Social relationships and depressive symptoms among older adults in southern Brazil

OBJECTIVES: This research tests hypotheses from equity theory and social integration theory regarding the effect of social relationships on depressive symptoms. METHODS: The data are based on a representative sample of people aged 60 and older from southern Brazil. The baseline sample consists of 871 subjects interviewed in 1995. Among those baseline subjects, 551 responded in 1999. Cross-sectional and longitudinal multivariate regression models estimate the effect of two dimensions of social relationships (i.e., social exchanges and social integration) on depressive symptoms, controlling for demographic, socioeconomic, and health characteristics. RESULTS: The results indicate that unbalanced exchange increases depressive symptoms, and social integration decreases depressive symptoms. Specifically, older Brazilians who overbenefit or underbenefit from exchanges with relatives have more depressive symptoms than those with balanced exchanges. In addition, depressive symptoms are lower when an older adult who is receiving support is able to reciprocate. More intensive exchanges with relatives, being married, and satisfaction with family relationships decrease depressive symptoms, whereas living alone increases depressive symptoms. DISCUSSION: The results highlight the relevance of social relationships to depressive symptoms among older Brazilians. In addition, the results indicate there is a nonlinear relationship between exchange balance and depressive symptoms in this population. The implications for policy are discussed.     

Social engagement and depressive symptoms in late life: longitudinal findings

OBJECTIVE: The purpose is to investigate whether social engagement protects against depressive symptoms in older adults. METHOD: Three waves of data from a representative cohort study of community-dwelling adults aged 65 years and above from the New Haven Established Populations for the Epidemiologic Study of the Elderly are examined using random effects models. RESULTS: Social engagement (an index combining social and productive activity) is associated with lower CES-D scores after adjustment for age, sex, time, education, marital status, health and functional status, and fitness activities. This association is generally constant with time, suggesting a cross-sectional association. In addition, social engagement is associated with change in depressive symptoms, but only among those with CES-D scores below 16 at baseline. DISCUSSION: Social engagement is independently associated with depressive symptoms cross-sectionally. A longitudinal association is seen only among those not depressed at baseline.     

English language skills,ethnic concentration,and household composition: older Mexican immigrants

OBJECTIVES: The authors examine the living arrangements of older Mexican immigrants to demonstrate how the formation of complex households is related to English language proficiency. Specifically, they examine whether the ability to use the English language is a determinant of an older Mexican immigrant persons' capacity to maintain residential independence. They also examine how living in communities with a relatively high proportion of Hispanic persons impacts household structure. METHODS: Data from the 1990 U.S. Census of Population are used to evaluate multilevel multinomial logistic regression models of living arrangements among older Mexican immigrants. RESULTS: The authors found that strong English language skills increase the likelihood of living independently and increase the likelihood of being the head of a household. They also found that living in an area with a relatively high proportion of Hispanic persons increases the likelihood that older Mexican immigrants will live independently as compared with living with others without headship. Finally, interaction models were examined, demonstrating that living in a community with a relatively high proportion of Hispanics reduces the strength of the relationship between English language proficiency and living arrangement outcomes for older Mexican immigrants. DISCUSSION: The authors discuss the implications of their findings and point out possible avenues for further research.     

Change of depressive symptoms in a French nine-year longitudinal study of aging: Gender differences and relationships between social support,health status and depressive symptoms

