CONCEPTUALIZING SOCIAL INTEGRATION AMONG FORMERLY HOMELESS ADULTS WITH SEVERE MENTAL ILLNESS

The multiple dimensions of social integration among formerly homeless adults with severe mental illness have not been well‐studied. Previous studies have focused on clinical measures or narrow components of social integration. We used a multisite study of chronically homeless adults who were provided housing to (a) identify the main factors related to social integration, (b) examine the association between clinical symptoms and social integration, and (c) examine whether social integration is associated with life satisfaction. A factor analysis identified six components of social integration: housing, community participation, civic activities, religious faith, social support, and treatment support. Social integration was found to be largely independent of clinical symptoms and had only a weak association with life satisfaction. These findings suggest supported housing programs needed to focus on improving client outcomes in several domains of social integration regardless of symptoms and that additional efforts are needed to improve life satisfaction among clients.     

PREDICTORS OF THE PHYSICAL AND PSYCHOLOGICAL INTEGRATION OF HOMELESS ADULTS WITH PROBLEMATIC SUBSTANCE USE

This study examined predictors of physical and psychological integration in homeless adults with problematic substance use. Homeless adults with problematic substance use (n = 115) in Ottawa, Canada, completed questionnaires regarding their demographics (age, gender, Aboriginal ethnicity), health and social functioning (physical health, mental health, alcohol use problems, drug use problems, social skills), environmental factors (satisfaction with personal safety, social support), physical integration, and psychological integration. Participants reported low physical integration (i.e., participation in activities in the community) and did not feel strongly psychologically integrated (i.e., sense of belonging). The final models accounted for 36% and 19% of the variance in physical and psychological integration, respectively. Higher levels of social skills and social support were associated with greater physical integration. Higher levels of mental health functioning and satisfaction with safety were related to greater psychological integration. Implications of the findings for community support services are discussed.     

Clinical correlates of anxious depression among elderly patients with depression

OBJECTIVE: The purpose of this study was to determine the clinical correlates of comorbid anxiety and depression in a sample of older patients with major depression. METHODS: 352 patients aged 59 and older with major depression were enrolled in the Study of Depression in Later Life at Duke University, of whom 148 met criteria for lifetime generalized anxiety disorder. Participants completed self-report assessments of performance in basic and instrumental activities of daily living, social support, suicidal ideation, life satisfaction, and stressful life events. Cognitive assessment was done with the Mini-Mental State Examination. RESULTS: The prevalence of lifetime anxiety in our depressed sample was 42%. Patients with anxious depression were significantly younger, and had greater suicidal ideation, more impairment of subjective social support, and more severe depressive symptoms. CONCLUSION: In elderly patients with anxious depression, psychosocial support and suicidal ideation should be assessed. Whether improvement of subjective social support leads to reduction in anxious depression should be investigated.     

Loneliness and social support: Differential predictive power on depression and satisfaction in senior citizens

The lack of social support and the feelings of loneliness among older adults are associated with physical and mental health negative outcomes. This study attempts to test for their differential predictive power on depression and satisfaction in seniors. Data were drawn from a sample of 335 older adults ranging from 55 to 80 years old, with a mean age of 63.97 years (standard deviation = 5.56) attending a learning program at the University of Valencia during the academic year 2014–2015. In addition to health and wellbeing outcomes, we used the Functional Social Support Questionnaire DUKE‐UNC, and two scales of loneliness, the de Jong Gierveld Loneliness Scale and the University of California Loneliness Scale version 3. Using structural equations models with Mplus, two models were proposed to assess the predictive power of social support and loneliness on wellbeing outcomes, specifically life satisfaction and depression, while controlling for health. Results confirm the negative association between loneliness and satisfaction with life and the positive one with depression.     

