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A growing body of evidence has provided support for the beneficial impact of human-animal interactions on a range of biological, social, and psychological outcomes for humans; however, less is conclusively known about the association between animal companionship and psycho-social health specifically among aging populations. In this study, we assessed the association between animal companionship and psycho-social well-being in a large sample (N = 30,865) of community dwelling Canadians aged 45 and older. Using cross-sectional data from the Canadian Community Health Survey-Healthy Aging, we conducted hierarchical multiple regression to assess the relationship between animal companionship and four domains of psycho-social well-being (satisfaction with life, loneliness, depression, and levels of social support) after controlling for socio-demographic factors and psycho-social measures. Results indicate that those with animal companionship report significantly higher levels of social support than aging Canadians without animal companionship; however, animal companionship was also associated with significantly lower levels of life satisfaction and higher levels of both loneliness and depression. These findings complicate the existing literature on human-animal interactions by suggesting the benefits associated with animal companionship may vary across distinct domains of psycho-social health. As such, results from this study highlight the need for more nuanced model specifications when assessing the relationship between animal companionship and psycho-social well-being. Implications of these findings for the provision of social services to older adults with pets are provided., Competing Interests: Declaration of competing interest The authors of this manuscript have no actual or potential conflicts of interest (personal, financial, or otherwise) to disclose in relation to the subject matter of this manuscript., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: Social contact may alleviate loneliness, but little is known about within-person daily fluctuations in loneliness and social encounters. Older adults who feel lonely may engage in different modes of social contact (in-person, phone, digital). This study asked how different forms of contact are associated with loneliness throughout the day., Methods: Participants were 313 community-dwelling older adults (aged 65-90). They completed ecological momentary assessments reporting on their social encounters (e.g., type of social partner, mode of contact) and their loneliness every 3 hr for 5-6 days. We differentiated close social ties from ties not identified as close (i.e., weak ties)., Results: We examined within-person effects using multilevel models. Findings revealed that momentary loneliness predicted a greater likelihood of phone contact in the next 3 hr. However, only in-person contact was associated with lower levels of loneliness. Regarding close and weak ties, momentary loneliness was associated with more in-person and phone contact with close ties, yet fewer in-person contacts with weak ties. In-person contact with both close and weak ties predicted lower levels of loneliness., Discussion: Although older adults engage in both in-person and phone contact when they feel lonely, it appears that only in-person contact may reduce loneliness. Digital contact was not widely adopted as a response to momentary loneliness among these older adults. Findings underscore older adults' willingness to maintain regular contact with close ties. Interventions addressing older adults who are lonely may consider innovative approaches to increase in-person contact., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background and Objectives: People aged 65 and older, deemed most "vulnerable" by public health, were targeted by the coronavirus disease 2019 protection measures, which sought to minimize physical contact and social activities. Older adults living alone were particularly affected by these measures. However, such measures meant to protect the older population may not have necessarily reflected older adults' individual prioritization choices. This study therefore aimed to understand how protecting oneself over the virus was considered in the prioritization of other health and social needs of older adults living alone during the pandemic., Research Design and Methods: This study adopted a qualitative design. A total of 17 semistructured interviews were conducted between May 2021 and June 2022 with older adults living alone. All interviews were audio-recorded and transcribed verbatim. A reflexive thematic analysis as defined by Braun and Clarke was performed., Results: Our analysis showed 2 forms of prioritization across 2 themes. This first theme focused on participants who reported prioritizing protecting themselves over the virus by limiting in-person contact and activities. The second theme showed that although several participants reported that protecting themselves over the virus was important to them, the prioritization of this need was not shared by all and, in some cases, evolved over the course of the pandemic., Discussion and Implications: Our study demonstrated heterogeneity in the prioritization of older adults needs. Future public health recommendations should consider these variations in the needs and priorities of older adults when determining public health measures., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Background and Objectives: Previous research has tended to prioritize the condition of dementia when investigating positive lived experiences, while there is no evidence that well-being becomes fundamentally different when living with dementia. The current exploratory qualitative study examined how people living with dementia describe how they realize their well-being, without treating dementia as a central concern, and specifically addressed people who are successful in maintaining their well-being., Research Design and Methods: Semistructured face-to-face interviews (n = 16) and 2 focus groups (n = 13) were conducted with community-dwelling older people living with dementia, aged 65-93 years (68% male). Conversations covered contributors to experienced life satisfaction, and life enjoyment, and were analyzed using inductive thematic analysis., Results: Two main themes described how people realize well-being. (1) To live a fulfilling life, participants engaged in activities in order to feel useful and relaxed, and they engaged with others, by interacting and sharing with others, and relying on others. (2) To have a positive attitude toward life, participants appreciated the good things in their current life, their lived life, and about their own person, and positively coped with difficulties by accepting them as part of life, not dwelling on the negative, and actively addressing difficulties., Discussion and Implications: The results appear to reflect universal ways of realizing well-being, justifying the use of universal models of well-being for people living with dementia. We can learn from people living with dementia that living a fulfilling life and having a positive attitude toward life are key to realizing their well-being., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Background: Although only a few patients with severe mental disorders (SMD) can commit violent behaviour in the community, violent behaviour aggravates the stigma towards patients with SMD. Understanding the subtypes of violent behaviour may be beneficial for preventing violent behaviour among patients with SMD, but it has rarely been studied., Methods: This longitudinal study investigated 1914 patients with SMD in the community at baseline, and the follow-up period ranged from February 2021 to August 2021. The Barratt Impulsiveness Scale Version-11, the Buss-Perry Aggression Questionnaire, the Impulsive/Premeditated Aggression Scale, the Personality Diagnostic Questionnaire and the MacArthur Community Violence Instrument were used at baseline. The Modified Overt Aggression Scale was used to assess the occurrence of violent behaviour (outcome) during the follow-up period. Cox regression models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Latent class analysis was used to characterise the subtypes of patients with SMD who engaged in violent behaviour at follow-up., Results: We found that 7.2% of patients with SMD presented violent behaviour within six months in the community. Younger age (OR = 0.98, 95% CI = 0.96-1.00, p = 0.016) and no economic source (OR = 1.60, 95% CI = 1.10-2.33, p = 0.014) were risk factors for violent behaviour. Patients with SMD who engaged in violent behaviour could be classified into three subtypes: one class characterised by a history of violence and impulsivity, another class characterised by high levels of aggression and motor impulsivity, and the last class characterised by median cognitive impulsivity., Conclusions: Socio-demographic factors were risk factors for violent behaviour among patients with SMD, which could eliminate the discrimination toward this group. Impulsivity played a vital role in identifying the three subtypes of patients with SMD who engaged in violent behaviour. These findings may be helpful for the development of a personalised violence risk management plan for patients with SMD who commit violent behaviour in the community., (© 2024. The Author(s).)

