Anne McMunn

Loneliness, social isolation and behavioral and biological health indicators in older adults.

OBJECTIVE A number of mechanisms have been proposed through which social isolation and loneliness may affect health, including health-related behavioral and biological factors. However, it is unclear to what extent isolation and loneliness are independently associated with these pathways. The objective of the present analysis was to determine the impact of social isolation and loneliness, individually as well as simultaneously, on health-related behavioral and biological factors using data from the English Longitudinal Study of Ageing (ELSA). METHOD Data on health behaviors (smoking and physical activity) were analyzed from 8,688 participants and data on blood pressure, cholesterol, and inflammatory markers were analyzed from over 5,000 of these participants who were eligible for a nurse visit and blood sampling. Loneliness was measured using the short form of the Revised UCLA scale and an index of social isolation was computed incorporating marital status; frequency of contact with friends, family, and children; and participation in social activities. RESULTS Fewer than 2% of participants reported being lonely all the time, while nearly 7% had the highest possible scores on social isolation. Both social isolation and loneliness were associated with a greater risk of being inactive, smoking, as well as reporting multiple health-risk behaviors. Social isolation was also positively associated with blood pressure, C-reactive protein, and fibrinogen levels. CONCLUSIONS Loneliness and social isolation may affect health independently through their effects on health behaviors. In addition, social isolation may also affect health through biological processes associated with the development of cardiovascular disease.

Social isolation and loneliness: relationships with cognitive function during 4 years of follow-up in the English Longitudinal Study of Ageing.

Objective This study aims to evaluate the impact of social isolation and loneliness, individually and simultaneously, on cognitive function in older adults during a 4-year period, using data from the English Longitudinal Study of Ageing, and to evaluate if these associations are moderated by educational level. Methods Data on social isolation, loneliness, and cognitive function (verbal fluency, immediate recall, and delayed recall) were obtained at baseline. Follow-up measures on cognitive function were obtained 4 years later for 6034 participants (mean age at baseline = 65.6 years). Regression analyses were used to evaluate the association between baseline isolation, loneliness, and cognitive function at follow-up. Interactions between social isolation, loneliness, and educational level were also evaluated. Results Baseline isolation was significantly associated with decreases in all cognitive function measures at follow-up (&bgr; = −.05 to −.03, p < .001), independently of baseline scores, whereas loneliness was associated with poorer immediate recall (&bgr; = −.05, p < .001) and delayed recall (&bgr; = −.03, p = .02). There was a significant interaction between educational level and both isolation (p = .02) and loneliness (p = .01) for delayed recall, such that isolation and loneliness were associated with poorer recall only among those with low levels of education. Conclusions Loneliness and isolation are associated with poorer cognitive function among older adults. Interventions to foster social connections may be particularly beneficial for individuals with low levels of education.

Participation in socially-productive activities, reciprocity and wellbeing in later life: baseline results in England

ABSTRACT This paper examines whether participation in social activities is associated with higher levels of wellbeing among post-retirement age people in England, and, if so, whether these relationships are explained by the reciprocal nature of these activities. Cross-sectional analysis of relationships between social activities (including paid work, caring and volunteering) and wellbeing (quality of life, life satisfaction and depression) was conducted among participants of one wave of the English Longitudinal Study of Ageing (ELSA) who were of state pension age or older. Participants in paid or voluntary work generally had more favourable wellbeing than those who did not participate in these activities. Caring was not associated with wellbeing, although female carers were less likely to be depressed than non-carers. Carers, volunteers and those in paid work who felt adequately rewarded for their activities had better wellbeing than those who were not participating in those activities, while those who did not feel rewarded did not differ from non-participants. These results point to the need to increase the rewards that older people receive from their productive activities, particularly in relation to caring work.

Health-Related Behaviors in Older Adults: Relationships with Socioeconomic Status

BACKGROUND There is limited information about the clustering of health behaviors in older people. PURPOSE This study aims to examine clustering of smoking, low levels of physical activity, and risky drinking in older adults and the relationship of these behaviors with measures of SES. METHODS Data on health behaviors were analyzed from 11,214 individuals aged > or =50 years (mean age=65.2 years) who participated in the 2002 wave of the English Longitudinal Study of Ageing. Clustering was examined by studying the ratio of observed to expected prevalence of each combination of health behavior. Logistic regressions tested the relationship between socioeconomic measures (education, wealth, and subjective social status) and health behaviors. Data were collected between March 2002 and March 2003, and analyses were conducted in 2008. RESULTS Only a small proportion of participants reported all three health-risk behaviors, although this was higher than that expected on the basis of prevalence of individual behaviors. Combinations of two health-risk behaviors were common. Multiple health-risk behaviors were less common among individuals of a higher SES. Total accumulated wealth and subjective social status were more consistently related to health-risk behaviors than education in this population. CONCLUSIONS This study provides evidence of clustering of health-risk behaviors in older adults and suggests that interventions aimed at multiple risk factors could usefully target less affluent groups.

Life course social roles and women’s health in mid-life: causation or selection?

Study objective: To investigate whether relations between social roles and health are explained by health selection into employment and parenthood by examining the influence of early health on relations between long term social role histories and health in mid-life. Design: Prospective, population based, birth cohort study. Participants and setting: Women from a national British cohort born in 1946, including 1171 women with a valid measure of self reported health at age 54 and valid work and family role measures at ages 26, 36, 43, and 53, as well as 1433 women with a valid body mass index (BMI) measure at age 53 and valid work and family role measures at ages 26, 36, 43, and 53. Outcome measures: Self reported health at age 54 and obesity at age 53, taken from objective height and weight measures conducted by a survey nurse during face to face interviews in respondents’ homes. Main results: Women who occupied multiple roles over the long term reported relatively good health at age 54 and this was not explained by early health. Women with weak long term ties to the labour market were more likely to be obese at age 53. Examination of body mass index (BMI) from age 15 showed that long term homemakers were larger than other women from age 26, but their mean BMI increased significantly more with age than that of other women. Conclusions: Relations between social roles and health were generally not explained by health selection into employment and parenthood, although some health selection may occur for obesity.

