaction and depressive symptoms. RESEARCH DESIGN AND METHODS: Baseline and follow-up data (after 3 years) were drawn from the Canadian Longitudinal Study on Aging to identify a subsample (n = 14,301) of participants aged at least 65 years with at least 2 chronic diseases. Path analysis examined sociobehavioral attributes (i.e., social support, social participation, walking) and loneliness as primary and secondary mediators, controlling for age, sex, education, and outcomes during baseline. RESULTS: Good model fit was found (TFI = 1.00; CFI = 1.00; RMSEA < 0.001; SRMR < 0.001). The total effects of housing quality (rtotal = 0.08, -0.07) and neighborhood cohesion (rtotal = 0.03, -0.06) were weak but statistically significant in the expected direction. The mediators explained 21%-31% of the total effects of housing quality and 67%-100% of the total effects of neighborhood cohesion. Loneliness mediated 27%-29% of these environmental influences on mental well-being, whereas walking mediated a mere 0.4%-0.9% of the total effects. Walking did not explain the relationship between housing quality and mental well-being. DISCUSSION AND IMPLICATIONS: Data supported a priori pathways from environment to mental well-being through sociobehavioral attributes and loneliness. If these pathways from neighborhood cohesion to life satisfaction reflect causal effects, community-based age-friendly interventions should focus on enhancing neighborhood cohesion to mitigate loneliness among multimorbid older adults for their mental well-being.

Dementia-Friendly Neighborhood and the Built Environment: A Scoping Review.

BACKGROUND AND OBJECTIVES: There has been a proliferation of research on dementia-friendly communities in recent years, particularly on interpersonal and social aspects. Nonetheless, the neighborhood built environment remains a co-constituent of the lived experience of people living with dementia (PLWD) that is amenable to interventions for health and well-being in the community. This scoping review presents a narrative synthesis of empirical research on dementia-friendly neighborhoods, with a focus on the built environment and its associated sociobehavioral aspects. Planning and design principles are distilled to identify research and policy implications. RESEARCH DESIGN AND METHODS: We reviewed 29 articles identified through a systematic search of AgeLine, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Global Health, Medical Literature Analysis and Retrieval System Online, and Scopus. Peer-reviewed articles that employed quantitative and/or qualitative methods in community settings were included. RESULTS: An equal number of studies focused on behavioral/psychosocial aspects of the built environment and assessment of specific environmental features. The former often used qualitative methods, whereas statistical methods were common in studies on discrete features of the neighborhood built environment. Few studies focused on rural contexts. Emerging research areas include interactions between dementia risk factors and neighborhood environments to support primary and secondary prevention. DISCUSSION AND IMPLICATIONS: The body of literature needs expansion into planning and design fields to foster community participation of PLWD by optimizing environmental stimuli, minimizing environmental barriers, and engaging PLWD in dementia-friendly community initiatives. While evidence has accumulated on landmarks and social participation at the individual level, research at the community and policy levels is limited. This requires advanced mixed methods.

Help-Seeking Behaviors Among Older Adults: A Scoping Review.

Although older adults may experience health challenges requiring increased care, they often do not ask for help. This scoping review explores the factors associated with the help-seeking behaviors of older adults, and briefly discusses how minority ethnic populations can face additional challenges in help-seeking, due to factors such as language barriers and differing health beliefs. Guided by Arksey and O'Malley's scoping review framework and the Preferred Reporting Items for Systematic Reviews and Meta-AnalysesScoping Review guidelines, a systematic search of five databases was conducted. Using a qualitative meta-synthesis framework, emergent themes were identified. Data from 52 studies meeting inclusion criteria were organized into five themes: formal and informal supports, independence, symptom appraisal, accessibility and awareness, and language, alternative medicine and residency. Identifying how factors, including independence and symptom appraisal, relate to older adults' help-seeking behaviors may provide insights into how this population can be supported to seek help more effectively.

Population pressures, system-level inertia and healthy aging policy revisited.

Chappell and Hollander provide support for a set of policy directives formulated for an aging population. An integrated continuum of care model is the fulcrum of the policy prescription, given evidence-based support for its cost-effectiveness; improved quality of care and quality of life; and the success of similar models found in Denmark, Japan and other countries. This commentary addresses the underlying assumptions of these policy recommendations, identifies the major barriers to their implementation and suggests solutions. Improving our understanding of the dynamics of population aging as it relates to health and healthcare use is a necessary requirement to reaching the aims set out by the authors.

Social Isolation Among Spousal and Adult-Child Caregivers: Findings From the Canadian Longitudinal Study on Aging.