Attachment, social support and well-being in young and older adults

The present study examined the link between attachment, social support and well-being in young and older adults. The results from multi-group path analyses showed significant between-group differences in the links between attachment, perceived support and well-being. Anxious attachment and well-being were inversely associated and this was stronger for the younger group than it was for the older group. Avoidant attachment was negatively related to perceived support satisfaction in the older age group only, and perceived support mediated the effects of avoidant attachment on mental health and loneliness in the older group. Generally, perceived satisfaction with support was more strongly related with well-being in older adults. The results point to differential links of insecure attachment styles with perceived support in different life-stages and to related cognitive, emotional and social processes.     

Association between participation in community groups and being more physically active among older adults from Florianópolis, Brazil

OBJECTIVE:

In Brazil, older adults frequently participate in community groups. However, the influence of this participation on physical activity levels has not been fully investigated. It is known that both regular physical activity and social support are beneficial for health. The aim of this study is to evaluate the association between participation in community groups and physical activity among older adults from Florianópolis, Brazil.

METHODS:

The sample consisted of 1062 adults with a mean age of 71.9 (±7.6) years. Among these individuals, 293 subjects participated in community groups and 769 did not. A questionnaire to collect sociodemographic data and the long version of the International Physical Activity Questionnaire were used for the assessment.

RESULTS:

The prevalence of active older adults was 66.6% among participants in community groups and 58.4% among non-participants. Participation in these groups was significantly associated with being more physically active in the transportation and domestic domains, but with being less physically active in the leisure-time domain. Some changes in these associations were observed when the sample was stratified by age, gender, body mass index, and health status. With respect to total physical activity, participation in community groups was associated with being more physically active in only two strata (subjects younger than 70 years and women).

CONCLUSION:

The results of this study indicate that older adults who participate in community groups are characterized by a greater probability of being more physically active. However, longitudinal studies are needed to determine whether participation in community groups facilitates the adoption of physically active behavior.     

Effect of satisfaction with social support on blood pressure in normotensive and borderline hypertensive men and women

The relation between blood pressure (BP) and two aspects of social support, perceived satisfaction and structural social support network characteristics, were examined in adults classified as having normal BP or borderline hypertension. Casual BP_s were taken by a trained technician on 3 separate visits, each approximately 1 week apart. Participants were categorized as borderline hypertensive if screening systolic blood pressure (SBP) fell in the range 130-160 mmHg and/ordiastolic blood pressure (DBP) fell in the range 85-100 mmHg; BP_s below these ranges were considered normotensive. Participants underwent ambulatory BP monitoring, Individuals classified as normotensive reported significantly greater support satisfaction than individuals with borderline hypertension. Social network characteristics were not associated with BP. During 24 hr of ambulatory BP monitoring, high perceived support satisfaction was associated with lower SBP and DBP at work, home, and during sleep. These data suggest that perceived satisfaction with social support is associated with lower BP. The presence of social support also may reduce BP levels during daily life. This study was supported by National Institutes of Health (NIH) Grants HL49427, HL49572. HL53724, and MOI-RR-30, National Center far Research Resources, Clinical Research Centers Program, National Institutes of Health.     

Social Support, Health and Satisfaction among the Elderly with Chronic Conditions in Taiwan

This study examines possible relationships between perceived social support, physical and mental health, satisfaction towards hospital services, and satisfaction towards life-asa-whole, among the community elderly with chronic conditions. A sample of 172 Chinese elderly living in a metropolitan Taiwanese city were home-interviewed. Results indicated that (a) the elderly perceived good social support, and tangible support was the most important aspect; (b) the elderly did not perceive great impact of illness(es) upon their life, and both physical and mental health were satisfactory; (c) the elderly were generally satisfied with both the hospital services and life-as-a-whole; (d) apart from health and illness factors, social support appeared to have profound and pervasive protective effects on adjustment and satisfaction of the elderly.     

