Social Isolation and Loneliness as Risk Factors for Grip Strength Decline Among Older Women and Men in China

ObjectiveThe purpose of this study was to examine the relationships of social isolation and loneliness, both individually and simultaneously, on changes in grip strength among Chinese older adults and whether these relations vary by gender.DesignA 4-year prospective observational study.Setting and ParticipantsThis study used data from the China Health and Retirement Longitudinal Study (CHARLS). Analyses were conducted with data from 2 waves (2011 and 2015) and were restricted to those respondents aged 50 and older [n = 7025, mean age (SD) = 61.46 (7.59); male, 48.4%].MethodsSocial isolation, loneliness, and grip strength were measured at baseline. Follow-up measures of grip strength were obtained 4 years later. Multiple linear regression was used to evaluate the associations among baseline isolation, loneliness, and decline of grip strength between 2 waves after adjustment for age, gender, education, body mass index, chronic diseases, smoking and drinking status, activities of daily living (ADL) and instrumental ADL disabilities, and depressive symptoms.ResultsFor women, baseline loneliness (β = 0.04, P = .035) rather than isolation (β = 0.03, P = .110) significantly predicted grip strength decline after 4 years when other confounding variables were taken into account. For men, baseline isolation (β = 0.05, P = .005) rather than loneliness (β = 0.01, P = .570) significantly predicted grip strength decline. No synergistic effect of isolation and loneliness on grip strength was found for either women or men.Conclusions and ImplicationsIn this prospective study, gender differences were found for the associations of social isolation and loneliness with grip strength decline. Our results suggest that older women and men may benefit from different social enhancement strategies for prevention of physical function decline.     

The personal and community impact of a Scottish Men's Shed

Social isolation and loneliness are known to be associated with increased morbidity and mortality. Therefore, reducing social isolation and loneliness may improve such outcomes. In relation to men's health, “Men's Sheds” have been shown as one mechanism to achieve this. Studies in Australia and England have shown social, health and personal benefits; however, this remains an area that has not yet been researched in Scotland. This study, therefore, aimed to assess the characteristics of attendees, self‐reported motivations for and the values and benefits of attending the Shed from the views of the attendees themselves. The participants of the study were the members of a Men's Shed in the North of Scotland, which was initially set‐up by a small number of core Shedders. A convenience sample was recruited by opportunistic interviewing of participants when they attended the Shed using a mixed methods approach from 1 to 15 November 2016. In the absence of a validated questionnaire, a bespoke questionnaire was developed in several iterative stages. The answers to the questionnaire were transferred to an electronic database and analysed by frequency and thematic analysis. The participants (n = 31) had a mean age (SD) of 69.7 ± 9.5 with 96.8% being retired, thus the majority of the Shed users were older and retired. The results suggest that there were several benefits from attending the Shed, with an overwhelming majority of the sample reporting personal, social and health benefits—however, more research is needed to determine the magnitude of these. This study has also shown that the men attending the Shed frequently discussed health, which could potentially have a beneficial effect. The Shed therefore, as a community project, has the potential to have a positive impact on health welfare by focusing on the social aspects of life.     

Social networks and health in later life: a state of the literature

Late life is a period frequently marked by decline in personal health and heightened need for social support. Consequently, the social networks in which individuals are embedded assume an increasingly central role in the health and wellbeing of older adults. In the present article, I review the state of the literature on social networks and health in later life. By drawing on insights from the sociology of ageing and the life course, I address new developments and current challenges within the field. Chief among these developments and challenges is the recognition that the ageing process does not occur in a vacuum. Rather, individuals are consistently exposed to numerous changes to their social lives which have strong implications for current and future health outcomes. Upon highlighting the latest innovations within the field of networks and health, I conclude with useful directions for future research.     