Positive and negative exchanges in social relationships as predictors of depression: evidence from the English Longitudinal Study of Aging.

Objective: To investigate whether the impact of negative and positive social exchanges on depression depends on relationship type among late middle age and older adults. Method: Using data from the English Longitudinal Study of Aging, baseline positive and negative exchanges with partners, children, other family and friends were linked to 2-year changes in depression on the eight-item Center for Epidemiologic Studies Depression Scale. Results: Positive and negative exchanges with partners and with children were independently associated with depression, adjusting for age, gender, wealth, and baseline depression. Negative but not positive exchanges with other family and with friends were associated with depression. The association between depression and positive/negative exchanges was weaker among the above 70s compared with those aged 50 to 70. Discussion: Negative and positive exchanges with partners and children appear equally salient for depression onset although negative exchanges with family and friends contribute to depression whereas positive exchanges do not.

Proximal predictors of change in quality of life at older ages

Objective To investigate whether changes in health, social and economic circumstances predict change in quality of life (QoL) at older ages. Design Secondary analysis, using multiple regression analyses, of waves 1 and 3 of the English Longitudinal Study of Ageing. Setting England, 2002–6. Participants A nationally representative sample of non-institutionalised adults aged over 50 years living in England with non-missing data for the variables of interest (N=4848). Main Outcome Measure QoL in 2006, with reference to QoL in 2002, both measured using the CASP-19 score. Results Mean QoL decreased over the 4 years, with becoming depressed (β −0.12) and developing difficulties with activities of daily living (β −0.08) contributing to this decrease. Improvements in family relationships (β 0.10), the neighbourhood (β 0.08) and perceived financial position (β 0.07) each counteracted the decline in QoL. Initial QoL strongly predicted QoL at follow-up (β 0.46). Regression models explained 59% of variation in QoL, and there were small differences between age and gender groups. Conclusions The maintenance of good QoL in older aged people is enabled by the avoidance of depression, maintenance of physical function, good neighbourhood standards, family relationships and financial circumstances.

Parental separation in childhood and adult inflammation: The importance of material and psychosocial pathways

BACKGROUND Childhood adversities are known to be associated with poorer health outcomes. A potential mechanism may be through changes in inflammatory processes. One such childhood adversity is separation of parents, however relatively little is known about the association between parental separation and inflammation in adulthood. The aims of this study were to (1) investigate whether parental separation is associated with inflammation in mid-life, (2) focus upon the mechanisms that may be involved in translating childhood adversities, such as parental separation, into poorer health outcomes in adulthood. METHODS We examine the association of parental separation in childhood, defined as the breakdown of the parents partnership, and levels of C-reactive protein (CRP) in middle age. The role played by material (through material disadvantage and educational attainment), psychosocial (through parent-child relationship quality and psychological distress) and adiposity (through BMI) mechanisms is investigated using path analysis in a multiply-imputed dataset from a British birth cohort with concurrent measurements made throughout the life course (n=7462). RESULTS Participants that report parental separation have higher CRP levels at age 44 than those who grew up with both parents (β=0.16, 95% CI: 0.06, 0.27). This association is largely explained by BMI, material and psychosocial factors. Material disadvantage after separation and educational attainment seem to be particularly important in this association. CONCLUSIONS Parental separation increases CRP in adulthood via chains of disadvantage across the life course. This study points towards potential points for intervention and highlights a need to support separating families in order to minimise the long-term impact on adult health.

Social isolation and loneliness: prospective associations with functional status in older adults

Objective: The present analysis aimed to examine the associations of isolation and loneliness, individually as well as simultaneously, with 2 measures of functional status (gait speed and difficulties in activities of daily living) in older adults over a 6-year period using data from the English Longitudinal Study of Ageing, and to assess if these associations differ by SES. Method: Loneliness was measured using the short form of the Revised UCLA scale, and an index of social isolation was computed incorporating marital status; frequency of contact with friends, family, and children; and participation in social activities. Measures of functional status were assessed identically at baseline and 6 years later for 3070 participants (mean age 69 years). Wealth was used as an indicator of SES. Results: In fully and mutually adjusted models, social isolation and loneliness were found to be associated with a decrease in gait speed at follow-up, with stronger effects among more disadvantaged individuals. Loneliness was associated with an increase in difficulties with activities of daily living. Conclusions: Isolation and loneliness were adversely associated with different aspects of functional status. Interventions to reduce isolation and loneliness may be particularly beneficial for individuals in disadvantaged groups.

Neighbourhood social environment and depressive symptoms in mid-life and beyond

ABSTRACT This prospective study examines the relationship between aspects of the neighbourhood social environment and subsequent depressive symptoms in over 7,500 participants of the English Longitudinal Study of Ageing (ELSA). Neighbourhood social environment at baseline was operationalised using four items capturing social cohesion and three items capturing perceived safety and associations with the Center for Epidemiologic Studies Depression Scale (CES-D) at two-year follow-up were assessed. Friendship quality and personal sense of control were tested as mediators of this relationship using structural equation modelling. Neighbourhood social cohesion was found to be associated with reporting fewer depressive symptoms independent of demographic and socioeconomic factors and baseline depressive symptoms. Friendship quality and sense of control mediated this association. The study highlights that greater personal sense of control, higher quality friendships and fewer depressive symptoms are found in neighbourhoods seen to be characterised by higher social cohesion.