Marja Aartsen

A Longitudinal Study of the Impact of Physical and Cognitive Decline on the Personal Network in Old Age

The effects of cognitive and physical decline on changes in the size and composition of four types of personal networks over a period of six years were investigated in a Dutch sample of 1552 older adults, aged 55–85 years. The effects of age and a decline in cognitive and physical functioning on the probability of changes in all possible network types were investigated. Transitions related to age and to cognitive and physical decline were observed for about one-third of the study sample. Greater age was associated with an increase in the number of family members in the network. Physical decline was associated with a replacement of friends and neighbors by family members only if the network was large. In small networks, no such association occurred. Cognitive decline was associated with a loss of relationships, most likely friends and neighbors, who were not found to be replaced by family members. Physical decline appears to be associated with an increase in the potential number of supporters in the network, whereas cognitive decline is associated with a decrease in the number of potential supporters.

Gender Differences in Level and Change in Cognitive Functioning Results from the Longitudinal Aging Study Amsterdam

Background: Gender differences in level of cognitive functioning are frequently observed, but little is known about gender differences in rate of decline of cognitive functioning. Objective: The present study aims to describe variability between and within men and women specified for four different cognitive abilities at baseline, and variability in change in these abilities among men and women over 6 years. Methods: We started with a study sample of 1,132 men and 1,175 women, with a measurement interval of 3 years. At wave 3 of the study, 1,552 of the respondents from wave 1 were still present. Differences in level and rate of change were estimated with latent change models. Results: Women have higher levels of memory functioning then men, but no gender differences were observed for speed or non-verbal reasoning changes. Conclusion: In spite of evidence for a stronger age-related atrophy of the brain structure of men, no gender differences in decline of cognitive functions could be observed.

Does Loneliness Mediate the Relation between Social Support and Cognitive Functioning in Later Life

Research in gerontology has demonstrated mixed effects of social support on cognitive decline and dementia: Social support has been shown to be protective in some studies, but not in others. Moreover, little is known about the underlying mechanisms between social support and cognitive functioning. We investigate one of the possible mechanisms, and argue that subjective appraisals rather than received amounts of social support affect cognitive functioning. Loneliness is seen as an unpleasant experience that occurs when a persons network of relationships is felt to be deficient in some important way. As such, loneliness describes the extent to which someones needs are not being met and thus provides a subjective assessment of support quality. We expect that receiving instrumental and emotional support reduces loneliness, which in turn preserves cognitive functioning. Data are from the Longitudinal Aging Study Amsterdam (LASA) and include 2255 Dutch participants aged 55-85 over a period of six years. Respondents were measured every three years. Cognitive functioning was assessed with the Mini-Mental State Examination (MMSE), the Coding Task, and the Ravens Coloured Progressive Matrices. The analytical approach comprised latent growth mediation models. Frequent emotional support related to reduced feelings of loneliness and better cognitive functioning. Increases in emotional support also directly enhanced cognitive performance. The protective effect of emotional support was strongest amongst adults aged 65 years and older. Increase in instrumental support did not buffer cognitive decline, instead there were indications for faster decline. After ruling out the possibility of reversed causation, we conclude that emotional support relationships are a more powerful protector of cognitive decline than instrumental support relationships.

Does widowhood affect memory performance of older persons

BACKGROUND The loss of a spouse has been found to have a negative effect on physical and mental health and leads to increased mortality. Whether conjugal bereavement also affects memory functioning has largely been unexamined. The present study investigates the effect of widowhood on memory functioning in older persons. METHOD The sample consisted of 474 married women and 690 married men aged 60-85 years in 1992, followed up in 1995 and 1998. During the study 135 (28%) of the women and 69 (10%) of the men lost their spouse. Linear regression analysis was used to examine whether widowed men and women differed from those who had not been widowed in rate of memory change over 6 years. Cross-domain latent-change models were subsequently used to evaluate the extent to which changes in memory are related to changes in other domains of functioning that may be affected by widowhood. RESULTS Older adults who lost a spouse during follow-up showed a greater decline in memory over 6 years than those who remained married. A higher level of depressive symptoms at baseline was related to lower levels of memory functioning and a greater decline. Memory decline was unrelated to changes in depressive symptoms and physical health. CONCLUSIONS Loss of the spouse is related to a greater decline in memory in older adults. The absence of an association with physical functioning and the weak association with mental functioning suggest that losing a spouse has an independent effect on memory functioning.

