Theo van Tilburg

Major and minor depression in later life: a study of prevalence and risk factors

In this paper, the results of a community-based study into the prevalence and risk factors associated with depression in the older (55-85 years) population of The Netherlands are presented. The prevalence of major depression was 2.02%, that of minor depression 12.9%, while 14.9% had clinically relevant levels of depressive symptoms. Associations with a comprehensive set of risk factors were not affected dramatically by age or sex. However, comparing major to minor depression, risks were substantially differently distributed. It appears that major depression is more often an exacerbation of a chronic mood disturbance, with roots in long-standing vulnerability factors; while minor depression is more often a reaction to the stresses commonly experienced in later life.

Changes in older adult loneliness: results from a seven-year longitudinal study

This study examines loneliness and its correlates—health, residential care, partner status, and network size—over a seven-year period among adults born between 1908 and 1937. The four waves of data are from the Dutch “Living Arrangements and Social Networks of Older Adults” and the “Longitudinal Aging Study of Amsterdam”programs. Data from at least two waves are available for 2,925 respondents. Results show that older adults generally become lonelier as time passes. The increase is greater for the oldest, the partnered, and those with a better functional capacity at baseline. Older adults who lose their partner by death show the greatest increase in loneliness. Not all older adults become more lonely: Improvement in functional capacity and network expansion lead to less loneliness. Entry into residential care does not affect loneliness. The longitudinal design provides new insights into factors that protect against loneliness compared to cross-sectional studies.

Direct and buffer effects of social support and personal coping resources in individuals with arthritis

The direct and buffer effects of various aspects of social support and personal coping resources on depressive symptoms were examined. The study concerned a community-based sample of 1690 older persons aged 55-85 yrs, of whom 719 had no chronic disease, 612 had mild arthritis and 359 had severe arthritis. Persons with arthritis reported more depressive symptoms than persons with no chronic diseases. Irrespective of arthritis, the presence of a partner, having many close social relationships, feelings of mastery and a high self-esteem were found to have direct, favourable effects on psychological functioning. Mastery, having many diffuse social relationships, and receiving emotional support seem to mitigate the influence of arthritis on depressive symptoms, which is in conformity with the buffer hypothesis. Favourable effects of these variables on depressive symptomatology were only, or more strongly, found in persons suffering from severe arthritis.

Loneliness and social isolation

textabstractLoneliness is nowadays considered to be one of the main problems in society. The negative experience of a discrepancy between the desired and the achieved personal network of relationships is common and affects both younger and older adults. This chapter first addresses well-established aspects and new developments in the main concepts of loneliness and social isolation, the measuring instruments and the prevalence of loneliness. The chapter continues by an overview of theoretical ideas regarding loneliness, focusing on individuallevel and societal predisposing characteristics as well as on genetic/evolutionary perspectives on the onset and continuation of loneliness. The main part of the chapter is dedicated to empirical evidence from many sources and disciplines including psychology, sociology and epidemiological sciences. The prevention of loneliness, coping and interventions are addressed in the final part of the chapter. Other chapters in this volume address topics related to loneliness, namely social rejection, the neuroscience of social disconnection, social networks, and relationships and health (see Leary & Acosta, this volume; Cacioppo, this volume; Felmlee & Sinclair, this volume; and Holt-Lunstad, this volume).

Social Network, Social Support, and Loneliness in Older Persons with Different Chronic Diseases

Objectives:This study examines whether patterns of social network size, functional social support, and loneliness are different for older persons with different types of chronic diseases. Methods:In a community-based sample of 2,788 men and women age 55 to 85 years participating in the Longitudinal Aging Study Amsterdam, chronic diseases status, social network size, support exchanges, and loneliness were assessed. Results:Social network size and emotional support exchanges were not associated with disease status. The only differences between healthy and chronically ill people were found for receipt of instrumental support and loneliness. Disease characteristics played a differential role: greater feelings of loneliness were mainly found for persons with lung disease or arthritis, and receiving more instrumental support was mainly found for persons with arthritis or stroke. Discussion:The specifics of a disease appear to play a (small) role in the receipt of instrumental support and feelings of loneliness of chronically ill older persons.