The use of telephone befriending in low level support for socially isolated older people--an evaluation

There is increasing policy recognition that the alleviation of social isolation and loneliness in older people should be prioritised. Recently, technology, such as telephone networks and the Internet, has received attention in supporting isolated and lonely older people. Despite lack of evidence, telephone befriending has been considered an effective low-level method to decrease loneliness among older people. This study evaluated the impact of a national befriending scheme for isolated and/or lonely older people, involving eight project sites across the UK 2007-2008. The purpose was to assess the impact of different models of telephone-based befriending services on older people's health and well-being. A mixed methods approach was used. This paper reports on the findings from 40 in-depth interviews with older service recipients. The most important finding was that the service helped older people to gain confidence, re-engage with the community and become socially active again. Three topics were identified: why older people valued the service, what impact it had made on their health and well-being and what they wanted from the service. In addition, nine subthemes emerged: life is worth living, gaining a sense of belonging, knowing they had a friend, a healthy mind is a healthy body, the alleviation of loneliness and anxiety, increased self-confidence, ordinary conversation, a trusted and reliable service, the future--giving something back. In conclusion, the findings present in-depth qualitative evidence of the impact of telephone befriending on older people's well-being. Befriending schemes provide low-cost means for socially isolated older people to become more confident and independent and develop a sense of self-respect potentially leading to increased participation and meaningful relationships.     

Only available to a selected few? Is it feasible to rely on a volunteer workforce for complex intervention delivery?

This paper recounts the process of undertaking a randomised controlled trial which was designed to examine the effectiveness of an intervention for socially isolated older people aged 75 years and over. It describes the reasons for early cessation of the study and raises the implications of this outcome for policy, practice and research. The intervention under investigation was designed to alleviate loneliness and foster companionship. It involves participants being linked with a small group of others through a teleconferencing system with each group being facilitated by trained volunteers. There was a requirement to recruit and train a minimum of 30 and a maximum of 60 volunteers over 1 year to facilitate 20 friendship groups to meet the number of older people required to be recruited to the study. Problems with recruiting and retaining the volunteer workforce by the voluntary sector organisation, who were commissioned to do so, led to the study closing even though older people were recruited in sufficient numbers. The paper draws upon analysis of various data sources from the study to identify the potential reasons. The discussion raises considerations regarding the extent of infrastructure required to deliver community services to vulnerable user groups at scale, identifies some of the issues that need to be addressed if such volunteer‐initiated services are to be successful and informs future research programmes in this area.     

上海市264名男男性行为者孤独感与多性伴行为研究

目的 了解男男性行为者（MSM）孤独心理并探讨其与艾滋病高危多性伴性行为的关系。方法 2015年3—6月,采用滚雪球抽样的方法对上海市264名MSM进行一般人口学信息,多性伴行为,孤独感评定的问卷调查。结果 MSM人群孤独检出比例为17.4%,多性伴检出比例为52.7%,单因素、多因素logistic回归分析均显示,非本地户籍（OR=2.08,95% CI：1.20~3.63）和高孤独感（OR=2.00,95% CI：1.01~3.94）是发生多性伴行为的危险因素。结论 对MSM人群进行艾滋病高危行为干预时,应当注意他们的孤独心理的问题。     

How access, isolation and other factors may influence food consumption and nutrient intake in materially deprived older men in the UK

Summary   The proportion of older people in the UK population is rising, and those aged 65 years and over are particularly at risk of malnutrition. This is caused by factors such as underlying disease, poor oral health, decreased mobility, limited transport to local shops, social isolation and poverty. Older men, particularly those who live alone, may be even more at risk of an inadequate diet. This paper presents findings from a subset of the Low Income Diet and Nutrition Survey, a national survey of materially deprived individuals aged 2 years and over in the UK. The influence of social, physical and other factors on foods consumed and nutrient intake in 234 men (unweighted sample) aged 65 years and over who either lived alone or with other(s) of retirement age is investigated. Mean energy intakes fell below the estimated average requirement (84%), while mean intakes of several micronutrients fell below the reference nutrient intake (vitamin D 35%, magnesium 77%, potassium 75%, and zinc 88%). Men living in households where the person mainly responsible for shopping and preparing food had poorer cooking skills had a lower consumption of vegetables, wholemeal bread and fish and fish dishes, and lower intakes of energy and selected nutrients. Men who experienced difficulty in chewing consumed less fruit, vegetables, wholemeal bread and meat and meat dishes, and had lower intakes of protein and selected nutrients. Interventions need to focus on improving cooking skills, especially in men who live or eat alone, and on increasing the consumption of fruit and vegetables in those with poor oral health, especially those who have difficulty chewing.     

