T.G. van Tilburg

Cohort Profile: The Longitudinal Aging Study Amsterdam

The Longitudinal Aging Study Amsterdam (LASA) was initiated by the Dutch Ministry of Welfare, Health and Culture (currently Ministry of Health, Welfare and Sports). By the end of the 1980s, ministry officials recognized that ageing would be a major demographic driving force, shaping the need for health care in the Dutch population in the near future. Therefore, they became increasingly interested in the process of ageing and ageing-related determinants of health-care use, and wanted to develop policies for older people in The Netherlands who were in need of extra care and support. Maintaining independent functioning, quality of life and participation of older people were recognized to be major challenges for Dutch society. Multi-disciplinary and longitudinal scientific research was considered to be needed to inform the ministry’s policy and monitor functioning and well-being of older Dutch people, leading to the start of the LASA study in 1991. The study was designed by researchers from the VU University and VU University Medical Center in Amsterdam, in a close collaboration between social and biomedical scientists. This collaboration ensured a thoroughly multi-disciplinary approach fitting the scope of the intended focus of LASA.

Increased risk of mortality associated with social isolation in older men: only when feeling lonely? Results from the Amsterdam Study of the Elderly (AMSTEL)

BACKGROUND Loneliness has a significant influence on both physical and mental health. Few studies have investigated the possible associations of loneliness with mortality risk, impact on men and women and whether this impact concerns the situation of being alone (social isolation), experiencing loneliness (feeling lonely) or both. The current study investigated whether social isolation and feelings of loneliness in older men and women were associated with increased mortality risk, controlling for depression and other potentially confounding factors. METHOD In our prospective cohort study of 4004 older persons aged 65-84 years with a 10-year follow-up of mortality data a Cox proportional hazard regression analysis was used to test whether social isolation factors and feelings of loneliness predicted an increased risk of mortality, controlling for psychiatric disorders and medical conditions, cognitive functioning, functional status and sociodemographic factors. RESULTS At 10 years follow-up, significantly more men than women with feelings of loneliness at baseline had died. After adjustment for explanatory variables including social isolation, the mortality hazard ratio for feelings of loneliness was 1.30 [95% confidence interval (CI) 1.04-1.63] in men and 1.04 (95% CI 0.90-1.24) in women. No higher risk of mortality was found for social isolation. CONCLUSIONS Feelings of loneliness rather than social isolation factors were found to be a major risk factor for increasing mortality in older men. Developing a better understanding of the nature of this association may help us to improve quality of life and longevity, especially in older men.

Prospective effects of hearing status on loneliness and depression in older persons: Identification of subgroups

Abstract Objective: To determine the possible longitudinal relationships between hearing status and depression, and hearing status and loneliness in the older population. Design: Multiple linear regression analyses were used to assess the associations between baseline hearing and 4-year follow-up of depression, social loneliness, and emotional loneliness. Hearing was measured both by self-report and a speech-in-noise test. Each model was corrected for age, gender, hearing aid use, baseline wellbeing, and relevant confounders. Subgroup effects were tested using interaction terms. Study sample: We used data from two waves of the Longitudinal Aging Study Amsterdam (2001–02 and 2005–06, ages 63–93). Sample sizes were 996 (self-report (SR) analyses) and 830 (speech-in-noise test (SNT) analyses). Results: Both hearing measures showed significant adverse associations with both loneliness measures (p < 0.05). However, stratified analyses showed that these effects were restricted to specific subgroups. For instance, effects were significant only for non-hearing aid users (SR-social loneliness model) and men (SR and SNT-emotional loneliness model). No significant effects appeared for depression. Conclusions: We found significant adverse effects of poor hearing on emotional and social loneliness for specific subgroups of older persons. Future research should confirm the subgroup effects and may contribute to the development of tailored prevention and intervention programs. Sumario Objetivo: Determinar las posibles relaciones longitudinales entre la condición auditiva y la depresión, y la condici n auditiva y la soledad, en adultos mayores. Diseño: Se usaron múltiples análisis de regresión lineal para evaluar las asociaciones entre la audición basal y el seguimiento a 4 años con la depresiún, la soledad social y la soledad emocional. La audición se midió tanto por auto-reporte como por la prueba de audición en ruido. Cada modelo fue corregido por edad, g nero, uso del auxiliar auditivo, bienestar basal y elementos relevantes de confusión. El efecto de subgrupo fue evaluado usando términos de interacción. Muestra del Estudio: Usamos datos de dos etapas del Estudio Longitudinal de Envejecimiento e Amsterdam (2001-02 y 2005-06, edades 63-93). El tamaño de las muestras fue 996 (análisis de auto-reporte (SR) y 830 (análisis de la prueba de audición en ruido). Resultados: Ambas mediciones auditivas mostraron asociaciones adversas significativas con ambas medidas de soledad (p < 0.05). Sin embargo, los análisis estratificados mostraron que estos efectos eran restringidos a subgrupos específicos. Por ejemplo, los efectos fueron significativos solo para quienes no usaban auxiliar auditivo (modelo SR – soledad social) y para hombres (SR y SNT – modelo de soledad emocional). No hubo efecto significativo para la depresión. Conclusiones: Encontramos efectos adversos significativos de un audición pobre sobre la soledad emocional y social para subgrupos específicos de personas mayores. Investigaciones futuras deberán confirmar el efecto de subgrupo y podrán contribuir al desarrollo de programas de prevenci n e intervenci n a la medida.