Psychological and relational factors in ESRD hemodialysis treatment in an underserved community

ObjectiveThe researchers investigated the association of depression with treatment adherence, and examined the possible moderating roles of social support and of the physician-patient working alliance (PPWA) on treatment adherence, satisfaction with treatment, and quality of life.MethodsThe current study sampled ninety-five patients with End Stage Renal Disease who were receiving outpatient hemodialysis (HD) treatment.ResultsFindings indicated that higher levels of depression were significantly associated with lower ratings of adherence, quality of life, and social support. In contrast, higher levels of social support and of the PPWA were significantly associated with higher ratings of adherence, satisfaction with treatment, and quality of life. Analyses of moderation showed no effect for PPWA between depression and adherence, satisfaction, or quality of life; however, there was a significant moderation effect for social support.ConclusionThere are mild but significant associations between PPWA and social support. Positive associations between the PPWA and social support on adherence, satisfaction, and quality of life indicate that each one, PPWA and social support, plays its own role on patients’ experiences of and behavior in treatment. Affective social support significantly limits the negative influence of depression on adherence.Practice ImplicationsAssessment of depression and social support is essential in hemodialysis treatment.     

Effects of a peer-led senior health education program

The effect of a health education course guided by peers aged 55 and over was evaluated. The aim of the course was to empower older adults to participate in society and to promote their wellbeing. Evaluation included determining the effect on attitude toward aging, self-efficacy, perception of the societal opinion regarding the place of the elderly in society (social influence), social participation, perceived social support, and wellbeing of the participants aged 55 to 79 years. A quasi-experimental approach was used. The effect on the experimental group of course participants was studied compared to a control group of older adults on the waiting list. The respondents filled out postal questionnaires at three time points (before starting the course (t₀), immediately after termination (t₁) and three months later (t₂)). Using a multivariate analysis procedure, a significant interaction effect between time of measurement and group membership was found with respect to the outcome of social influence. At t₁ an effect was absent, but at t₂, the current idea that elderly occupy a marginal position in society, found less favour with the experimental group than the control group. Moreover perceived social support and subjective health improved significantly at t₁ and t₂ among the course members, when compared to the control group. No effect was found on attitude, self-efficacy, social participation and wellbeing in the short time span of a three months follow-up.     

Course of social support and relationships between social support and life satisfaction in spouses of patients with stroke in the chronic phase

Objective

To describe the course of social support in spouses of patients with stroke, and to examine direct and indirect relationships between social support and life satisfaction over time.

Methods

Prospective cohort study (N = 180) with measurements at 2 months after discharge from inpatient rehabilitation, 1 year, and 3 years after stroke. Social support was assessed using the Social Support List-12, Life satisfaction with the Life Satisfaction Questionnaire (LiSat-9) and Caregiver strain with the Caregiver Strain Index. Random coefficient analyses was used.

Results

Total social support and the 3 subtypes of social support decreased significantly over time. In all models, caregiver strain was associated with lower life satisfaction and social support was associated with higher life satisfaction, but there were no interaction effects between caregiver strain and social support on life satisfaction.

Conclusion

Spouses of patients with stroke experienced a decline of social support over time. Social support was positively associated with life satisfaction, regardless of the amount of caregiver strain experienced by the spouses.

Practice implications

It is important to discuss with caregivers of stroke patients the importance of maintaining their own social contacts and to facilitate this by arranging support if appropriate.     

Ambulatory independence is associated with higher incidence of latent tuberculosis infection in long-term care facilities in Taiwan

Background/purposeTuberculosis (TB) in the elderly population remains a major challenge in areas with intermediate disease burden like Taiwan. Despite the increasing burden and high risks of TB in the elderly population, particularly those living in long-term care facilities (LTCFs), diagnostic testing for latent tuberculosis infection (LTBI) has not been carefully evaluated in this group. This study aimed to investigate the prevalence and predictors of LTBI in older adults living in LTCFs.MethodsOlder adults living in seven LTCFs in Taiwan were prospectively enrolled between January and July 2017. Interferon-gamma release assay (IGRA) through QuantiFERON-TB Gold In-tube was used to determine presence of LTBI. Predictors for LTBI were analyzed.ResultsA total of 258 participants were enrolled, including 240 older residents (mean age, 81.6 years; male, 51.2%) and 18 employees (mean age, 64.8 years; male, 22.2%). The proportion of independent status in ambulation assessments significantly declined with aging (p < 0.001). The IGRA-positivity rate in LTCFs was 31.4% (81/258), which consisted of 73 (30.4%) residents and 8 (44.4%) employees. The IGRA results were different with respect to the ambulation status (p = 0.052). In the multivariate logistic regression analysis, the only independent predictor of LTBI among older adults in LTCFs was independent ambulation (odds ratio, 2.16; 95% confidence interval, 1.09–4.28; p = 0.027).ConclusionsThere was a high prevalence of LTBI among older adults in LTCFs in Taiwan. Independent ambulation was the only independent predictor of LTBI.     