Feelings of loneliness, but not social isolation, predict dementia onset: results from the Amsterdam Study of the Elderly (AMSTEL)

Background Known risk factors for Alzheimers disease and other dementias include medical conditions, genetic vulnerability, depression, demographic factors and mild cognitive impairment. The role of feelings of loneliness and social isolation in dementia is less well understood, and prospective studies including these risk factors are scarce. Methods We tested the association between social isolation (living alone, unmarried, without social support), feelings of loneliness and incident dementia in a cohort study among 2173 non-demented community-living older persons. Participants were followed for 3 years when a diagnosis of dementia was assessed (Geriatric Mental State (GMS) Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT)). Logistic regression analysis was used to examine the association between social isolation and feelings of loneliness and the risk of dementia, controlling for sociodemographic factors, medical conditions, depression, cognitive functioning and functional status. Results After adjustment for other risk factors, older persons with feelings of loneliness were more likely to develop dementia (OR 1.64, 95% CI 1.05 to 2.56) than people without such feelings. Social isolation was not associated with a higher dementia risk in multivariate analysis. Conclusions Feeling lonely rather than being alone is associated with an increased risk of clinical dementia in later life and can be considered a major risk factor that, independently of vascular disease, depression and other confounding factors, deserves clinical attention. Feelings of loneliness may signal a prodromal stage of dementia. A better understanding of the background of feeling lonely may help us to identify vulnerable persons and develop interventions to improve outcome in older persons at risk of dementia.

Network and Health Changes Among Older Dutch Adults

A negative effect of good health on the instrumental support received can be viewed as an effect of the mobilization of helpers. A positive effect of good health on the personal network size and the instrumental support given demonstrates that people in poor health have difficulty actively maintaining their relationships. Furthermore, the support received and given is positively related to the support given and received in the past. In four waves of a seven-year longitudinal study, personal interviews were conducted with 2,302 older Dutch adults (aged 60 to 85) who live on their own. The hypotheses have been confirmed. An implication is that investing in relationships by giving support might pay off in times of need. Individuals enter and leave a variety of roles throughout their lifetime, and each role is accompanied by a specific set of personal relationships as Kahn and Antonucci (1981) have illustrated in their metaphor of the convoy network. In old age, one’s personal network reflects the transitions earlier in life affecting the opportunities and individual choices to maintain and develop relationships. These life course differences not only produce differences in the networks of older adults, they affect the dynamics of these networks as well (Schulz & Rau, 1985; Stueve & Gerson, 1977). In old age, the process of making and losing personal relationships goes on, leading to changes in the size, composition and functioning of the network.

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.

Social integration and loneliness: A comparative study among older adults in the Netherlands and Tuscany

On the average, older adults in Italy are lonelier than those in the Netherlands. The results of a study by Jylha & Jokela (1990) showed that loneliness was more prevalent in regions of Europe where living alone was rarest and where community bonds were strongest. This inverse macro-level association, an increasing proportion of lonely older people and a decreasing proportion of older people who live alone from northern to southern Europe, could not be explained by differences in individual social integration. The aim of the present study was to reinvestigate this association. The data were from surveys conducted in the Netherlands (N = 3750) and northwestern Tuscany, Italy (N = 1543). Fewer older adults lived alone in Tuscany than in the Netherlands, which indicates that the Dutch were less integrated. As regards their participation in social organizations and personal networks, the Tuscan older adults were less integrated. To a large extent, loneliness among the Dutch and Tuscans based on differences in social integration could be similarly explained, and regional loneliness differences could be attributed to individual situations and characteristics:

Network size and support in old age: differentials by socio-economic status in childhood and adulthood

This paper examines the impact of childhood and adulthood socio-economic status (SES) on personal network characteristics in later life. Data are derived from 2,285 married older adults (born between 1903 and 1937) who participated in face-to-face interviews for the Dutch survey on ‘Living arrangements and social networks of older adults’ conducted in 1992. Childhood and adulthood SES were indicated by the fathers and own level of education and occupation. Multivariate analyses showed that SES in adulthood has more impact on network features in old age than fathers SES. People with low lifetime SES or with downward SES mobility had small networks, low instrumental and emotional support from non-kin, but high instrumental support from kin, when compared with the upwardly mobile or those with high lifetime SES. The level of education was a better indicator of network differences than occupational prestige. It is concluded that obtaining a high SES during life pays off in terms of having more supportive non-kin relationships in old age. The small networks and less supportive non-kin relationships of low-status older adults make them more vulnerable to situations in which kin are unavailable or less willing to provide support. This study underscores the distinction between types of support and types of relationships in the SES–network association. Further research on the social pathways of socio-economic inequality in health and wellbeing should take these distinctions into account.