Background: With the trend of digitalization, social activities among the older population are becoming more diverse as they increasingly adopt technology-based alternatives. To gain a comprehensive understanding of social activities, this study aimed to identify the patterns of digital and in-person social activities among community-dwelling older adults in South Korea, examine the associated factors, and explore the difference in depressive symptoms by the identified latent social activity patterns., Methods: Data were extracted from a nationwide survey conducted with 1,016 community-dwelling older adults (mean age 68.0 ± 6.5 years, 47.8% male). The main variables assessed were digital social activities (eight items), in-person social activities (six items), and depressive symptoms (20 items). Data were analyzed using latent class analysis, multinomial logistic regression, and multiple linear regression., Results: We identified four distinct social activity patterns: "minimal in both digital and in-person" (22.0%), "moderate in both digital and in-person" (46.7%), "moderate in digital & very high in in-person" (14.5%), and "high in both digital and in-person" (16.8%). Younger age, living in multi-generational households, and higher digital literacy were associated with a higher likelihood of being in the "moderate in both digital and in-person" than the "minimal in both digital and in-person" group. Younger age, male, living in multi-generational households, residing in metropolitan areas, no dependency on IADL items, doing daily physical exercise, and higher digital literacy were associated with a higher likelihood of being in the "moderate in digital & very high in in-person" than the "minimal in both digital and in-person" group. Younger age, living in multi-generational households, no dependency on IADL items, doing daily physical exercise, and higher digital literacy were associated with a higher likelihood of being in the "high in both digital and in-person" than the "minimal in both digital and in-person" group. Depressive symptoms were significantly higher in the group with minimal engagement in both digital and in-person activities, compared to other three groups., Conclusions: This study highlights distinct patterns of social activities among Korean community-dwelling older adults. Since older adults with minimal social activity engagement can be more vulnerable to depressive symptoms, interventions that address modifiable attributes, such as supporting digital literacy and facilitating physical activity of older adults, could serve as potential strategies to enhance their social activity engagement and, consequently, their mental well-being., (© 2024. The Author(s).)

Background: Advance personal planning (APP) involves planning for future periods of incapacity, including making legal decisions and documents. APP ensures that a person's values and preferences are known and respected. This study aimed to examine knowledge of APP, attitudes and confidence towards APP, and participation in APP activities among older people residing in regional and rural areas., Methods: A cross-sectional survey was conducted with people aged over 65 years residing in and around regional towns in New South Wales, Australia. Participants responded to a social media advertisement or information provided through a community organisation. Data was collected via pen and paper survey or an online survey. The survey was developed for the study and included questions about the participant and their experiences with APP. Poisson regression modelling was conducted to explore the relationship between APP participation and APP knowledge, confidence and attitudes as well as the participant characteristics associated with APP participation., Results: Overall, 216 people completed the survey. Most participants had a will (90%) but only a third (32%) had documented an advance care directive. Knowledge of APP was low with only 2.8% of participants correctly answering all 6 knowledge questions. Participants had a positive attitude towards APP and high level of confidence that they could discuss APP issues with important people in their life. Those with increased knowledge, confidence and attitude towards APP were significantly more likely to participate in APP activities. Older age and having private health insurance were significantly associated with engaging in APP activities. Increased frailty and the presence of health conditions were not associated with increased APP participation., Conclusions: There is a need to increase engagement with APP particularly among those who may be considered frail or have chronic health conditions. Increasing knowledge of, confidence and attitudes towards, APP could help to increase engagement in APP activities., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Cameron et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Although significant and disabling consequences are presented due to geriatric population-related depression, an insufficient comprehension of various biological, psychological, and social factors affecting this issue has been observed. Notably, these factors can contribute to geriatric population-related depression with low social support. This study aimed to identify factors associated with depression among the community-dwelling geriatric population with low social support in Malaysia., Methods: This study used secondary data from a population-based health survey in Malaysia, namely the National Health Morbidity Survey (NHMS) 2018: Elderly Health. The analysis included 926 community-dwelling geriatric population aged 60 and above with low social support. The primary data collection was from August to October 2018, using face-to-face interviews. This paper reported the analysis of depression as the dependent variable, while various biological, psychological and social factors, guided by established biopsychosocial models, were the independent variables. Multiple logistic regression was applied to identify the factors. Analysis was performed using the complex sampling module in the IBM SPSS version 29., Results: The weighted prevalence of depression among the community-dwelling geriatric population aged 60 and above with low social support was 22.5% (95% CI: 17.3-28.7). This was significantly higher than depression among the general geriatric Malaysian population. The factors associated with depression were being single, as compared to those married (aOR 2.010, 95% CI: 1.063-3.803, p: 0.031), having dementia, as opposed to the absence of the disease (aOR 3.717, 95% CI: 1.544-8.888, p: 0.003), and having a visual disability, as compared to regular visions (aOR 3.462, 95% CI: 1.504-7.972, p: 0.004). The analysis also revealed that a one-unit increase in control in life and self-realisation scores were associated with a 32.6% (aOR: 0.674, 95% CI: 0.599-0.759, p < 0.001) and 24.7% (aOR: 0.753, 95% CI: 0.671-0.846, p < 0.001) decrease in the likelihood of developing depression, respectively., Conclusion: This study suggested that conducting depression screenings for the geriatric population with low social support could potentially prevent or improve the management of depression. The outcome could be achieved by considering the identified risk factors while implementing social activities, which enhanced control and self-fulfilment., (© 2024. The Author(s).)

