Association of inflammatory markers with hearing impairment: The English Longitudinal Study of Ageing

BackgroundHearing impairment is common at an older age and has considerable social, health and economic implications. With an increase in the ageing population, there is a need to identify modifiable risk factors for hearing impairment. A shared aetiology with cardiovascular disease (CVD) has been advanced as CVD risk factors (e.g. obesity, type 2 diabetes) are associated with a greater risk of hearing impairment. Moreover, low-grade inflammation is implicated in the aetiology of CVD. Accordingly, our aim was to investigate the association between several markers of inflammation – C-reactive protein, fibrinogen and white blood cell count – and hearing impairment.MethodsParticipants of the English Longitudinal Study of Ageing aged 50–93 were included. Inflammatory marker data from both wave 4 (baseline, 2008/09) and wave 6 (2012/13) were averaged to measure systemic inflammation. Hearing acuity was measured with a simple handheld tone-producing device at follow-up (2014/15).ResultsAmong 4879 participants with a median age of 63 years at baseline, 1878 (38.4%) people presented hearing impairment at follow-up. All three biomarkers were positively and linearly associated with hearing impairment independent of age and sex. After further adjustment for covariates, including cardiovascular risk factors (smoking, physical activity, obesity, diabetes, hypertension, cholesterol), memory and depression, only the association with white blood cell count remained significant: odds ratio per log-unit increase; 95% confidence interval = 1.46; 1.11, 1.93.ConclusionsWhile white blood cell count was positively associated with hearing impairment in older adults, no relationships were found for two other markers of low-grade inflammation.     

Hearing Impairment,Loneliness, Social Isolation,and Cognitive Function: Longitudinal Analysis Using English Longitudinal Study on Ageing

ObjectiveThis study examines the relationships between hearing impairment and cognitive function among older adults, and whether that association is mediated by loneliness and social isolation.MethodsData were drawn from English Longitudinal Study of Ageing (ELSA) wave two (2004/2005) until wave seven (2014/2015). The study sample consisted of 8,199 individuals aged 50 years or older. Cognitive function was measured using episodic memory. We performed analysis using a generalized structural equation modeling (GSEM) technique.ResultsGSEM analysis shows that the direct effect of hearing impairment on episodic memory was negative and significant (β = ?0.29, p <0.001). Loneliness and social isolation mediated that effect. Hearing impairment was positively associated with loneliness (β = 0.10, p <0.001) and social isolation (β = 0.04, p <0.001). Loneliness (β = ?0.08, p <0.001) and social isolation (β = ?0.09, p = 0.001) were significantly associated with lower memory scores.ConclusionThe link between hearing impairment and episodic memory was partly mediated by loneliness and social isolation. Interventions to improve the social networks of older adults with hearing impairment are likely to be beneficial in preventing cognitive decline. Thus, the importance of maintaining social relationships among older adults, especially those with hearing impairment is highlighted.     

Social stress in early adolescents' daily lives: Associations with affect and loneliness

Adolescence is characterized by increased social stress due to changes in interpersonal relationships, but little is known about daily experiences of social stress. The aim of the present study was to examine daily life predictors of increases in social stress, how these increases affected adolescents' mood, and whether loneliness moderated these relations. The Experience Sampling Method was used to measure positive and negative affect and increases in social stress in 278 early adolescents from the Netherlands. Results showed that adolescents were most likely to experience increases in social stress when they were with classmates, during week days, and in the morning. Lonely adolescents showed higher increases in social stress and responded more negatively to increases in social stress, compared to non-lonely adolescents.     