The Impact of Change in Cognitive Functioning and Cognitive Decline on Disability, Well-Being, and the Use of Healthcare Services in Older Persons

The study investigated the impact of change in cognitive functioning and cognitive decline on disability, well-being, and the use of healthcare services among older persons in the Longitudinal Aging Study Amsterdam (LASA). Data were collected from 1,349 subjects, aged 65–85 years, who had scores of 24 and higher on the Mini-Mental State Examination (MMSE) at baseline, over a period of 6 years in three waves. The results indicate that cognitive decline and changes in cognitive functioning in older persons who were either not impaired or only mildly cognitively impaired at baseline have an impact on disability, well-being, and the use of healthcare services. With the aging of the population, the number of persons with cognitive impairment is likely to increase, and appropriate services should be available to them.

The mix matters: Complex personal networks relate to higher cognitive functioning in old age

Stronger engagement of older adults in social activities and greater embeddedness in networks is often argued to buffer cognitive decline and lower risks of dementia. One of the explanations is that interaction with other people trains the brain, thereby enhancing cognitive functioning. However, research on the relationship between personal networks and cognitive functioning is not yet conclusive. While previous studies have focused on the size of personal networks as a proxy of cognitive stimulation, little attention has been paid to the complexity of the personal network. Adults embedded in a broad range of network relationships (i.e., various relationship types) are likely to be exposed to a wider range of stimuli than adults embedded in a homogeneous network including similar relationship types. We expect that higher numbers of personal relationship types rather than a higher number of similar contacts relate to higher levels of cognitive functioning and slower cognitive decline. Data are from the Longitudinal Aging Study Amsterdam (LASA) and include 2959 Dutch participants aged 54 to 85 at baseline in 1992 and six follow-ups covering a time span of twenty years. Cognitive functioning is assessed with the Mini-Mental State Examination (MMSE), and for network complexity we use the Social Network Index. We test our expectations using fixed-effects regression models. The results reveal that a reduction in network complexity is associated with a reduction in cognitive functioning, which is neither explained by size of the network nor by presence of specific relationship types. However, enhanced complexity has only a marginal buffering effect on decline in cognitive functioning. We conclude that network characteristics and cognitive functioning are intertwined and that their association is mostly cross-sectional in nature.

The Relationships Between ADHD and Social Functioning and Participation in Older Adults in a Population-Based Study

Objective: To examine the associations between ADHD and social functioning and participation among older adults. Method: Data were used from the Longitudinal Aging Study Amsterdam (LASA). In 2008/2009, respondents were asked about social functioning and participation. A diagnostic interview to diagnose ADHD was administered among a subsample (N = 231, age 60-94 years). ADHD diagnosis and level of ADHD symptoms were assessed. Results: ADHD diagnosis was associated with being divorced/never married, having less family members in their network, and emotional loneliness. Level of ADHD symptoms was associated with more emotional support given, emotional and social loneliness, greater recreational social participation, and lower income level. Conclusion: ADHD in old age is related to being divorced/never married and loneliness but not to work participation. Psycho geriatric practices should direct their attention to loneliness when treating ADHD.

Personal networks and mortality risk in older adults: A twenty-year longitudinal study