Religious involvement and depression in older Dutch citizens

It has been suggested that religiosity helps prevent depression in older people. This study examines the association between religious involvement and depression in older Dutch citizens and focuses on models of the mechanism in which religious involvement has an impact on other factors related to depression. The subjects were 2,817 older adults aged 55–85 years living in the community who participated in the Longitudinal Aging Study Amsterdam. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Religious involvement was assessed using items on frequency of church attendance and strength of church affiliation. Further data were collected on physical health, size of social network, social suppoor, sense of mastery and selfesteem. As in North American studies, religious involvement appeared to be inversely associated with depression, both on symptom and syndrome levels. Controlling for sociodemographics, physical impairment and network support did not substantially affect this association, particularly among subjects aged 75–85 years. The inverse association between religious involvement and depression was not selectively more pronounced among older people with physical impairments. However, the association appeared to be most specific for subjects with a small social network and those with a low sense of mastery.

Participation of the elderly after vision loss

Purpose. To assess the degree of participation of the visually impaired elderly and to make a comparison with population-based reference data. Method. This cross-sectional study included visually impaired elderly persons (≥55 years; n = 173) who were referred to a low-vision rehabilitation centre. Based on the International Classification of Functioning, Disability and Health (ICF) participation in: (1) domestic life, (2) interpersonal interactions and relationships, (3) major life areas, and (4) community, social and civic life was assessed by means of telephone interviews. In addition, we assessed perceived participation restrictions. Results. Comparison with reference data of the elderly showed that visually impaired elderly persons participated less in heavy household activities, recreational activities and sports activities. No differences were found for the interpersonal interactions and relationships domain. Participants experienced restrictions in household activities (84%), socializing (53%), paid or voluntary work (92%), and leisure activities (88%). Conclusions. Visually impaired elderly persons participate in society, but they participate less than their peers. They experience restrictions as a result of vision loss. These findings are relevant, since participation is an indicator for successful aging and has a positive influence on health and subjective well-being.

Gender differences in the relation between depression and social support in later life.

BACKGROUND Prevalence of depression is twice as high in women as in men, also in older adults. Lack of social support is a risk factor for late-life depression. The relation between depression and social support may be different for men and women. METHODS Data from the Longitudinal Aging Study Amsterdam were used to investigate gender differences in the relation between social support and depression in a population-based sample aged 55-85 years, with n = 2,823 at baseline and using the 13-year follow-up data on onset of depression. RESULTS Respondents without a partner in the household, with a small network, and with low emotional support were more often depressed, with men showing higher rates of depression than women. A high need for affiliation was associated with depression in women but not in men. Lack of a partner in the household and having a small network predicted onset of depression in men but not in women. In respondents with high affiliation need and low social support, depression rates were higher, with men being more often depressed than women. CONCLUSIONS Low social support and a high need for affiliation were related to depression in later life, with men being more vulnerable for depression than women. Considering the serious consequences of depression, especially in older people, it is important to identify the persons with low social support and a high need for affiliation, and to help them to increase their social support or to adjust their needs.

Cohort differences in having and retaining friends in personal networks in later life

Friendship has increased in importance during the last few decades. The study examines whether friendship has become more prevalent in personal networks of older adults. Three cohorts of older persons have been followed since 1992 for 17 years in the Longitudinal Aging Study Amsterdam. The younger cohort had friends more often and retained friends longer than two older cohorts. The differences are related to personal choice, relational competence and greater structural opportunities for making and keeping friends that were available to the younger cohort. Women retained same-sex friends longer than men. The oldest women lost cross-sex friends more often than did men. This is related to different gender-specific survival rates and to women’s tendency to retain friendships longer.