Interplay between social isolation and loneliness and chronic systemic inflammation during the COVID-19 pandemic in Japan: Results from U-CORONA study

In the face of the global coronavirus disease 2019 (COVID-19) pandemic, billions of people were forced to stay at home due to the implementation of social distancing and lockdown policies. As a result, individuals lost their social relationships, leading to social isolation and loneliness. Both social isolation and loneliness are major risk factors for poor physical and mental health status through enhanced chronic inflammation; however, there might be an interplay between social isolation and loneliness on the association with chronic inflammation. We aimed to clarify the link between social relationships and inflammation in the context of the COVID-19 pandemic by distinguishing whether social isolation only, loneliness only, or both were associated with chronic inflammation markers among community-dwelling adults. The data of 624 people (aged 18–92 years, mean 51.4) from the Utsunomiya COVID-19 seROprevalence Neighborhood Association (U-CORONA) study, which targeted randomly sampled households in Utsunomiya city, Japan, were analyzed. Social isolation was assessed as a structural social network by asking the number of social roles they have on a daily basis. Loneliness was measured with the UCLA loneliness scale. As chronic inflammation biomarkers, neutrophil-to-lymphocyte ratio (NLR) and the concentration of high-sensitivity C-reactive protein (CRP) were measured. Generalized estimating equations method was employed to take into account the correlations within households. Isolated-Lonely condition (i.e., being both socially isolated and feeling lonely) was associated with higher NLR among men (B = 0.141, 95%CI = −0.01 to 0.29). Interestingly, Nonisolated-Lonely condition (i.e., not socially isolated but feeling lonely) was associated with lower CRP among women (B = −0.462, 95%CI = −0.82 to −0.10) and among the working-age population (B = −0.495, 95%CI = −0.76 to −0.23). In conclusion, being both socially isolated and feeling lonely was associated with chronic inflammation. Assessing both social isolation and loneliness is critical for proper interventions to mitigate the impact of poor social relationships on health, especially in the context of the COVID-19 pandemic.     

Gender-specific changes in well-being in older people with coronary heart disease: evidence from the English Longitudinal Study of Ageing

Objectives: The objective of this study is to investigate gender-specific trajectories in well-being among older people with coronary heart disease (CHD) and to compare them with those of healthy people.

Method: The study included a sample of 4496 participants from the first three waves of the English Longitudinal Study of Ageing (2002–2003 to 2006–2007). We measured well-being using quality of life (CASP-19; ‘control’, ‘autonomy’, ‘pleasure’ and ‘self-realization’) and depressive caseness (three or more symptoms on the CESD-8; Centre for Epidemiologic Study Depression scale).

Results: After adjustment, at two– and four–years follow-ups, women had three points higher quality of life than men (p < 0.001). When looking at each quality of life's domain we found that women reported higher scores of autonomy compared to men. The gender difference in the probability of having depressive caseness reduced to 7 percentage points at four-year follow-up from 13 percentage points in the previous occasions. Men's quality of life declined progressively over time by 3 points (p < 0.001) (equivalent to the effect of having diabetes) but no changes in prevalence of depressive caseness were found. Women's quality of life only declined after four-year follow-up by less than 2 points (p < 0.001), while in the same period their probability of reporting depressive caseness reduced by 6 percentage points (p < 0.001).

Conclusion: Women had better quality of life than men in the two and four years following a CHD event, and were not more likely than men to report depressive caseness in the long term. Men's quality of life deteriorated progressively over time, among women it did not deteriorate in the first two years following a CHD event; women had a long-term improvement in depressive caseness.     

女性中专护生负性情绪、孤独感与社会支持的相关研究

目的探讨女性中专护生负性情绪、孤独感与社会支持三者之间的关系,为制定有针对性的心理干预措施以及开展女性中专护生的心理健康教育工作提供参考。方法于2018年6月-10月采用随机抽样方法抽取西南医科大学护理学院1 300名在校中专护生为研究对象,采用抑郁-焦虑-压力量表中文精简版(DASS-21)、UCLA孤独感量表(UCLA-LS)和社会支持评定量表(SSRS)对其负性情绪、孤独感及社会支持等进行调查,并探索三者之间的关系。结果女性中专护生DASS-21总评分为(22.39±8.26)分,其中抑郁、焦虑、压力分量表评分分别为(7.56±3.32)分、(8.82±3.49)分、(7.00±3.58)分;UCLA-LS评分为(46.25±8.12)分,SSRS总评分为(33.16±5.82)分。女性中专护生DASS-21评分与UCLA-LS评分呈正相关(r=0.431,P0.01),SSRS总评分与DASS-21评分及UCLA-LS评分均呈负相关(r=-0.193、-0.345,P均0.01)。结论女性中专护生的负性情绪、社会支持与孤独感之间存在相关性。     