Background/aims: Our current study aimed to investigate the determinants of dementia among the oldest old using longitudinal data from a representative sample covering both community-dwelling and institutionalized individuals., Methods/design: Longitudinal representative data were taken from the "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)" that surveyed community-dwelling and institutionalized individuals aged 80 years and above (n = 1,296 observations in the analytic sample), living in North Rhine-Westphalia (most populous state of Germany). The established DemTect was used to measure cognitive impairment (i.e., probable dementia). A logistic random effects model was used to examine the determinants of probable dementia., Results: The mean age was 86.3 years (SD: 4.2 years). Multiple logistic regressions revealed that a higher likelihood of probable dementia was positively associated with lower education (e.g., low education compared to medium education: OR: 3.31 [95% CI: 1.10-9.98]), a smaller network size (OR: 0.87 [95% CI: 0.79-0.96]), lower health literacy (OR: 0.29 [95% CI: 0.14-0.60]), and higher functional impairment (OR: 13.45 [3.86-46.92]), whereas it was not significantly associated with sex, age, marital status, loneliness, and depressive symptoms in the total sample. Regressions stratified by sex were also reported., Discussion: Our study identified factors associated with dementia among the oldest old. This study extends current knowledge by using data from the oldest old; and by presenting findings based on longitudinal, representative data (also including individuals residing in institutionalized settings)., Conclusions: Efforts to increase, among other things, formal education, network size, and health literacy may be fruitful in postponing dementia, particularly among older women. Developing health literacy programs, for example, may be beneficial to reduce the burden associated with dementia., (© 2024. The Author(s).)

Background: Changes in sleep, physical activity and mental health were observed in older adults during early stages of the COVID-19 pandemic. Here we describe effects of the COVID-19 pandemic on older adult mental health, wellbeing, and lifestyle behaviors and explore predictors of better mid-pandemic mental health and wellbeing., Methods: Participants in the Adult Changes in Thought study completed measures of lifestyle behaviors (e.g., sleep, physical activity) and mental health and wellbeing both pre-pandemic during regular study visits and mid-pandemic via a one-time survey. We used paired t-tests to compare differences in these measures pre- vs. mid-pandemic. Using multivariate linear regression, we further explored demographic, health, and lifestyle predictors of pandemic depressive symptoms, social support, and fatigue. We additionally qualitatively coded free text data from the mid-pandemic survey for related comments., Results: Participants (N = 896) reported significant changes in mental health and lifestyle behaviors at pre-pandemic vs. mid-pandemic measurements (p < 0.0001). Qualitative findings supported these behavioral and wellbeing changes. Being male, never smoking, and lower pre-pandemic computer time and sleep disturbance were significantly associated with lower pandemic depressive symptoms. Being partnered, female, never smoking, and lower pre-pandemic sleep disturbance were associated with higher pandemic social support. Pre-pandemic employment, more walking, less computer time, and less sleep disturbance were associated with less pandemic fatigue. Participant comments supported these quantitative findings, highlighting gender differences in pandemic mental health, changes in computer usage and physical activity during the pandemic, the value of spousal social support, and links between sleep disturbance and mental health and wellbeing. Qualitative findings also revealed additional factors, such as stresses from personal and family health situations and the country's concurrent political environment, that impacted mental health and wellbeing., Conclusions: Several demographic, health, and lifestyle behaviors appeared to buffer the effects of the COVID-19 pandemic and may be key sources of resilience. Interventions and public health measures targeting men and unpartnered individuals could promote social support resilience, and intervening on modifiable behaviors like sleep quality, physical activity and sedentary activities like computer time may promote resilience to fatigue and depressive symptoms during future community stressor events. Further research into these relationships is warranted., (© 2024. The Author(s).)

Background: The number of patients with dementia increases rapidly in aging populations. Dementia is an irreversible disease that causes a patient to be dependent on others' care and also causes family caregivers to experience difficulties in multiple domains., Purpose: In this study, a dementia caregiver's burden scale that addresses family caregivers' characteristics and caring environments was developed and validated., Methods: In-depth interviews with nine caregivers were conducted to identify the attributes of perceived burden and establish preliminary questions. Content validity was confirmed by seven experts using the item content validity index and scale content validity index/average. Construct validity, criterion-related validity, and reliability were verified using data from 205 primary caregivers of patients with dementia., Results: Exploratory factor analysis revealed that five factors, including physical health deterioration, responsibility and role of caregiver, emotional distress, medical expense concerns, and family conflict, and 24 items explained 68.6% of the total variance. The calculated Cronbach's α for the overall scale was .96., Conclusions: The scale developed in this study may be used to measure the burden perceived by family caregivers of patients with dementia in the physical, emotional, social, financial, and situational domains. Also, the scale may be used to guide the development of tailored interventions that take into consideration different family caregiver and caring situation-related characteristics., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.)

Objectives: In India, frailty has been predominantly studied as a physiological aspect, overlooking the subjective perceptions of community-dwelling older adults, which holds global significance. This study aims to explore frailty perceptions among community-dwelling older adults, comparing those enrolled in a geriatric welfare program facility to those not-enrolled., Methods: A cross-sectional design with a qualitative descriptive framework was employed, using focus group methodology. The study took place in rural West Bengal, located in eastern India, with a sample of 27 participants aged 60-87 years. Data collection occurred between October 2018 and January 2020, conducted through a face-to-face, semistructured discussion guide. Thematic analysis was performed to ensure data saturation and reliability., Results: Three key themes emerged from the analysis: (a) Perceptions of frailty were associated with aging, functional dependence, and psychosocial health, (b) Exposure to a scientific definition led to an ideological dilemma influenced by personal experiences, (c) Walking speed and grip strength were prominent components of frailty. The findings revealed that there was no difference in perception between program-enrolled and nonenrolled older adults, likely due to the concept of frailty being new to all participants. However, it was noteworthy that participants enrolled in the welfare program exhibited a resilient mindset toward the definition and demonstrated a proactive interest in preserving their overall health., Discussion: This novel study underscores the necessity of enhancing community awareness and integrating frailty management into the Indian health care system, which is yet to be fully integrated, aiming to promote the well-being of older adults., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Older adults' engagement in age-friendly community (AFC) initiatives is considered an essential element of community transformation. However, research on older adults' experiences of engaging in AFC initiatives remains nascent. Based on qualitative interviews with 23 older adult participants from 15 AFC initiatives across four states in the United States (U.S.), our reflexive thematic analysisidentified three themes regarding what participants value from their engagement: (a) social contribution; (b) social connectedness and integration; and (c) staying active and personal growth. Exploring older adults' interest in contributing to, connecting with, and growing in their community can inform recruitment and retention in AFC initiatives.