Treatment satisfaction, perceived treatment effectiveness, and dropout among older users of mental health services

Objectives: To examine the rates and correlates of treatment satisfaction, perceived treatment effectiveness, and dropout among older users of mental health services. Method: We used data from the Canadian Community Health Survey‐Mental Health and Well‐Being (CCHS‐1.2), which includes 12,792 individuals aged ≥55 years. The average age of these participants was 67 years and 53.2% were female. We examined the rates of treatment satisfaction, perceived treatment effectiveness, and dropout for those who had used mental health services in the past year, and used logistic regression to examine the correlates of these outcomes. Results: Of the older adults included in the CCHS‐1.2, 664 (5.3%) had used mental health services in the past year. The majority of these were satisfied with services (88.5%) and perceived treatment to be effective (83.6%), which is likely why only 15.5% dropped out in the past year. In logistic regression models, social support was significantly and positively related to both treatment satisfaction and perceived effectiveness. Perceived treatment effectiveness was the only variable related to dropout, with lower levels of perceived effectiveness associated with greater odds of dropping out of treatment. Conclusions: Results from this study indicate that older adults have very good self‐reported treatment outcomes. The modest influence of individual characteristics on treatment outcomes suggests the potential importance of contextual characteristics. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1197–1209, 2011.     

Predictors of patient satisfaction after primary hamstring anterior cruciate ligament reconstruction

BackgroundPredictors of patient satisfaction (PS) after anterior cruciate ligament (ACL) reconstruction are not well known. This study investigated predictors of PS and whether PS was associated with pre-injury level of sport participation, patient reported knee function and quality of life after ACL reconstruction.MethodsPatients who underwent primary hamstring ACL reconstruction between January 2015 and December 2017 were retrospectively evaluated. An online survey was used to evaluate PS (yes = satisfied, no = unsatisfied), duration of supervised postoperative rehabilitation, timing of return to pre-injury level of sport, pre-injury level of sport participation, patient reported knee function and quality of life. Preoperative, operative and postoperative variables were collected from the medical records.ResultsA total of 183 patients completed the survey at a median of 3.6 (1.5) years after ACL surgery. At final follow-up, 82% of patients were satisfied with the outcome. Preoperative (e.g. age) and operative (e.g. meniscal tear) variables were not predictors of PS (p > 0.05). Duration of supervised postoperative rehabilitation, timing of return to pre-injury level of sport and postoperative ACL injury were predictors of PS (p = 0.018, p = 0.016 and p < 0.001, respectively). Pre-injury level of sport participation was significantly higher in satisfied compared to unsatisfied patients: 44.7% (n = 67) versus 18.2% (n = 6) (p = 0.005). In addition, satisfied patients reported significantly higher patient reported knee function and quality of life compared to unsatisfied patients (p < 0.001).ConclusionThis study provided data on predictors of PS after primary ACL reconstruction. Furthermore, PS was associated with pre-injury level of sport participation, patient reported knee function and quality of life.     