ObjectivesThe aims of this study were to examine the trajectory of depressive symptoms among older French people, to investigate the role of gender in the developmental trajectory of depressive symptoms and to explore whether the linear increase in depressive symptoms might be accentuated or attenuated at time points during which the older adults’ scores on social support and health satisfaction scales were higher than their individual averages.Methods/materialsData were used from a subsample of older adults living at home who participated in a longitudinal study initiated by researchers from the University of Tours. They were collected at five time points over a 9-year period (T1: 2003; T2: 2005; T3: 2007; T4: 2009; T5: 2011). This study included 707 participants, and multilevel growth curve analysis was used on measures of depressive symptoms, gender differences, social support and health satisfaction.ResultsResults indicated (1) a significant positive linear effect of age on depressive symptoms; (2) that women reported significantly higher scores of depressive symptoms than men at 63 years old (i.e., intercept) and that this gender difference remained constant across age; (3) that the slope of depressive symptoms appeared to increase at time points during which participants had higher levels of social support and to decrease when they had greater health satisfaction.ConclusionThis study provides pertinent information about the change of depressive symptoms in older people living at home and particularly highlights the interest in studying gender, social support and health satisfaction.     

The social determinants of depression in elderly Korean immigrants in Canada: does acculturation matter?

Depression in old age significantly decreases the quality of life and may lead to serious consequences, such as suicide. Existing literature indicates that elderly Korean immigrants may experience higher levels of depression than other racial ethnic group elders. The purpose of this exploratory study was to investigate factors that influence depression among older Korean immigrants in Toronto. A total of 148 participants, ages 60 years or older (mean age = 74.01, SD = 8.24), completed face-to-face interviews in Korean language. Hierarchical regression analyses were conducted by adding variables in three steps: (1) demographic variables; (2) acculturation variables (years of immigration and English proficiency); and (3) social determinants (social integration variables, physical health, and financial satisfaction). Results showed that acculturation factors were not associated with depression. Instead, social determinants variables, including lower physical health status and lower financial status, living alone, and lower level of social activity, predicted higher level of depressive symptoms, along with lower education. The final regression model explained about 37% of variance of depression in the sample. These results suggest that social determinants, not acculturation, are important factors explaining the levels of depression in Korean immigrant elders living in a metropolitan city in Canada. Implications for practice are discussed.     

Limited English proficiency, social network characteristics, and depressive symptoms among older immigrants

OBJECTIVES: The purpose of the study was to examine differences in social network characteristics and their relationship to depressive symptoms among two groups of older Asian Indian immigrants: those with limited English proficiency and those proficient in English. METHODS: Telephone surveys were conducted with 226 English-speaking (Sample 1) and 114 Gujarati-speaking (Sample 2) immigrants in Atlanta. RESULTS: The samples differed significantly in demographics and patterns of social integration. Sample 2 had shorter residence in the United States, a more traditional ethnic identity, greater reliance on family for social activities, greater participation in religious events, lower likelihood of having good friends nearby, and less frequent interactions with friends. Rates of depressive symptoms did not differ, and network composition was unrelated to symptoms. For both samples, poorer health and a more traditional ethnic identity were related to depressive symptoms. Quality of relationship with children was predictive of symptoms for Sample 2. DISCUSSION: I found no differences in depressive symptoms despite differing social network structures. This may be due to the differing expectations of social ties among older immigrants. Interventions to improve well-being should focus on issues that generate acculturative stress. Cognitive and social support interventions may help individuals develop the adaptive coping strategies needed to live in a different culture.     

Living arrangements among older immigrants in the United States

This analysis uses data from the 1990 5% Public Use Microdata Sample (PUMS) to identify the individual-level characteristics that influence residential dependence among immigrants age 60 and older in the United States. Particular attention is given to differences among 11 immigrant groups. Separate models are shown by gender and marital status. The results indicate that Hispanic and most Asian immigrants, particularly those from Mexico, Central or South America, India, and the Pacific Islands, are at a greater risk of living with family than non-Hispanic White immigrants. Although resource, need, and demographic characteristics influence the risk of living with Family, these individual-level characteristics do not explain the observed differences across the immigrant groups. These findings suggest that preferences that are shaped by the immigrant's experience as well as cultural background are an important determinant of immigrant living arrangements in later life.     