Background: Previous research examining the relationship between loneliness and depressive symptoms often treated these constructs as static traits rather than dynamic states. The current study focused on the short-term, prospective link between loneliness and depressive symptoms, while also analyzing potential gender differences., Methods: We modeled panel data from seven bi-weekly assessments gathered in the FRequent health Assessment In Later life (FRAIL70+) study. At baseline, the sample size amounted to N = 426 community-dwelling older adults aged 70 years or older in Austria. The relationship between loneliness and depressive symptoms was analyzed using a latent change score modeling framework., Results: As regards depressive symptoms, women showed higher initial levels and more change across the three months than men. Loneliness did not considerably change across time for both sexes. Moreover, greater levels of loneliness at a given point in time were associated with an accelerated increase in depressive symptoms two weeks later in women but not in men., Conclusion: Loneliness appeared to be a potential determinant of future increases in depressive symptoms. The varying effects observed between men and women suggest potential gender differences in short-term fluctuations of depressive symptoms and their underlying mechanisms., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier B.V.)

Objectives: To clarify the factors associated with loneliness in individuals aged 80 years and older in Germany (also stratified by sex)., Methods: Data from the nationally representative "Old Age in Germany (D80+)" were employed. The analytic sample equaled 10,031 individuals. The D80+ study included community-dwelling and institutionalized individuals ≥ 80 years in Germany. Multiple linear regressions were used (with sociodemographic and health-related explanatory factors). The collection of data occurred between November 2020 and April 2021 (written questionnaire)., Results: Higher loneliness was significantly associated with not being married (e.g., widowed compared to being married, β=0.37, p<.001), being institutionalized (β=0.33, p<.001), low education (high education compared to low education, β=-0.07, p<.01), a higher number of chronic conditions (β=0.02, p<.001), poor self-rated health (β=-0.19, p<.001) and greater functional impairment (β=0.15, p<.001). Sex-stratified regressions produced comparable results. However, low education was only associated with higher loneliness among men, but not women (with significant interaction: education x sex)., Conclusion: Several sociodemographic and health-related factors can contribute to loneliness among the oldest old in Germany, with sex-specific associations between education and loneliness. Overall, such knowledge can aid to address individuals with higher loneliness levels., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objectives: Understanding what influences changes over time in caregiver well-being is important for the development of effective support. This study explores differences in trajectories of caregiver stress and positive aspects of caregiving (PAC)., Methods: Caregivers of community-dwelling individuals with mild-to-moderate dementia at baseline from the IDEAL cohort were interviewed at baseline (n = 1,203), 12 months (n = 917), and 24 months (n = 699). Growth mixture models identified multiple growth trajectories of caregiver stress and PAC in the caregiver population. Associations between study measures and trajectory classes were examined using multinomial logistic regression and mixed-effects models., Results: Mean stress scores increased over time. A 4-class solution was identified: a "high" stable class (8.3%) with high levels of stress, a "middle" class (46.1%) with slightly increasing levels of stress, a "low" class (39.5%) with initial low levels of stress which slightly increased over time, and a small "increasing" class (6.1%) where stress level started low but increased at a steeper rate. Mean PAC scores remained stable over time. A 5-class solution was identified: 3 stable classes ("high," 15.2%; "middle," 67.6%; "low" 9.3%), a small "increasing" (3.4%) class, and 1 "decreasing" class (4.5%). For stable classes, positive ratings on study measures tended to be associated with lower stress or higher PAC trajectories and vice versa. Those with "increasing" stress also had worsening trajectories of several study measures including depression, relationship quality, competence, and ability to cope., Discussion: The findings highlight the importance of identifying caregivers at risk of increased stress and declining PAC and offering them targeted support., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Background: Time-restricted eating (TRE), a type of intermittent fasting in which all daily calories are consumed within a window of ≤12 hours, is hypothesized to promote long-term weight management because of its relative simplicity., Objective: This study reports correlates of adherence among community-dwelling adults currently or formerly following a TRE dietary strategy., Design: A 25-minute cross-sectional online survey was developed, including questions about TRE perceptions, behaviors, motivators and drivers, and demographics. The survey was administered in February 2021 via Prolific, an online platform for sample recruitment and survey dissemination., Participants: Eligibility criteria included US adult ages 18+ who currently or formerly (past 3 months) followed TRE (ie, consumed all daily calories within a window of ≤12 hours) for a minimum of 1 week., Statistical Analyses: χ 2 tests and analysis of covariance (ANCOVA; adjusting for sex and age) compared responses between current and former followers., Results: Current followers (n = 296, mean [SD]: 34.2 ± 12.2y) were older than former followers (n = 295, mean [SD]: 31.1 ± 10.9 y) and practiced TRE for longer (median: 395 vs 90 days, P < 0.001). Current followers reported more success with meeting TRE goals (P ≤ 0.015), were less likely to report TRE concerns (P < 0.001), and more likely to report TRE satisfaction (P < 0.001). Four TRE motivators were more important among current (vs former) followers: weight maintenance, health (not weight), improved sleep, and preventing disease (P ≤ 0.017); weight loss was more important among former (vs current) followers (P = 0.003). Among adherence drivers, ability to work from home and the impact of COVID-19 were reported as more helpful for TRE adherence among current compared with former followers (P ≤ 0.028)., Conclusions: TRE motivators and drivers differed between current and former followers; interventions tailored to individuals' preferences and circumstances may benefit TRE adherence., (Published by Elsevier Inc.)