男男性行为者生存质量及与社会支持相关性

目的了解重庆市男男性行为者（MSM）的生存质量、社会支持及其相关性,为干预提供依据。方法以“滚雪球”抽样和网络调查相结合的方法,采用世界卫生组织生存质量测定量表简表（WHOQOL-BREF）、社会支持评定量表（SSRS）对803名重庆市MSM进行自填式问卷调查。结果重庆市MSM生存质量生理领域得分为（14.03±2.14）分,心理领域为（13.38±2.44）分,社会关系领域为（13.45±2.88）分,环境领域为（12.52±2.48）分;典则相关分析得到4对典则变量,前3对典则变量的相关系数分别为0.5706、0.2801、0.2010,差异均有统计学意义（均P<0.05）,3者的累积贡献率为96.20%;第一对典则变量中V₁主要由主观支持、对支持的利用度、月收入、有无固定性伴侣、圈内朋友个数决定;W₁主要由心理领域和社会关系领域决定。结论男男性行为者的社会支持水平尤其是主观支持、对支持的利用度可以较大地影响其个体的生存质量;月收入/生活费,有无固定性伴侣和圈内朋友个数也是MSM生存质量的重要影响因素。     

Connecting communities: A qualitative investigation of the challenges in delivering a national social prescribing service to reduce loneliness

Loneliness is a global public health concern linked to a range of negative health outcomes (Cacioppo & Cacioppo, 2018. The Lancet. 391(10119), 426). Internationally, this has led to the development of a number of interventions, but these are rarely implemented or evaluated on a large scale. This paper is one of the first of its kind to describe elements of an evaluation of a large‐scale national social prescribing scheme to reduce loneliness, deploying individual link workers to signpost people to community activities. Reporting on findings from interviews with staff (n = 25 of which 6 were repeat interviews) and volunteers (n = 9) between October 2017 and December 2018 in localities across the United Kingdom. We reflect on the complexities of the link worker role, the challenges of service delivery and the importance of community infrastructure. There was evidence that highly skilled link workers who had developed positive relationships with providers and service‐users were key to the success of the intervention. As well as providing an effective liaison and signposting function, successful link workers tailored the national programme to local need to proactively address specific gaps in existing service provision. For social prescribing services to be successful and sustainable, commissioners must consider additional funding of community infrastructure.     

“Growing Old is not for the Weak of Heart”: Social isolation and loneliness in Muslim immigrant older adults in Canada

The increase in global migration means more immigrants are ageing in host countries with unique experiences and needs. Muslim immigrants in Canada are from diverse ethnocultural communities and experience unmet health and social needs in older age. A community‐based participatory research project was conducted in Alberta, Canada, in 2017–2018 to understand the experiences and needs of healthy ageing in this population. A community advisory committee participated in all phases of the research project including initial framing of the research focus, recruitment, data collection and data analysis. In total, 67 older adults and stakeholders from South Asian, Arab and African Muslim communities participated in one of 23 individual interviews or seven focus group discussions over a 1‐year period. Participants were asked about their experiences of growing old in Canada, unmet health and social needs, and community perspectives on healthy ageing. All data were audio‐taped and transcribed verbatim. Interpreters were used for non‐English speaking participants. Data were thematically analysed with a focus on social isolation and loneliness. Using an exclusion lens two major themes were identified: (a) intersections of exclusion: ageism, sexism, racism, and; (b) strategies for inclusion: local, national, transnational. Findings highlight both the vulnerability of Muslim immigrant older adults and their capacity for agency. The study findings point to the intersecting influences of exclusionary practices on social isolation and loneliness in immigrant older adults and the need to incorporate an exclusion lens in developing social policies and programs for healthy ageing.     