De ingekorte schaal voor algemene, emotionele en sociale eenzaamheid

A Shortened Scale for Overall, Emotional and Social LonelinessLoneliness is an indicator of social well-being and pertains to the feeling of missing an intimate relationship (emotional loneliness) or missing a wider social network (social loneliness). The 11-item De Jong Gierveld scale has proved to be a valid and reliable measuring instrument for overall, emotional and social loneliness, although its length has sometimes rendered it difficult to use the scale in large surveys. In this study, we empirically tested a shortened version of the scale on data from two surveys (N = 9448). Confirmatory factor analyses confirmed the specification of two latent factors. Congruent validity and the relationship with determinants (partner status, health) proved to be optimal. The 6-item De Jong Gierveld scale is a reliable and valid measuring instrument for overall, emotional and social loneliness, which is suitable for large surveys. Tijdschr Gerontol Geriat 2008; 39: 4-15SamenvattingEenzaamheid wordt algemeen beschouwd als belangrijke indicator van sociaal welbevinden en betreft gevoelens verbonden aan het missen van een intieme relatie (emotionele eenzaamheid) en/of een tekort en gemis betreffende het bredere sociale netwerk (socialeenzaamheid). De 11-item De Jong Gierveld schaal is uitgebreid getoetst en daarvan is bewezen dat het een valide en betrouwbaar meetinstrument vormt voor eenzaamheid in het algemeen, maar ook voor emotionele en sociale eenzaamheid. De lengte van deze schaal vormde soms een bezwaar voor gebruik in grootschalige survey’s. In deze studie wordt de kwaliteit van een verkorte versie van deze schaal getoetst in nieuwe survey’s (N = 9448). Toetsende factoranalyses onderbouwen de twee latente factoren. Congruente validiteit en de samenhang met verschillende determinanten (partnerstatus, gezondheid) bleken optimaal te zijn. De 6-item De Jong Gierveld schaal kan in grootschalige survey’s worden ingezet als een betrouwbaar en valide meetinstrument voor emotionele en sociale eenzaamheid, alsook voor eenzaamheid in het algemeen.

Zin en onzin van eenzaamheidsinterventies bij ouderen

Loneliness interventions among older adults: Sense or nonsense? This article focuses on the most important findings of a unique evaluation study of loneliness interventions among older adults. Eighteen interventions have recently been carried out and closely monitored in various parts of the Netherlands. In ten of these interventions the number of participants was sufficiently large to quantitatively determine the effect of the intervention on loneliness. It does not appear to be easy to overcome loneliness: no more than two of the ten interventions resulted in a reduction in loneliness among participants that may be attributed to the intervention. Two other interventions may have had a preventive effect: whereas loneliness increased among members of the control group, it remained more or less constant over time among participants. The effect measurements were followed by process evaluations in an effort to gain insight into the possible reasons why feelings of loneliness were not alleviated among participants in the case of most of the interventions. This resulted in a number of lessons for the future, which may be used as a checklist when designing new interventions projects.Tijdschr Gerontol Geriatr 2007; 38: 186-218SamenvattingCentraal in dit artikel staan de belangrijkste uitkomsten van een uniek evaluatieonderzoek naar eenzaamheidsinterventies bij ouderen. Recent zijn verspreid over Nederland achttien interventies uitgevoerd en van nabij gevolgd. Bij tien van deze interventies was het aantal deelnemers voldoende groot om het effect van de interventie op eenzaamheid kwantitatief vast te stellen. Bestrijding van eenzaamheid blijkt niet eenvoudig te zijn: bij slechts twee van de tien interventies is een daling van eenzaamheid onder de deelnemers waargenomen die zeer waarschijnlijk aan de interventie kan worden toegeschreven. Twee andere interventies hebben wellicht een preventieve werking gehad: terwijl de eenzaamheid toeneemt binnen de controlegroep, blijft de eenzaamheid onder de deelnemers over de tijd nagenoeg constant. Om inzicht te krijgen in de mogelijke oorzaken voor het uitblijven van een eenzaamheidsreductie onder de deelnemers bij de meerderheid van de interventies, is het effectonderzoek gevolgd door procesevaluaties. Dit heeft geresulteerd in een aantal lessen voor de toekomst die gehanteerd kunnen worden als een checklist wanneer een nieuw interventieproject wordt ontworpen.

The trend in sport participation among Dutch retirees, 1983-2007

ABSTRACT This paper investigates the trend in sport participation among retirees between 1983 and 2007. Sport participation is important for retirees because of its health benefits and the opportunities it offers for social interaction. Factors that influence sport participation such as educational level, physical limitations, and occupational background have changed during the last decades, possibly accounting for changes in sport participation. Data are from the Amenities and Services Utilization Survey (AVO), a nationally representative Dutch survey with seven observations between 1983 and 2007. The trend in sport involvement, sports club membership, and competition was investigated in a sample of 2,497 male and 1,559 female retirees aged 58–67 years. Increases in participation were observed in sport involvement and sports club membership. This trend can partially be explained by increases in educational level, decreases in the number of retirees with physical limitations, and in those retiring from sedentary jobs. Yet, sport participation seems to have increased for all retirees, regardless of their socio-economic background and health status. Alternative explanations for the observed trend are discussed.