Background: Life skills play a key role in the transition of a child with intellectual disabilities into a young adult. According to previous research, students with intellectual disabilities often lack such skills. However, most studies on this topic have been conducted on teachers or parents. Limited studies are available on adolescents with intellectual disabilities. Therefore, this study investigates how adolescents with disabilities perceive their competence in life skills post-school., Method: The sample consisted of 201 adolescents with disabilities (67 % with mild intellectual disabilities and 33 % with other disabilities)., Results: The results revealed that adolescents with intellectual disabilities' perception of their life skills in all areas (independent living, personal money management, community involvement and usage, leisure activities, health, and social/interpersonal relationships) was significantly lower compared to adolescents with other disabilities. In four out of the six sub-scales, female respondents reported that their competence level in life skills was lower compared to males. In addition, adolescents with disabilities in daycare centers stated that they could establish better social and personal relationships when compared to adolescents from other schools., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: In previous research, older adults have been associated with reduced levels of health literacy (HL) influenced by a range of contextual factors. To optimise HL, it is essential to better understand the interactions between the ageing process and both personal and environmental factors as perceived by older adults. This study aimed to explore the experiences and needs of older community-dwelling adults when accessing, understanding, appraising and using health-related information., Methods: An explorative, qualitative design was used within the social constructivism framework. Semi-structured individual interviews were conducted with 20 adults aged 70-96 living at home in three areas in Northern Iceland. The transcribed interviews were constructed into categories and subcategories using qualitative content analysis., Findings: Four categories emerged. "Expectations for responsibility" describes the experience that individuals are responsible for taking care of their health, including accessing, understanding, appraising and using information and services, showing initiative and keeping needed communications active. "A gap between expectancy and ability/context" includes experiences while taking responsibility for expectations not aligning with skills/situations, creating information gaps. "Finding one's own ways" comprises various adapted ways to access, understand, and use information and services. "Bridging the gap" describes experiences of needing shared responsibility and more manageable options to enable reasoned health-related decisions and navigation in the healthcare system., Conclusions: The participants valued and took full responsibility for accessing, understanding, appraising and using information and services as part of a social norm; however, they experience information gaps. They request shared responsibility by being provided with fundamental health-related information as a vital step in making reasoned health-related decisions and navigating the healthcare system. They also request more inclusive and accessible service opportunities to bridge the gaps and facilitate HL. It is necessary to critically address, at a systematic level, the conflict between expected individual responsibility and the existence of options to act upon this responsibility. In matters of health, health services and HL, the need to analyse and confront structural disadvantages experienced by older adults is highlighted., (© 2024. The Author(s).)

Background: Prior research has identified the mediating effect of physical activity in the relationship between self-perceptions of aging and physical health. However, this impact on mental health is unknown, and the influence of environmental contexts proposed by ecological models in this regard remains largely unexplored. Therefore, this study aimed to investigate the role of physical activity in the relationship between self-perceptions of aging and depressive symptoms in older adults, and compare the impact across four levels of neighborhood walkability., Methods: A sample of 1,055 community-dwelling older adults aged 65 or above was obtained through random-digit-dialing computer-assisted telephone interviewing. The individual's neighborhood walkability was calculated using Walk Score®, and categorized into four levels: car-dependent, somewhat walkable, very walkable, and walker's paradise. Partial least squares structural equation modelling was employed., Results: We found that more positive self-perceptions of aging were associated with fewer depressive symptoms and a mediation effect of physical activity in this relationship. Among the four levels of neighborhood walkability, the mediation effect of physical activity was only statistically significant in the lowest level (car-dependent). The findings supported our hypotheses regarding the mediating effect of self-perceptions of aging on depressive symptoms via physical activity. Neighborhood walkability might potentially influence the mediating role of physical activity., Conclusions: This study emphasizes key areas on intervention programs and policy formulation to promote mental health in older adults., (© 2024. The Author(s).)

Engaging in one's neighborhood fosters independence, promotes social connectedness, improves quality of life, and increases life expectancy in older adults. There is a lack of evidence synthesis on immigrant older adults' neighborhood perceptions and experiences, essential for addressing neighborhood-level influences on aging in place. This study systematically synthesizes qualitative evidence on immigrant older adults' perceptions and experiences of their neighborhoods. A comprehensive search was conducted from inception to 5 April 2023, in multiple databases. This review considered studies including immigrant older adults aged ≥60 years, included studies from any country where the neighborhood was the focus, and only considered qualitative data while excluding review studies, theoretical publications, and protocols. Eligible studies were appraised using the JBI critical appraisal checklist for qualitative research. The Joanna Briggs Institute meta-aggregation approach was used to synthesize findings, and the ConQual approach established confidence in the synthesis. A total of 30 studies were included. Most studies were conducted in North America and explored phenomena such as aging in place, social capital, social cohesion, sense of community, and life satisfaction. Key contextual factors were walkable safe access to social spaces, accessible transportation to amenities, social cohesion with neighbors, and pre-migration neighborhood experiences. Immigrant older adults have varied experiences related to their sense of belonging and social cohesion. Factors such as racial discrimination, feeling unsafe, and social isolation contributed to negative perceptions. This review highlights the need for inclusive neighborhoods that align with the needs and values of immigrant older adults aging in place.

With the increasing number of older adults, research on cognitive function has expanded. However, studies examining the mediating effect of depression on the association between complex factors and cognitive function in older adults are still insufficient. Additionally, there is a lack of studies that have investigated these relationships by integrating multiple factors related to the cognitive function of older adults. Therefore, our study investigated the association between the number of family members, self-rated health, depression, and cognitive function in community-dwelling older adults and highlighted the mediating role of depression in these relationships. We used data from 218 older adults aged over 65 collected in a previous study. The independent variables were the number of family members and self-rated health, and the dependent variable was cognitive function measured by the cognitive impairment screening test (CIST). The mediation variable was depression measured by the Patient Health Questionnaire-9 (PHQ-9). Structural equation modeling was used to examine the association between the independent, dependent, and mediation variable. The mean ages of the participants were 81.71 (standard deviation [SD] = 6.00) years, with 198 females (90.83%) and 20 males (9.17%). The structural equation model demonstrated a good model fit (chi-square value = 33.375; degrees of freedom = 24; p-value = 0.0964; RMSEA = 0.042; CFI = 0.970; TLI = 0.956; SRMR = 0.042). Self-rated health and the number of family members were not directly associated with cognitive function; however, depression had significant indirect effects (self-rated health to cognitive function: coefficient = -0.023, p-value = 0.017; number of family members and cognitive function: coefficient = 0.012, p-value = 0.030). Our findings indicated that depression plays a crucial mediating role between self-rated health, number of family members, and cognitive function. The results highlight the need for comprehensive strategies for mental health care to support cognitive health in older adults., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bae et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aim: To construct a health empowerment framework for the Chinese older people with chronic conditions., Design: A Strussian grounded theory design was selected to generate the theoretical framework., Methods: Data were collected from 53 community-dwelling older people with chronic conditions in China between November 2017 and August 2019, via semi-structured interviews and with participating observation. The constant comparative method identified the key categories., Results: 'Responsibility endowing power', the health empowerment core theme, was defined as initiating, performing and realizing responsibility towards health through the interaction between the self, family and society. The framework enriches the meaning of health empowerment, changing older people's nursing practice., (© 2024 The Author(s). Nursing Open published by John Wiley & Sons Ltd.)