成人后期抑郁情绪的年龄特征及其相关因素研究

目的：对成人后期抑郁情绪的年龄特征及相关因素进行研究。方法：选取被试225名,年龄范围55－75岁。采用CES－D量表和自编背景问卷,测评其抑郁情绪、生活满意感、婚姻满意感、社会支持、健康状况、受教育水平和经济状况,并进行有关统计分析。结果：进入成人后期以后,抑郁情绪随年龄增长而呈下降趋势,55－59岁年龄组的抑郁总分显著高于60－64岁、65－69岁和70－75岁年龄组;生活满意感和社会支持感是预测抑郁情绪产生的直接因素;婚姻满意感和健康状况通过影响生活满意感和社会支持感对抑郁情绪产生间接作用。结论：成人后期抑郁情绪随年龄增长而减轻,这种改变与自我感受到的满意度和支持感有关。     

The influence of social support on loneliness and depression among older elderly people in China: Coping styles as mediators

This study examines the direct effect of social support and the mediating effects of coping styles on loneliness and depression of older elderly people in China using data from the 2014 China Longitudinal Aging Social Survey. Our sample includes 905 males and 741 females aged 75 years and over. The mean age of the sample is 79.71 (standard deviation = 4.01). We use structural equation modeling to show that social support is significantly negatively associated with the incidence of loneliness and depression among older elderly people. Higher levels of social support are also significantly negatively associated with the use of negative coping styles and consequently predict fewer symptoms of loneliness and depression. A higher level of social support is significantly positively associated with positive coping styles and consequently predicts fewer depressive symptoms. However, positive coping styles are not significantly associated with loneliness. These findings emphasize the importance of social networks in resilience and have significant implications for gerontological social work practice in China.     

SUPPORT,SENSE OF COMMUNITY,AND PSYCHOLOGICAL STATUS IN THE SURVIVORS OF THE YAAN EARTHQUAKE

This research examined associations among social support, governmental support, sense of community, and psychological status, including depression and life satisfaction, in Yaan earthquake survivors, based on a cross‐sectional survey conducted in June 2014. The survey applied a nonprobability sampling method and a total of 495 survivors aged 18 years and older completed the questionnaire. Regression analyses revealed that social support and sense of community were associated with depression. Sense of community mediated the relationships between depression and both social and governmental support. Governmental support and sense of community were associated with life satisfaction. Sense of community mediated the relationships between life satisfaction and both social and governmental support. The findings suggest that social support, governmental support, and sense of community would enhance the psychological well‐being of disaster survivors.     

Characteristics Associated with High Resilience among Aged People Exposed to the Jeju 4·3 Incident

The purpose of this study was to identify characteristics related to high resilience among older people exposed to the Jeju 4·3 incident. A total of 1,121 aged adults were assigned to low, medium, and high resilience groups, and factors associated with low and high resilience were investigated. High resilience was significantly associated with a low prevalence of depression and high levels of life satisfaction and psychosocial support, as well as with younger age, being a man, higher education level, and current employment. The results deepen our understanding of resilience in the aged people who experienced the early life trauma.     

Social capital and health in a national cohort of 82,482 Open University adults in Thailand

We report associations between social capital and health among 82,482 adults in a national cohort of Open University students residing throughout Thailand.After adjusting for covariates, poor self-assessed health was positively associated with low social trust (OR = 1.88; 95% CI 1.76-2.01) and low social support (OR = 1.79; 95% CI 1.63-1.95). In addition, poor psychological health was also associated with low social trust (OR = 2.52; 95% CI 2.41-2.64) and low social support (OR = 1.80; 95% CI 1.69-1.92). Females, elderly, unpartnered, low income, and urban residents were associated with poor health. Findings suggest ways to improve social capital and heath in Thailand and other middle-income countries.     

Sense of community and life satisfaction in Chinese older adults: Moderating roles of personal and partner resilience

From an ecological perspective, this study aimed to examine the relationship between a sense of community and life satisfaction as moderated by personal resilience and partner resilience among Chinese older adults. Using a cross‐sectional design, a total of 258 Chinese couples (age range 60–97 years) completed measures related to sense of community, resilience, and life satisfaction. The results showed that (a) sense of community was positively associated with life satisfaction after controlling for personal resilience, partner resilience, and other covariates, and (b) a three‐way interaction between sense of community, personal resilience, and partner resilience emerged to predict life satisfaction. Specifically, the effect of sense of community on life satisfaction under the condition of low personal resilience–low partner resilience was weaker than it was under other conditions. Tailored interventions to enhance community resources, individual resilience, and couples’ strengths are recommended to promote the life satisfaction of Chinese older adults.