Healthy but unhappy? Cross-national comparative analysis of depressive symptoms in Japanese vs. Korean elders

BackgroundJapan and South Korea, two neighbouring countries in East Asia, enjoy the highest life expectancies in the world, yet suffer paradoxically from high suicide rates.AimWe sought to conduct a cross-national comparative analysis of depressive symptoms among older adults in Japan vs. Korea, focusing particularly on poverty and physical health status.MethodsWe used nationally representative samples aged 65 and over from the Comprehensive Survey of Living Conditions in Japan and the Korean Community Health Survey in South Korea. Multivariate logistic regression models were conducted to examine if equivalized household income, poor self-rated health, disability and comorbidity (number of diseases) were associated with depressive symptoms, adjusting for age, education, marital status, alcohol use, smoking and living alone.ResultsOlder Japanese adults with poor self-rated health and disability were more likely to report depressive symptoms, but income level was not significantly associated with mental distress. By contrast, among older Korean people, depressive symptoms were strongly patterned by household income level, as well as poor self-rated health, disability, and comorbidity.ConclusionPoor physical health status was correlated with depressive symptoms among both Japanese and Korean seniors. However, income level was associated with depressive symptoms among only Korean elders, but not Japanese. Thus, the current generation of older Japanese adults appears to enjoy (relative) financial security, longevity, and mental wellbeing. By contrast, older Koreans experience high levels of mental distress, especially if they are financially insecure.     

Low supply of social support as risk factor for mortality in the older adults

ObjectivesTo determine the relationship between social support and mortality in older adults, independent of other health conditions.MethodThis was a longitudinal study using the database of the 2006 SABE Study (Heath, Well-being and Aging), composed of 1413 individuals aged 60 years and over, living in São Paulo/Brazil. The present study used a questionnaire constructed for the SABE Study, which was reviewed by experts of Latin America and the Caribbean. The social network was evaluated using the variables: social support received; social support offered; number of members in the social network. The covariates included were age, gender, living arrangements, marital status, income, education, comorbidity, depressive symptoms, cognition and functional difficulties. Death as an outcome was evaluated after four years of follow-up.ResultsFrom a total of 1413 older adults at baseline, 268 died in a mean follow-up period of 3,9 years (SE = 0,03). In the model adjusted offering social support and having networks composed of 9 or more members reduced the risk of death in the older adults.ConclusionsThis study suggest that older adult who are offered support can benefit from mutual exchanges since reciprocity in relationships improves psychological well-being and is indicative of the quality of relationships. Thus, the older adults are part of a group of people whose role is not only to receive, but also to provide help to others, and the support offered seems to be as important as that received.     

The effects of socioeconomic status and health on transitions in living arrangements and mortality: a longitudinal analysis of elderly Finnish men and women from 1997 to 2002

OBJECTIVE: . Objectives were to study the effects of socioeconomic factors on transitions in living arrangements and mortality for men and women. METHODS: We used a sample of Finns aged 65 years and older living alone or with a partner at the end of 1997 (N = 250,787) drawn from population registers, and followed them up for transitions in living arrangements (with partner, alone, with others, institutionalized) and death at the end of 2002. RESULTS: Health conditions associated with functional difficulties were major determinants of institutionalization and death and were associated with transitions between private households. Low income among men and in particular not owning a home were independently associated with institutionalization and death among those living alone or with a partner at baseline. Among those living with a partner, the transition to living alone was associated with all socioeconomic factors but most strongly with a low income and not owning a home. Transitions to living with others were associated in particular with low occupational social class and education. DISCUSSION: Variations in the associations of different socioeconomic indicators with living arrangement transitions imply different social pathways. However, material socioeconomic indicators dominated other measures of socioeconomic status in determining such transitions, and their effects were only partly mediated by chronic conditions.     