Association between social isolation and inflammatory markers in depressed and non-depressed individuals: results from the MONICA/KORA study

Introduction

Depressed individuals not only suffer from chronic low grade inflammation, but also exhibit an inflammatory hyper-responsiveness to acute stress. We investigate whether chronic stress also induces an exaggerated inflammatory response in individuals with increased depression features. As model for chronic stress, social isolation was chosen.

Methods

Interleukin (IL)-6 and hs-CRP levels were assessed in 1547 subjects (847 men and 700 women), derived from the population-based MONICA/KORA study. Standardized questionnaires were used to assess depressed mood (depression and exhaustion subscale) and social isolation (social network index). The relationship between the two inflammatory markers, social isolation and depressed mood was examined taking into account interactions social isolation × depressed mood using multivariable linear regression models, adjusted for age, BMI, smoking, alcohol, and physical activity. Analyses were performed in men and women separately.

Results

We observed a significant interaction between depressed mood and social isolation regarding IL-6 and hs-CRP, respectively in men (p-value = 0.02 for IL-6 and <0.01 for hs-CRP), evidencing a substantial synergistic effect of social isolation, and depressed mood on inflammatory responses. Furthermore, depressed and socially isolated men had highly significantly elevated IL-6 levels (geometric mean: 3.76 vs. 1.92 pg/ml, p-value <0.01) and heightened hs-CRP levels (geometric mean: 2.01 vs. 1.39 mg/l, p = 0.08) in comparison with non-depressed and socially integrated men. In women, no significant associations were seen.

Conclusion

The interaction of depressed mood and social isolation elicits a substantial synergistic impact on inflammatory markers in men, but not in depressed women.     

Sleep and future cardiovascular risk: prospective analysis from the English Longitudinal Study of Ageing

Study objectivesHypertension and inflammation may contribute to the increased risk of cardiovascular disease in individuals with suboptimal sleep, but large prospective studies are lacking. This study tested whether sleep duration and disturbance were predictive of incident hypertension and inflammation four years later.MethodsParticipants were men and women aged 50 years and older from the English Longitudinal Study of Ageing. Sleep was assessed by self-report, incident hypertension (N = 3068) was defined by clinical examination and C-reactive protein and fibrinogen (N = 3768) were measures of inflammation.ResultsBoth men (odds ratio, OR:1.73, confidence interval, C.I. 1.08–2.76) and women (OR: 1.44, C.I. 1.00–2.07) reporting short sleep at baseline had increased odds of incident hypertension 4 years later, after adjustment for covariates. Age-stratified analyses revealed that short sleep was predictive of incident hypertension in men (OR: 2.27, C.I. 1.01–5.11) and women (OR: 2.10, C.I. 1.08–4.09) younger than 60 years but not in older people. Disturbed sleep also predicted incident hypertension in men (OR: 1.20, C.I. 1.02–1.41). In women, disturbed sleep was associated with elevated C-reactive protein (B = 0.030, C.I. 0.00–0.06) and fibrinogen (B = 0.030, C.I. 0.01–0.05) at follow-up controlling for baseline inflammation and other covariates. Sleep duration was unrelated to inflammatory markers in either sex.ConclusionsThis study of older men and women adds to growing evidence that aberrant sleep patterns may increase the risk of cardiovascular outcomes through its adverse impact on blood pressure and inflammation.     

Impacts of Poor Social Support on General Health Status in Community-Dwelling Korean Elderly: The Results from the Korean Longitudinal Study on Health and Aging

Objective

We investigated the influence of social support on health, quality of life (QOL), and the risk of depression in elderly Korean people.