Background Research on aging has consistently demonstrated an increased chance of survival for older adults who are integrated into rich networks of social relationships. Theoretical explanations state that personal networks offer indirect psychosocial and direct physiological pathways. We investigate whether effects on and pathways to mortality risk differ between functional and structural characteristics of the personal network. The objective is to inquire which personal network characteristics are the best predictors of mortality risk after adjustment for mental, cognitive and physical health. Methods and Findings Empirical tests were carried out by combining official register information on mortality with data from the Longitudinal Aging Study Amsterdam (LASA). The sample included 2,911 Dutch respondents aged 54 to 85 at baseline in 1992 and six follow-ups covering a time span of twenty years. Four functional characteristics (emotional and social loneliness, emotional and instrumental support) and four structural characteristics (living arrangement, contact frequency, number of contacts, number of social roles) of the personal network as well as mental, cognitive and physical health were assessed at all LASA follow-ups. Statistical analyses comprised of Cox proportional hazard regression models. Findings suggest differential effects of personal network characteristics on survival, with only small gender differences. Mortality risk was initially reduced by functional characteristics, but disappeared after full adjustment for the various health variables. Mortality risk was lowest for older adults embedded in large (HR = 0.986, 95% CI 0.979—0.994) and diverse networks (HR = 0.948, 95% CI 0.917—0.981), and this effect continued to show in the fully adjusted models. Conclusions Functional characteristics (i.e. emotional and social loneliness) are indirectly associated with a reduction in mortality risk, while structural characteristics (i.e. number of contacts and number of social roles) have direct protective effects. More research is needed to understand the causal mechanisms underlying these relations.

Review: a conceptual model of perceived burden of informal caregivers for older persons with a severe functional psychiatric syndrome and concomitant problematic behaviour

AIMS AND OBJECTIVES This literature review aims to delineate the determinants of perceived burden by informal caregivers and provide insight into the interrelatedness between these determinants. BACKGROUND Despite the attention given to the various determinants of perceived burden, their interrelatedness has not been unravelled. Insight into this interrelatedness is mandatory for the development of successful, complex, multivariate interventions to reduce perceived burden of informal caregivers. DESIGN; Systematic review. METHOD Four electronic databases, CINAHL, Embase psychiatry, Medline, Psychinfo and reference lists of selected articles, were searched. Publications between January 1985-2008 were included if they concerned mental illness, burden and care giving. Articles were selected according to predefined inclusion and exclusion criteria. RESULTS The results of mostly descriptive, cross-sectional and univariate research and the more process-oriented results coming from qualitative burden research are organised in a process orientated conceptual scheme or model adapted from the stress-theoretical framework by Lazarus and Folkman. The model indicates that perceived burden must be understood through the individual appraisal of stressors and the availability and use of internal and external resources. Perceived burden is the outcome of multiple, clinically overlapping psychiatric problems, problematic behaviour and functional disabilities. CONCLUSIONS So far, intervention programs to reduce perceived burden of informal caregivers have not devoted much attention to the interrelatedness of the origins of burden. The conceptual model provides an overview of the various determinants of perceived burden and a clear picture of the possible interrelatedness appears. This overview of the most important sources of burden helps to develop a complex, multivariate intervention that is comprehensive, long-term, individually tailored and has the flexibility to meet the dynamics of burden over time. RELEVANCE TO CLINICAL PRACTICE Use of the conceptual model is crucial to professional nursing and the quality of support of informal caregivers.

Adverse effects of frailty on social functioning in older adults: Results from the Longitudinal Aging Study Amsterdam

OBJECTIVES The aim of this study was to examine the association between physical frailty and social functioning among older adults, cross-sectionally and prospectively over 3 years. STUDY DESIGN The study sample consisted of 1115 older adults aged 65 and over from two waves of the Longitudinal Aging Study Amsterdam, a population based study. MAIN OUTCOME MEASURES Frailty was measured at T1 (2005/2006) using the criteria of the frailty phenotype, which includes weight loss, weak grip strength, exhaustion, slow gait speed and low physical activity. Social functioning was assessed at T1 and T2 (2008/2009) and included social network size, instrumental support, emotional support, and loneliness. RESULTS Cross-sectional linear regression analyses adjusted for covariates (age, sex, educational level and number of chronic diseases) showed that pre-frail and frail older adults had a smaller network size and higher levels of loneliness compared to their non-frail peers. Longitudinal linear regression analyses adjusted for covariates and baseline social functioning showed that frailty was associated with an increase in loneliness over 3 years. However, the network size and levels of social support of frail older adults did not further decline over time. CONCLUSIONS Frailty is associated with poor social functioning, and with an increase in loneliness over time. The social vulnerability of physical frail older adults should be taken into account in the care provision for frail older adults.