Nursing Home Transition and Depressive Symptoms in Older Medical Rehabilitation Patients

Abstract

The present study of older medical rehabilitation patients investigated whether transition to a nursing home after rehabilitation was significantly related to increased depressive symptoms at baseline and at 3-, 6-, and 18-month follow-ups. All participants lived alone prior to their medical rehabilitation. Those returning to live alone (N = 86) were compared to those discharged to live with others (N = 62), or to a nursing home (N = 38). Cross-sectionally, patient's discharged to live alone reported the lowest levels of depressive symptoms followed by those living with others. Patients discharged to a nursing home reported higher levels of depressive symptoms that were marginally significant at baseline (p < .10) and 18 months (p < .10), while statistically significant at 3 months (p < .01). At 6 months post-discharge, results were not significant as the highest levels of depressive symptoms were seen in both nursing home patients and those who were living with others. Longitudinally, those who remained in a nursing home during all four assessment points reported higher levels of depressive symptoms compared to those who continuously lived alone or continuously lived with others after 18 months (p < .01). However, depressive symptomatology was stable over time among those who continuously resided in a nursing home following discharge. These findings provide additional support for a link between loss of independence and elevated depressive symptomatology.     

Religious involvement and 6-year course of depressive symptoms in older Dutch citizens: results from the Longitudinal Aging Study Amsterdam

OBJECTIVES: Expanding on cross-sectional studies, associations are examined between religious involvement and the 6-year course of depressive symptoms in older adults. METHODS: Subjects are 1,840 community-dwelling older adults (aged 55 to 85) participating in three measurement cycles of the Longitudinal Aging Study, Amsterdam. Assessments include aspects of religious involvement, depressive symptoms, physical health, self-perceptions, social integration, urbanization, and alcohol use. RESULTS: Church attendance is negatively associated with the course of depressive symptoms, also after adjustment for explanatory variables. Among respondents with functional limitations, lower depression scores are found for those who attend church on a regular basis. For respondents who are bereaved or nonmarried, however, slightly higher depression scores are found for those with high levels of orthodox beliefs. DISCUSSION: There is a consistent negative association over time between church attendance and depressive symptoms in older Dutch citizens. Both stress-buffering as well as depression-evoking effects of religious involvement are found.     

The significance of nonmarital cohabitation: marital status and mental health benefits among middle-aged and older adults

OBJECTIVES: According to the 2000 Census, about 1.2 million persons over age 50 are currently cohabiting. Do these unmarried cohabiting partnerships provide adults with mental health benefits that are similar to those enjoyed by marrieds? We extended prior work on marital status and depression by including cohabitation in our conceptualization of marital status. METHODS: We used data from the 1998 Health and Retirement Study (N = 18,598) to examine the relationship between marital status and depressive symptoms among adults over age 50. We also examined gender differences in this association. RESULTS: We found that cohabitors report more depressive symptoms, on average, than do marrieds, net of economic resources, social support, and physical health. Additional analyses revealed that only among men do cohabitors report significantly higher depression scores. Cohabiting and married women as well as cohabiting men experience similar levels of depression, and all of these groups report levels that are significantly higher than married men's. DISCUSSION: Our findings demonstrate the importance of accounting for nontraditional living arrangements among persons aged 50 and older. Cohabitation appears to be more consequential for men's than women's depressive symptoms.     

Effects of Social Exclusion on Depressive Symptoms: Elderly Chinese Living Alone in Shanghai,China