Methods

This study was conducted as a part of the Korean Longitudinal Study on Health and Aging (KLoSHA). A total of 787 nondemented community-dwelling elderly aged 65 years or older were recruited and underwent clinical evaluations for dementia and psychiatric disorders conformed to Korean version of the Consortium to Establish a Registry for Alzheimer''s Disease Clinical Assessment Battery (CERAD-K) and the Korean version of the Mini-International Neuropsychiatric Interview (MINI), respectively. Social support was assessed using the Medical Outcome Study Social Support Survey (MOS-SSS). Poor social support (PSS) was defined as having a MOS-SSS score below the 25^th percentile of the entire sample. General health status was comprehensively evaluated using the modified Cumulative Illness Rating Scale (CIRS), the Korean version of the Geriatric Depression Scale (GDS-K), Mini-Mental Status Examination (MMSE-KC), Korean Activities of Daily Living (KADL), and Korean Instrumental Activities of Daily Living (KIADL). Health-related QOL was evaluated using the Short Form 36 (SF-36).

Results

Low educational attainment and living alone were associated with PSS. Geriatric depression was more prevalent in the PSS group (OR=3.05, 95% CI=1.77-5.27) than in the normal social support (NSS) group. Among the various forms of social support, positive social interaction was significantly associated with risk of geriatric depression (OR=2.25, 95% CI=1.07-4.73). Although health-related QOL was lower in the PSS group than in the NSS group, the ADL and IADL scores of the subjects in the PSS group were better than those of the subjects in the NSS group. In the subjects with geriatric depression, PSS was associated with more severe depression, higher medical morbidity, and poor QOL.

Conclusion

PSS had a negative influence on the general health status and QOL among community-dwelling elderly and was an independent risk factor of geriatric depression.     

Informal caregiving transitions,subjective well-being and depressed mood: Findings from the English Longitudinal Study of Ageing

Objectives: To prospectively investigate the impact of transitions in informal caregiving on emotional well-being over two years in a large population study of older people.

Methods: Information on provision of unpaid care in 2004/2005 and 2006/2007 was available for 6571 participants in the English Longitudinal Study of Ageing. Three well-being domains were also assessed on each occasion: life satisfaction (measured with the Satisfaction with Life Scale); quality of life (assessed with the CASP-19 scale); and depression symptoms (measured using the Centers for Epidemiologic Studies Depression Scale). Multivariable analyses of the impact on well-being of two-year caregiving transitions (caregiving entry and caregiving exit, or continued caring) were conducted separately for spousal/child carers and carers of other family/non-relatives.

Results: Compared to non-caregiving, entry into spousal/child caregiving was associated with decline in quality of life (B = ?1.60, p < .01) whereas entry into caregiving involving other kin relations increased life satisfaction (B = 1.02, p < .01) and lowered depression symptoms (B = ?0.26, p < .05). Contrary to expectations, caregiving exit was related to increased depression in both spousal/child (B = 0.44, p < .01) and non-spousal/child (B = 0.25, p < .05) carers. Continued spousal/child caregiving was also related to decline in quality of life (B = ?1.24, p < .05). Other associations were suggestive but non-significant.

Conclusion: The emotional impact of different caregiving transitions in later life differs across kin relationships; notably, spousal and child carers' well-being was consistently compromised at every stage of their caregiving career over the two-year study period.     

Affective symptoms are associated with markers of inflammation and immune activation in bipolar disorders but not in schizophrenia

Objective

Elevated levels of inflammation are reported in bipolar disorders (BP), but how this relates to affective symptoms is unclear. We aimed to determine if immune markers that consistently have been reported elevated in BP were associated with depressive and manic symptoms, and if this was specific for BP.

Methods

From a catchment area, 112 BP patients were included together with 153 schizophrenia (SCZ) patients and 239 healthy controls. Depression and mania were assessed and the patients were grouped into depressed, neutral, and elevated mood. We measured the immune markers tumor necrosis factor receptor 1 (sTNF-R1), interleukin 1 receptor antagonist (IL-1Ra), interleukin 6 (IL-6), high sensitive C-reactive protein (hsCRP), osteoprotegerin (OPG) and von Willebrand factor (vWf) which have been found increased in severe mental disorders.