Social networks, social support, health and HIV-positive gay men

The present pilot study explored the experiences of social support on the part of a number of HIV-positive gay men. It drew upon the growing body of literature that highlights links between social support, and the health and well-being of people with chronic illnesses. In particular, it drew upon the way in which social network analysis can be used to illustrate patterns of both emotional support and instrumental support. The study informants were 30 HIV-positive gay men who were recruited through community support organisations which they accessed at the time of the study. The findings highlighted patterns of support among members of this marginalised community. At a time when access to treatment is extending the life expectancy of people infected with HIV and when, in the UK at least, there are major changes in the funding of HIV services, this paper raises pertinent questions about the impact of social support on people suffering from this illness and about the development of appropriate services.     

Social isolation,loneliness and health in old age: a scoping review

The health and well‐being consequences of social isolation and loneliness in old age are increasingly being recognised. The purpose of this scoping review was to take stock of the available evidence and to highlight gaps and areas for future research. We searched nine databases for empirical papers investigating the impact of social isolation and/or loneliness on a range of health outcomes in old age. Our search, conducted between July and September 2013 yielded 11,736 articles, of which 128 items from 15 countries were included in the scoping review. Papers were reviewed, with a focus on the definitions and measurements of the two concepts, associations and causal mechanisms, differences across population groups and interventions. The evidence is largely US‐focused, and loneliness is more researched than social isolation. A recent trend is the investigation of the comparative effects of social isolation and loneliness. Depression and cardiovascular health are the most often researched outcomes, followed by well‐being. Almost all (but two) studies found a detrimental effect of isolation or loneliness on health. However, causal links and mechanisms are difficult to demonstrate, and further investigation is warranted. We found a paucity of research focusing on at‐risk sub‐groups and in the area of interventions. Future research should aim to better link the evidence on the risk factors for loneliness and social isolation and the evidence on their impact on health.     

Community involvement among behaviourally bisexual men in the Midwestern USA: experiences and perceptions across communities

Limited research exists regarding community involvement and social support among behaviourally bisexual men. Previous studies suggest that bisexual men experience high levels of social stigma in both heterosexual and homosexual community settings. Research focusing on social support has demonstrated that individuals with limited access to similar individuals experience greater risk for negative health outcomes. Using a community-based research design, participants were recruited using multiple methods. Researchers conducted in-depth, semi-structured interviews with 75 men who reported having engaged in bisexual behaviour within the past six months. Interviews elucidated the experiences of behaviourally bisexual men in heterosexual and homosexual settings, as well as their perceptions of the existence of a bisexual community or bisexual spaces. All participants perceived a lack of a visible bisexual community and expressed difficulty with being comfortable, or a feeling of belonging, within a variety of heterosexual and homosexual community spaces. Findings suggest the need for interventions focused on community building among, as well as creating spaces specifically designed for, bisexual men in order to increase perceived social support and decrease isolation and possible negative health outcomes.     