Research has identified social exclusion as one of the social determinants of health. There are risks of social exclusion in later life in recent years. However, despite the fact that China has the largest aging population in the world and reports a rapid growth in the proportion of older people living alone, research on the role of social exclusion on depression is limited. This study examined the effects of social exclusion on depressive symptoms in older Chinese who are living alone in China, based on the data from one Shanghai neighbourhood. The data used were obtained between August and October 2008 through face-to-face interviews, using a structured survey questionnaire, from a simple random sample of 228 Chinese 60 and older living alone in a Shanghai community. Depressive symptoms were measured by a 15-item Chinese version Geriatric Depression Scale. Social exclusion was represented by income adequacy, social relations, civic participation, and housing condition. Over 30% of participants reported symptoms of a mild or above mild level of depression. When controlled for the demographics and health variables in hierarchical multiple regression, social exclusion variables, represented by a lower level income adequacy, a less favourable housing condition, and feeling more lonely correlated significantly with more depressive symptoms. Contrary to previous studies on depression in the older adults in China, this study has obtained findings indicating that social exclusion variables are more important than other socio-demographic factors in the context of contemporary China. While two significant social exclusion variables (i.e. income and housing) are related to structural changes in the economic context in China, the intra-personal role of feeling lonely that ties strongly living alone and role of older adults in an increasingly competitive market economy should not be underestimated. To address depression and mental health of older Chinese who live alone, social policies and programs to reduce various forms of social exclusion should be developed. In additional to providing assistance in financial support and housing improvement, services to strengthen the social networks and social relations of these older people are essential.     

The Informal Networks in Food Procurement by Older People—A Cross European Comparison

Healthy dietary profiles contribute to successful aging, and dietary intake is dependent upon food procurement capabilities. Both formal and informal social networks can contribute to grocery shopping capabilities and methods of food procurement. This investigation explores the role of informal networks in food procurement methods among adults aged 65 years and older, and compares differences across eight European countries. Food shopping ways (FSW), identified by quantitative analysis (cluster analysis and correspondence analysis), guided the content qualitative analysis which was carried out addressing three main research questions addressing food shopping routines, feelings of dependency and needs of informal support for shopping, and differences between past and present food shopping behaviours. Living circumstances influence food shopping habits. Informal networks differed between two groups of individuals: those living alone and those living with others. Gender differences emerged in shopping pleasure. Geographical factors were associated with preference for shopping companions, attitudes toward receiving support, and availability of a car for shopping. The importance of living circumstances (i.e., alone vs. with others) in FSW was revealed. Informal social networks may play an important role in public health and welfare policies, particularly given the increase in this demographic group. Assistance with grocery shopping and the availability of trained personnel could widen informal networks, and effective informal networks may be an important supportive service for older adults. The comparison across countries highlighted relationships between food procurement capabilities and social networks. These findings may be used to develop resources to better meet the nutritional needs of older adults.     

Living arrangements and participation in leisure-time physical activities in an older population

OBJECTIVES. This is a cross-sectional investigation of living arrangements, social contacts, and level of leisure-time physical activity (LTPA) among residents of Sonoma, California, aged 55 and older. METHODS. The odds of different levels of LTPA were assessed by living arrangements and social contacts following adjustment for measures of health, functioning, physical performance, selected health behaviors, and socioeconomic status for men and women separately (n = 2,073). Level of LTPA also was examined among married couples only (subset of sample, n = 511 spouse pairs). RESULTS. The relationship between living arrangements, social contacts, and LTPA varied by gender and level of LTPA. Among married couples, the LTPA of the partner was the most significant predictor of the LTPA of the participant, with the exception of those who engaged in less than brisk activity. DISCUSSION. Living arrangements and social contacts are important determinants of LTPA and should serve as the basis for future interventions.     

Depressive symptoms in older African-American and white adults with functional difficulties: the role of control strategies