Results

In BP all inflammatory markers were lowest in depressed state, with significant group differences after control for confounders with respect to TNF-R1 (p = 0.04), IL-1Ra (p = 0.02), OPG (p = 0.004) and IL-6 (p = 0.005). STNF-R1 was positively correlated with the item elevated mood (p = 0.02) whereas sad mood was negatively correlated with OPG (p = 0.0003), IL-1Ra (p = 0.001) and IL-6 (p = 0.006). Compared to controls the neutral mood group had significantly higher levels of OPG (p = 0.0003) and IL-6 (p = 0.005), and the elevated mood group had higher levels of TNF-R1 (p = 0.000005) and vWf (p = 0.002). There were no significant associations between affective states orsymptoms in SCZ.

Conclusions

The current associations between inflammatory markers and affective symptomatology in BP and not SCZ suggest that immune related mechanisms are associated with core psychopathology of BP.     

Social support and mental health status of older people: a population-based study in Iran-Tehran

Objectives: To investigate direct and stress-buffering associations between social support from family and the mental health of older people in Iran, a country which has recently undergone an exceptionally fast fertility transition and is consequently experiencing rapid population ageing.

Method: A cross-sectional stratified random survey of 800 people aged 60+ years resident in Tehran was conducted. In total, 644 people responded. The Social Provisions Scale and the General Health Questionnaire were used to measure perceived social support and mental health, respectively. Multilevel mixed-effects models were used to examine the hypotheses.

Results: The findings supported the hypothesis of a direct association between perceived and received social support and mental health. However, we did not find strong evidence to suggest that social support buffered the effects of stress arising from limitations of physical functioning. Lack of help doing paperwork was associated with worse mental health for women but not men. Source of support did not seem to be important.

Conclusion: Our results indicated that in Tehran, as in Western settings, social support is important for the mental well-being of older people. Recommendations for policy and further research priorities based on the study findings were provided.     

Correlates of social and emotional loneliness in older people: evidence from an English community study

Objectives: Loneliness is an important influence on quality of life in old age and has been conceptualised as consisting of two dimensions, social and emotional. This article describes analyses that sought to produce models of social and emotional loneliness in older people, using demographic, psychological and health, and social variables.Method: Older people (aged 65+, n = 1255) from the Barnsley metropolitan area of the United Kingdom were recruited randomly from within a stratified sampling frame and received a questionnaire-based interview (response rate: 68.1%). The questionnaire contained items and scales on demographic, psychological and health, and social characteristics, and a validated measure of loneliness that assesses both social and emotional loneliness.Results: Of the respondents, 7.7% were found to be severely or very severely lonely, while another 38.3% were moderately lonely. Social and emotional loneliness shared 19.36% variance. Being male, being widowed, low well-being, low self-esteem, low-income comfort, low contact with family, low contact with friends, low activity, low perceived community integration, and receipt of community care were significant predictors of social loneliness (R = 0.50, R² = 0.25, F(18, 979) = 18.17, p < 0.001). Being widowed, low well-being, low self-esteem, high activity restriction, low-income comfort, and non-receipt of informal care were significant predictors of emotional loneliness (R = 0.55, R² = 0.30, F (18, 973) = 23.00, p < 0.001).Conclusion: This study provides further empirical support for the conceptual separation of emotional and social loneliness. Consequently, policy on loneliness in older people should be directed to developing a range of divergent intervention strategies if both emotional and social loneliness are to be reduced.     