OBJECTIVES: The caregiving outcomes of spousal and adult-child caregivers are widely studied since they are the most common source of support provided to adults. However, the literature on social isolation among spousal and adult-child caregivers is very limited. In order to further elaborate and specify unique caregiving outcomes, this study focuses on social isolation, both longitudinally and comparatively between spousal and adult-child caregivers. METHODS: This study was based on the Baseline and Follow-up 1 data from the Canadian Longitudinal Study on Aging. A total of 5,226 participants (1,293 spousal caregivers and 3,933 adult-child caregivers) were selected. The Linear mixed models were used to examine the effect of caregiver type and caregiving intensity on social isolation over the course of survey. RESULTS: Spousal and adult-child caregivers reported greater social isolation over time, and spousal caregivers exhibited a steeper increase in social isolation from Baseline to Follow-up 1 than adult-child caregivers. Also, an increase in caregiving hours resulted in greater social isolation. Finally, male spousal or adult-child caregivers were more likely to be socially isolated over time than their female counterparts. DISCUSSION: The findings of this study contribute to the existing literature on caregiving outcomes by demonstrating an association between family caregiving and social isolation. The results indicate a strong need for intervention programs that aim to enhance social connectedness among family caregivers, and especially for those who perform intensive caregiving, are older age, and are from a lower socioeconomic status.

Age and sex trends in depressive symptoms across middle and older adulthood: Comparison of the Canadian Longitudinal Study on Aging to American and European cohorts.

BACKGROUND: The literature suggests depressive symptoms differ in a non-linear fashion across adulthood and are more commonly reported in women as compared to men. Whether these trends are observed across countries in population-based cohorts is unclear. METHODS: Cross-sectional observational study of approximately 138,000 women and men between the ages of 45 and 95 from three population-based cohorts representing Canadian, European, and American populations. Age, gender, educational attainment and annual income were assessed in each cohort. Depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale in the US and Canadian cohorts, and by the EURO-D in the European cohort. RESULTS: Across all three cohorts, non-linear age trends and gender differences were observed in the report of depressive symptoms, independent from educational attainment and annual income effects. The non-linear age trends reflected a negative association between depressive symptoms and age during midlife and then a positive association in late life. Females reported greater depressive symptoms than males; however, an interaction between gender and age was also observed in the Canadian and European cohorts. Among Canadians, the gender differences were largest after age 70, whereas among Europeans, gender differences where largest among those approximately aged 60. LIMITATIONS: Limitations include: 1) the cross-sectional nature of the study, resulting in age differences potentially reflecting cohort effects rather than a developmental process; and 2) the use of different depressive symptoms measures across cohorts. CONCLUSIONS: Characterization of depressive symptoms over mid and late adulthood in women and men provides insights into potential focal points for intervention and allocation of resources.

Social determinants of health for older women in Canada: does rural-urban residency matter?

This study provided an exploratory analysis of key social determinants of health for older Canadian women, with a focus on differences between rural and urban residency, given that socio-economic status (SES) and social capital have been shown to differ by rural-urban residence. Secondary analysis was conducted using the 2000/2001 Canadian Community Health Survey. A comparative logistic regression analysis revealed, unexpectedly, that SES and social capital variables were more strongly associated with the health status of urban older women than for the health status of their rural counterparts. Associations between health status measures and household income, food insecurity, and community belonging were largely not supported among rural women, but were for their urban counterparts. Findings are discussed concerning applications of the social-determinants-of-health model for explaining health patterns among older urban and rural women. Cost of living, access to health services, and dimensions of rural culture are discussed as potential explanations.

Health supports needed for homeless persons transitioning from hospitals.

Being homeless has a negative effect on health and the health needs of individuals experiencing homelessness are complex and challenging to address. As a result of limited access to and use of primary healthcare, the main point of entry into the healthcare system for individuals experiencing homelessness is often hospitals and emergency departments. Persons experiencing homelessness are commonly discharged from hospital settings to locations that do not support recovery or access to follow-up care (e.g. shelters or the street). This can be costly to both the healthcare system and to individuals' health and quality of life. We conducted a scoping review of the literature published between 2007 and 2017 to identify the types of health supports needed for persons experiencing homelessness who are discharged from the hospital. Thirteen literature sources met inclusion criteria and thematic data analyses by two researchers resulted in the identification of six themes related to the types of health supports needed for persons experiencing homelessness who are transitioning (i.e. being discharged) from the hospital. Using a community consultation approach, the scoping review themes were validated with 23 health and shelter service providers and included in our integrated findings. Themes included: (a) a respectful and understanding approach to care, (b) housing assessments, (c) communication/coordination/navigation, (d) supports for after-care, (e) complex medical care and medication management, and (f) basic needs and transportation. These themes were found to resonate with participants of the community consultation workshop. Recommendations for trauma-informed care and patient- or client-centred care approaches are discussed.

A health profile of community-living nonagenarians in Canada.

Due to increasing life expectancy over time, persons who live into their ninety, known as nonagenarians, are an important and growing segment of the Canadian population. In 2001, there were 130,325 nonagenarians (compared to 3,795 centenarians), and it is estimated that they will top 400,000 by 2026. This paper provides a health profile and an exploratory analysis of selected social determinants of health for community-living nonagenarians, using the 2001 Canadian Community Health Survey (Statistics Canada, 2003). Perceived health, selection of prevalent chronic illnesses, and several health behaviours are examined. One dominant pattern is the tendency for male nonagenarians to be in better health than their female counterparts. This finding is consistent with research on centenarians and is discussed in terms of a mortality selection effect. Other key findings include the strength of sense of belonging, income, and physical activity as potential social determinants of health, connected to particular dimensions of health status.