Background: Dietary intervention is an important method to manage sarcopenic obesity, but the implementation in real world is difficult to achieve an ideal condition. This study aimed to the experiences of older people with sarcopenic obesity during the implementation of dietary behavioural change (DBC) intervention., Methods: This study is a semi-structured individual interview embedded within a pilot randomized controlled trial on community-dwelling older people with sarcopenic obesity. Purposive sampling was applied to invite 21 participants who had received a 15-week DBC intervention. The interviews were audio-recorded and transcribed verbatim. Content analysis was performed to analyze the data., Results: The themes for facilitators included: (a) Attach importance to self's health; (b) Family's support; (c) Concern self's body shape; (d) Instructor's support; (e) Regular food diary taken. The themes for barriers included: (a) Difficulties of taking food diary; (b) Difficulties of calculating the food amount; (c) Yield to offspring's appetite; (d) Misjudging self's or family's appetite., Conclusion: Support from family members and instructor, caring about self's health and body image facilitated the intervention implementation. The complication of food amount estimation and diary record, personal sacrifice for next generations, and previous living experience were barriers for implementing the intervention. Overall, the older people with sarcopenic obesity can accept the design of DBC intervention program and have great willing to join., (© 2024. The Author(s).)

Older adults living in a community are looking for alternative and complementary methods to improve their healthy longevity and quality of life. This study aimed to examine the effects of the Qigong therapy on psychological well-being, physical health state, sleep state, and life satisfaction of older adults living in community. This study used a quasi-experimental pretest-posttest control group design. The study samples were 69 older adults (intervention, n = 34; control, n = 35) over 65 years old in community in South Korea. Qigong therapy was performed 50 minutes per session, twice a week for a total of 20 times over a 10-week period in a comfortable and quiet environment without external noise. Measures were the study participant's general characteristics survey, psychological well-being scale, Cornell Medical Index-Korean version, sleep scale, and life satisfaction scale standardized for the elderly. Effects of Qigong therapy according to interaction effect over time and the group showed statistically significant differences in psychological well-being, physical health state, sleep state, and life satisfaction. This study suggests that Qigong therapy was an effective nursing intervention for improving the psychological well-being, physical health state, sleep state, and life satisfaction of older adults living in community., Competing Interests: The authors declare they have no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Developed countries worldwide face the challenge of aging populations in which loneliness is problematic, leading to mental and physical health issues. Diabetes mellitus (DM) can cause decreased physical activity, reduced functioning, and depressive symptoms. However, how interactions between loneliness and DM influence health outcomes remains unclear. We aimed to determine the effects of loneliness and DM-related complications on the incidence of disability among older individuals., Methods: We analyzed data from the Japanese National Center for Geriatrics and Gerontology Study of Geriatric Syndromes for community-dwelling adults aged ≥65 years without initial long-term care needs. Loneliness was assessed using the University of California Los Angeles Loneliness Scale, and DM status was determined based on medical history obtained through face-to-face interviews. Disability incidence was identified by monthly tracking of certifications under the Japanese long-term care insurance system. The combined effect of DM and loneliness on care needs was examined using Cox proportional hazard regression models., Results: Among 5,160 participants, 298 (5.8 %) developed incident disabilities within 24 months. Cox models adjusted for potential confounders revealed a significantly increased disability risk among persons with DM and loneliness. Having DM without loneliness and vice versa were not significant risk factors for disability incidence compared with having neither., Conclusions: The combination of loneliness with DM was a risk factor for disability development among community-dwelling older adults. Loneliness and DM might be interrelated and associated with disability development, suggesting that support along with assessments of mental health and illness might help to avoid disability in this population., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Memory plays a crucial role in cognitive health. Social isolation (SI) and loneliness (LON) are recognized risk factors for global cognition, although their combined effects on memory have been understudied in the literature. This study used three waves of data over six years from the Canadian Longitudinal Study on Aging to examine whether SI and LON are individually and jointly associated with memory in community-dwelling middle-aged and older adults (n = 14,208). LON was assessed with the question: "In the last week, how often did you feel lonely?". SI was measured using an index based on marital/cohabiting status, retirement status, social activity participation, and social network contacts. Memory was evaluated with combined z-scores from two administrations of the Rey Auditory Verbal Learning Test (immediate-recall, delayed-recall). We conducted our analyses using all available data across the three timepoints and retained participants with missing covariate data. Linear mixed models were used to regress combined memory scores onto SI and LON, adjusting for sociodemographic, health, functional ability, and lifestyle variables. Experiencing both SI and LON had the greatest inverse effect on memory (least-squares mean: -0.80 [95 % confidence-interval: -1.22, -0.39]), followed by LON alone (-0.73 [-1.13, -0.34]), then SI alone (-0.69 [-1.09, -0.29]), and lastly by being neither lonely nor isolated (-0.65 [-1.05, -0.25]). Sensitivity analyses confirmed this hierarchy of effects. Policies developed to enhance memory in middle-aged and older adults might achieve greater benefits when targeting the alleviation of both SI and LON rather than one or the other individually., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Network analysis provides an innovative approach to examining symptom-to-symptom interactions in mental health, and adverse external conditions may change the network structures. This study compared the networks of common risk factors and mental health problems (loneliness, depressive symptoms, and anxiety symptoms) in community-dwelling older people before and during COVID-19. Older adults (aged ≥ 60) at risk for depression were recruited through non-governmental organizations. Loneliness, depressive symptoms and anxiety symptoms were measured using the three-item Loneliness Scale (UCLA-3), nine-item Patient Health Questionnaire (PHQ-9), and seven-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Data from 2549 (before) and 3506 (during COVID-19) respondents were included using propensity score matching. Being restless (GAD-7-item5) was most central, indicated by Expected Influence, in both pre and during COVID-19 networks despite low severity (mean score). The network during COVID-19 had higher global strength and edge variability than the pre-pandemic network, suggesting easier symptom spread and potentially more complex symptom presentation. In addition, feeling isolated from others (UCLA-3-item3) had stronger connections with feeling worthless/guilty (PHQ-9-item6) and anticipatory anxiety (GAD-7-item7) during COVID-19 than before. These findings may enhance our knowledge of the symptom structure of common mental health problems and the impacts of the pandemic. Targeting central symptoms may offer novel preventive strategies for older people., (© 2024. The Author(s).)