Differential associations of age with volume and microstructure of hippocampal subfields in healthy older adults

Hippocampal atrophy in advanced healthy aging has frequently been reported. However, the vulnerability of different hippocampal subfields to age‐related atrophy is still a source of debate. Moreover, the association of age with the microstructural integrity of subfields is largely unknown. In this study, we investigated the associations between age and volume as well as microstructural integrity of hippocampal subfields using a three‐dimensional (3D) surface mapping approach. Forty‐three healthy older adults spanning the age range from 60 to 85 years underwent T1‐weighted and diffusion‐tensor imaging. Analyses demonstrated an association of age with hippocampal volume predominantly in the most anterior part of the hippocampal head, mainly corresponding to the subiculum. In contrast, the association of age with hippocampal microstructural integrity was mainly confined to regions located in the hippocampal body and tail, corresponding to the subiculum and CA1. Results indicate that age‐related volumetric and microstructural alterations within hippocampal subfields provide complementary information and reflect different age‐related processes. Potential mechanisms underlying the differential associations of age with volume and microstructure of hippocampal subfields are discussed. Hum Brain Mapp 36:3819–3831, 2015. © 2015 Wiley Periodicals, Inc.     

The role of loneliness in the development of depressive symptoms among partnered dementia caregivers: Evidence from the English Longitudinal Study of Aging

BackgroundDepressive symptoms are highly prevalent among partnered dementia caregivers, but the mechanisms are unclear. This study examined the mediating role of loneliness in the association between dementia and other types of care on subsequent depressive symptoms.MethodsProspective data from partnered caregivers were drawn from the English Longitudinal Study of Aging. The sample consisted of 4,672 partnered adults aged 50–70 living in England and Wales, followed up between 2006–2007 and 2014–2015. Caregiving was assessed across waves 3 (2006–2007), 4 (2008–2009), and 5 (2010–2011), loneliness at wave 6 (2012–2013), and subsequent depressive symptoms at wave 7 (2014–15). Multivariable logistic regression models were used to assess the association between caregiving for dementia and depressive symptoms compared to caregiving for other illnesses (e.g., diabetes, coronary heart disease (CHD), cancer, and stroke). Binary mediation analysis was used to estimate the indirect effects of caregiving on depressive symptoms via loneliness.ResultsCare for a partner with dementia was associated with higher odds of depressive symptoms at follow-up compared to those not caring for a partner at all (odds ratio [OR] = 2.6, 95% confidence intervals [CI]: 1.4, 5.1). This association was partially mediated by loneliness (34%). Care for a partner with other conditions was also associated with higher odds of depressive symptoms compared to non-caregiving partners (OR = 1.7, 95% CI: 1.2, 2.5), but there was no evidence of an indirect pathway via loneliness.ConclusionLoneliness represents an important contributor to the relationship between dementia caregiving and subsequent depressive symptoms; therefore, interventions to reduce loneliness among partnered dementia caregivers should be considered.     

Relationships with clinical staff after a diagnosis of breast cancer are associated with patients' experience of care and abuse in childhood

OBJECTIVE: Patients experiencing the crisis of the diagnosis and treatment of breast cancer need to form trusting and supportive relationships with clinical staff. However, adverse childhood experiences damage the ability to form supportive relationships as adults. We tested the prediction that women recalling childhood abuse and lack of parental care would experience poorer support from clinical staff caring for them around the time of diagnosis and surgical treatment of breast cancer. METHODS: Two to 4 days after surgery, women with primary breast cancer (N=355) self-reported: childhood sexual, physical, and emotional abuse and parental care; perceived social support; support experienced from the surgeon and breast and ward nurses; and current emotional distress. Logistic regression analyses and covariance structure modeling tested the dependence of perceived professional support on childhood abuse and care and on current social support, controlling for emotional distress and age. RESULTS: Women who reported feeling fully supported by clinical staff were more likely to recall no abuse and good parental care. The influence of parental care, but not abuse, was explained by its association with experiencing good social support generally, which was itself associated with feeling fully supported by clinical staff. These relationships were independent of current emotional distress. CONCLUSION: Patients' ability to feel fully supported by clinical staff reflects not only how much support staff make available but also patients' experience of close relationships in childhood. We suggest that, whereas lack of parental care compromises adult supportive relationships in general, abuse specifically reduces support from clinical staff.