OBJECTIVES: To examine whether control-oriented strategies buffer effects of functional difficulties on depressive symptoms over time in older African-American and white adults with disability. DESIGN: Community-based, prospective study. SETTING: Baseline and 12-month data from a randomized trial. PARTICIPANTS: One hundred twenty-nine African-American and 151 white older adults with 12-month data from 319 participants in the trial. MEASUREMENTS: Data were obtained for functional difficulties, the extent that respondents reported using control (cognitive and behavioral) strategies to enhance and maintain independence, and baseline and 12-month depressive symptoms (Center for Epidemiologic Studies Depression Scale; CES-D). RESULTS: African Americans reported greater baseline functional difficulty (P=.009), fewer depressive symptoms (P=.002) and higher control strategy use (P=.001) than whites. Functional difficulty was associated with depressive symptoms for both groups at baseline and 12 months. Living alone for whites and low spirituality for African Americans predicted higher 12-month depressive symptom scores. African Americans with baseline functional difficulty and high strategy use had lower 12-month depression than those with similar difficulty levels but low strategy use (P=.04 for interaction), representing a 28.5-point CES-D score differential. Control strategies did not buffer the function-depression relationship over time for whites. CONCLUSION: Control-oriented strategies moderated the experience of depressive symptomatology over time for African Americans with disability but not for whites. This may explain the paradox of greater functional disparities but less reported emotional distress in African Americans than whites. Results suggest that the use and benefits of adaptive resources to attain functional goals and determinants of depression differ by race. Depression prevention programs should be modified to be suitable for different cultural groups.     

The role of education on the association between disability and depressive symptoms among community-dwelling older adults: Evidence from Frailty in Brazilian Older People (Fibra) study

ObjectivesTo explore whether higher socioeconomic status attenuates the effects of depressive symptoms on disability among older adults.MethodsWe conducted a cross-sectional study based on 596 older adults, aged 65 and over, from a large city (Belo Horizonte) in Brazil. Disability was defined as limitation in activities such as Basic Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Covariates were age, comorbidities, Body Mass Index (BMI) and grip strength. Statistical analyses were based on Ordinal Logistic Regression and calculated separately for men and women.ResultsElderly women with disability and higher education levels have similar prevalence of depressive symptoms compared to those without disability (17.9% and 16.1%, respectively), but lower compared to those disabled with lower education (37.2%). A positive gradient trend was observed for depressive symptoms across disability categories among women (OR = 2.61; 95% CI 1.52, 4.48). However, these patterns were not observed among men.ConclusionA higher level of education attenuates odds of depressive symptoms in elderly women with disability but does not eliminate it. Therefore, screening for depressive symptoms in low-educated elderly women is important in order to identify them and start early prevention care for target risk population and decrease the disability expenses for health services.     

A population-based study of reported hepatitis C diagnoses from 1998 to 2018 in immigrants and nonimmigrants in Quebec,Canada

Immigrants living in low hepatitis C (HCV) prevalence countries bear a disproportionate HCV burden, but there are limited HCV population-based studies focussed on this population. We estimated rates and trends of reported HCV diagnoses over a 20-year period in Quebec, Canada, to investigate subgroups with the highest rates and changes over time. A population-based cohort of all reported HCV diagnoses in Quebec (1998–2018) linked to health administrative and immigration databases. HCV rates, rate ratios (RR) and trends overall and stratified by immigrant status and country of birth were estimated using Poisson regression. Among 38,348 HCV diagnoses, 14% occurred in immigrants, a median of 7.5 years after arrival. The average annual HCV rate/100,000 decreased for immigrants and nonimmigrants, but the risk (RR) among immigrants increased over the study period [35.7 vs. 34.5 (RR = 1.03) and 18.4 vs. 12.7 (1.45) between 1998–2008 and 2009–2018]. Immigrants from middle-income Europe & Central Asia [55.8 (RR = 4.39)], sub-Saharan Africa [51.7 (RR = 4.06)] and South Asia [32.8 (RR = 2.58)] had the highest rates between 2009 and 2018. Annual HCV rates decreased more slowly among immigrants vs. nonimmigrants (−5.9% vs. −8.9%, p < 0.001), resulting in a 2.5-fold (9%–21%) increase in the proportion of HCV diagnoses among immigrants (1998–2018). The slower decline in HCV rates among immigrants over the study period highlights the need for targeted screening for this population, particularly those from sub-Saharan Africa, Asia and middle-income Europe. These data can inform micro-elimination efforts in Canada and other low-HCV-prevalence countries.