Background: Although a growing body of literature documents the importance of neighborhood effects on late-life cognition, little is known about the relative strength of objective and subjective neighborhood measures on late-life cognitive changes. This study examined effects of objective and subjective neighborhood measures in three neighborhood domains (neighborhood safety, physical disorder, food environments) on longitudinal changes in processing speed, an early marker of cognitive aging and impairment., Methods: The analysis sample included 306 community-dwelling older adults enrolled in the Einstein Aging Study (mean age = 77, age range = 70 to 91; female = 67.7%; non-Hispanic White: 45.1%, non-Hispanic Black: 40.9%). Objective and subjective measures of neighborhood included three neighborhood domains (i.e., neighborhood safety, physical disorder, food environments). Processing speed was assessed using a brief Symbol Match task (unit: second), administered on a smartphone device six times a day for 16 days and repeated annually for up to five years. Years from baseline was used as the within-person time index., Results: Results from mixed effects models showed that subjective neighborhood safety (β= -0.028) and subjective availability of healthy foods (β= -0.028) were significantly associated with less cognitive slowing over time. When objective and subjective neighborhood measures were simultaneously examined, subjective availability of healthy foods remained significant (β= -0.028) after controlling for objective availability of healthy foods. Associations of objective neighborhood crime and physical disorder with processing speed seemed to be confounded by individual-level race and socioeconomic status; after controlling for these confounders, none of objective neighborhood measures showed significant associations with processing speed., Conclusion: Subjective neighborhood safety and subjective availability of healthy foods, rather than objective measures, were associated with less cognitive slowing over time over a five-year period. Perception of one's neighborhood may be a more proximal predictor of cognitive health outcomes as it may reflect one's experiences in the environment. It would be important to improve our understanding of both objective and subjective neighborhood factors to improve cognitive health among older adults., (© 2024. The Author(s).)

Background: With the conflict between the promise of ageing in health and longevity and the limited availability of health resources and social support, older adults in China inevitably experience anxieties surrounding health risks. This study aims to investigate how older adults perceive the health risks that come with getting older, explore the degree to which health risks affect older adults, and advocate for active engagement in practices for managing health risks., Methods: Using purposive sampling, three districts of Beijing (Xicheng District, Fengtai District, and Daxing District, respectively) were selected for the research. Qualitative semi-structured and in-depth interviews were conducted with 70 community-dwelling older adults who participated in the study. Data were extracted and analyzed based on a thematic framework approach., Results: Three main themes were identified: (i) the anxieties of older adults concerning health risks in ageing; (ii) the priorities of older adults for health risk management in ageing; (iii) the expectations of older adults for health risk management in ageing. The primary health concerns among older adults included disease incidence and function decline. It was found that basic health management emerged as a critical need for older adults to mitigate health risks. Moreover, it was observed that healthcare support for older adults from familial, institutional, and governmental levels exhibited varying degrees of inadequacy., Conclusions: The primary source of anxieties among older adults regarding health risks predominantly stems from a perceived sense of health deprivation. It is often compounded by persistent barriers to primary care of priorities in managing health risks among older adults. In addition, the expectations of older adults for health risk management emphasize the necessity for integrated care approaches. Therefore, further research should give priority to the prevention and management of health risks, aim to reduce anxieties, provide integrated care to meet the primary needs and expectations of older adults, and ultimately strive toward the overarching goal of promoting health and longevity., (© 2024. The Author(s).)

This study aimed to identify the factors associated with health-related quality of life (HRQOL) among community-dwelling older adults. Physical and mental HRQOL were measured by the 12-item Short Form Health Survey (SF-12) at baseline and follow-up. Linear regression models were used to evaluate associations between socio-demographic, health, and lifestyle factors and HRQOL. The sample included 661 participants (mean age = 77.4 years). Frailty was negatively associated with physical HRQOL (B = - 5.56; P < 0.001) and mental HRQOL (B = - 6.65; P < 0.001). Participants with a higher score on activities of daily living (ADL) limitations had lower physical HRQOL (B = - 0.63; P < 0.001) and mental HRQOL (B = - 0.18; P = 0.001). Female sex (B = - 2.38; P < 0.001), multi-morbidity (B = - 2.59; P = 0.001), and a high risk of medication-related problems (B = - 2.84; P < 0.001) were associated with lower physical HRQOL, and loneliness (B = - 3.64; P < 0.001) with lower mental HRQOL. In contrast, higher age (B = 2.07; P = 0.011) and living alone (B = 3.43; P < 0.001) were associated with better mental HRQOL in the multivariate models. Future interventions could be tailored to subpopulations with relatively poor self-reported HRQOL, such as frail or lonely older adults to improve their HRQOL., (© 2024. The Author(s).)