Loneliness and social support of older people in China: a systematic literature review

Loneliness is a serious problem for older people, which can be alleviated by social support. The dramatic population ageing together with social and economic change in China increases the likelihood of loneliness and the availability of different sources of social support of older people. The aim of this review was to identify the prevalence of loneliness and its related factors and sources of social support of older people in China. Electronic literature searches were conducted in September 2011 using Web of Science, PsycINFO, MEDLINE, PubMed, CINAHL, China Academic Journal and VIP Database for Chinese Technical Periodicals. Twenty‐six papers were identified and reviewed. The prevalence of loneliness varied across the studies, reflecting the different measurements and samples. Marital status, gender, age, educational level, economic level, living arrangements, health status and social support were significant factors related to loneliness. The family was the most important source of social support followed by friends. The receipt of family support improved subjective well‐being and mental health, but the effects of support from friends were inconsistent. Chinese older people received relatively little support from neighbours, governmental or other social organisations. Further well‐designed studies are needed to identify additional factors related to loneliness and to understand the support from friends, neighbours, formal organisations and other sources.     

Social networks, social support, personal empowerment, and the adaptation of psychiatric consumers/survivors: Path analytic models

In this paper, we examine the relationships between social network characteristics, personal empowerment, social support, and adaptation of psychiatric consumer/survivors. Using path model analyses, we found that: (1) personal empowerment had statistically significant direct effects on positive affect, meaningful activity, and negative affect; (2) positive social support mediated the relationship between the proportion of women in consumer/survivors' networks and positive affect and meaningful activity; and (3) negative social interaction mediated the relationship between consumer/survivors' gender and negative affect. The results point out the importance of gender effects in social support processes, the differential association between type of social interaction (positive vs negative) and adaptation indices (positive vs negative), and the importance of personal empowerment for consumer/survivors' adaptation. We discuss the findings in terms of their implications for further research and community-based housing programmes for psychiatric consumer/survivors.     

深圳市HIV阳性男男性行为者的社会网络和社会支持现况研究

目的 分析HIV阳性男男性行为者(men who have sex with men, MSM)的社会网络特征和社会支持现况及其影响因素,为改善该人群的社会支持提供依据。 方法 收集2017—2018年在深圳市宝安区疾病预防控制中心转介治疗的HIV阳性的MSM的相关资料,采用描述性流行病学方法进行分析。 结果 110例HIV阳性MSM中,报告105个核心社会网络,提名249个网络成员,网络大小(3.37±1.43),网络密度(0.86±0.21)。社会支持总分为(26.42±7.74)分,主观支持得分(15.24±4.88)分,客观支持得分(4.98±2.62)分,支持利用度得分(6.20±1.98)分。方差或t检验分析显示,不同社会网络大小,网络成员的性别、社会关系种类、文化程度构成、性取向构成以及是否和网络成员有性行为的HIV阳性MSM社会支持得分差异有统计学意义。多重线性回归分析显示,网络成员的文化程度构成、性取向构成、关系亲密度和网络成员有性行为是社会支持得分的影响因素。 结论 应尽可能提高HIV阳性MSM的社会支持。     

A “separation of worlds”: The support and social networks of family carers of people with dementia at the end of life,and the possible role of the internet

Caring for someone with dementia is one of the most challenging caring roles; however, the demands of the role towards the end of life often mean carers are unable to maintain face‐to‐face support. The aim of this study was to: (a) Explore the experiences of older (over 65 years) family carers of people with dementia of support towards the end of life; (b) Explore with family carers the role of the internet as a support for them at the end of life. Semi‐structured interviews were conducted, with purposive sampling from general practice and research networks to recruit 20 current and former family carers aged 65 and over in England (2016–2017). Interviews were audio‐recorded, transcribed, and analysed using thematic analysis. An overarching theme of the “separation of worlds” (the internal caring world and the outside world of society) was identified, with four sub themes: (a) the support role of relationships and social networks; (b) loss as a consequence of caring; (c) reconstruction of life as a carer; and finally; (d) life within and beyond the computer screen. This study demonstrates the complexity of social support at the end of life for family carers depicted in a model of two worlds. The internet can be seen as a viable approach to help carers maintain existing networks, reconstruct networks they have lost or developing new networks to meet their new needs and circumstances as a carer. Future support interventions should focus on a mixed model of technology and human interaction.