Background: Most people want to remain at home as they age. Ageing in place - remaining at home and connected to the community - is a national and international policy priority; however, to better understand how policy might be implemented, a more nuanced understanding is required about older adults' lived experiences of ageing in place, especially the experiences of those aged 80 and above., Objective: To describe and explore the social processes which enable ageing in place from the perspective of community-dwelling older people (80+)., Methods: Forty-six respondents (80-100+ years) participated in the first wave of a longitudinal qualitative study set in North East England. Semi-structured interviews were conducted in participants' homes between June 2022 and January 2023. Interviews were analysed using reflexive thematic analysis., Results: Participants positioned their homes as a place of freedom and as the antithesis of a 'care home'. Remaining in place was important for all participants; a key priority for them was to remain physically active to enable this. However, many participants faced significant hurdles to remaining in place. These were primarily related to health and mobility issues. Some participants were able to overcome such barriers by drawing on financial resources and available social networks., Conclusion: The home is central to understanding older peoples' (80+) experiences of ageing. In a socio-political context which promotes ageing in place, the social factors shaping experiences of ageing in place must be considered. This involves attending to the challenges of later life, particularly health and especially mobility and physical function. Currently, those with resources (social and economic) are better equipped to respond to such challenges, thus potentially exacerbating widening inequalities in ageing. By foregrounding the perspectives of those ageing in place alongside social factors shaping their experiences, our study has important implications for policy and health and social care. We show that a more equitable allocation of resources is vital to fulfil the ageing in place policy agenda. Furthermore, we highlight a need to recognise commitments to ageing in place displayed by people aged 80 and above, especially when remaining in place becomes difficult to achieve., (© 2024. The Author(s).)

Background: Older people are the fastest-growing age group, with the highest risk of cognitive impairment. This study assessed the prevalence and associated factors with cognitive impairment in community-dwelling older people., Methods: Older people were interviewed and accomplished through sociodemographic and health questionnaires. The quantitative variables were described by mean and standard deviation or median and interquartile range. The significance level adopted was 5 % (p < 0.05). The association between the quantitative variables was evaluated using the Pearson or Spearman correlation coefficients., Results: The research population comprised 165 long-lived adults aged ≥80. The youngest one was 80, and the oldest one was 94 years old. The participants were 84.8 ± 3.6 years old, female (63 %) with a mean of education of 2.9 ± 1.8 years. A poor performance in the Mini-Mental State Examination (MMSE) was found in 58 (35.2 %) individuals when adjusted for educational level. After adjustment for confounding factors, body mass index (BMI) (p = 0.09), total older adults' income (up to 1 minimum wage [mw], p = 0.023; over 1 to 2 mw, p = 0.023), functional disability (Moderate dependence 75 %, p = 0.038; Moderate dependence 50 %, p = 0.081; Moderate dependence 25 %, p = 0.054), and the anxiety scale (p = 0.032), remained associated with cognitive impairment., Conclusions: This study showed that BMI, total older adults' income, functional disability, and anxiety are related to cognitive impairment in long-lived adults. This study has some limitations, such as the fact that it is a cross-sectional study, the reduced number of individuals, and the fact that there were no comparisons among different ages and populations., Competing Interests: Declaration of competing interest The authors declare there is no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Sedentary behavior (SB) is deeply ingrained in the daily lives of community-dwelling older adults with type 2 diabetes mellitus (T2DM). However, the specific underlying mechanisms of the determinants associated with SB remain elusive. We aimed to explore the determinants of SB based on the behavior change wheel framework as well as a literature review., Methods: This cross-sectional study recruited 489 community-dwelling older adults with T2DM in Jinan City, Shandong Province, China. Convenience sampling was used to select participants from relevant communities. This study used the Measure of Older Adults' Sedentary Time-T2DM, the Abbreviated-Neighborhood Environment Walkability Scale, the Social Support Rating Scale, the Lubben Social Network Scale 6, the Subjective Social Norms Questionnaire for Sedentary Behavior, the Functional Activities Questionnaire, the Numerical Rating Scale, the Short Physical Performance Battery, and the Montreal Cognitive Assessment Text to assess the levels of and the determinants of SB. Descriptive statistical analysis and path analysis were conducted to analyze and interpret the data., Results: Pain, cognitive function, social isolation, and social support had direct and indirect effects on SB in community-dwelling older adults with T2DM (total effects: β = 0.426, β = -0.171, β = -0.209, and β = -0.128, respectively), and physical function, walking environment, and social function had direct effects on patients' SB (total effects: β = -0.180, β = -0.163, and β = 0.127, respectively). All the above pathways were statistically significant (P < 0.05). The path analysis showed that the model had acceptable fit indices: RMSEA = 0.014, χ 2 /df = 1.100, GFI = 0.999, AGFI = 0.980, NFI = 0.997, RFI = 0.954, IFI = 1.000, TLI = 0.996, CFI = 1.000., Conclusion: Capability (physical function, pain, and cognitive function), opportunity (social isolation, walking environment, and social support), and motivation (social function) were effective predictors of SB in community-dwelling older adults with T2DM. Deeper knowledge regarding these associations may help healthcare providers design targeted intervention strategies to decrease levels of SB in this specific population., (© 2024. The Author(s).)

A sense of community is known to be a protective factor for the well-being of older adults and meaning in life associated with positive mental outcomes. Nevertheless, there is a need to expand the knowledge of the role of a sense of community in meaning in life, particularly among older adults. Intending to broaden the empirical understanding from this perspective, the current study examined the mediating roles of optimism, loneliness, and psychological distress in the association between a sense of community and meaning in life. Participants included 740 community dwelling Israeli older adults (M = 71.96; SD = 5.81). Participants completed questionnaires on a sense of community, optimism, loneliness, psychological distress, meaning in life, and sociodemographic characteristics. A positive association was found between a sense of community with optimism, and a negative association with loneliness. A negative association between optimism with psychological distress and a positive link between loneliness with psychological distress was found, while a higher level of psychological distress was associated with a lower level of meaning in life. Practitioners should focus interventions with older adults on developing a sense of community, with the aim to promote optimism and, at the same time, reduce loneliness and thus decrease psychological distress while strengthening meaning in life., (© 2023 Society for Community Research and Action.)

Older adults prefer ageing in place (AIP) rather than institutionalized facilities. Although its advantages, AIP can be challenging when communities are unable to meet residents' needs. This study aims to identify the relationship between the level of age-friendliness of community and AIP. We used AARP Age-friendly Community Survey data with 6670 older adults in the USA. We used responses from 63 items assessing various aspects of a community's age-friendliness to identify different types of age-friendly communities (AFCs) through latent profile analysis (LPA). We then ran multinomial logistic regression to examine whether the types of AFC were associated with AIP. LPA revealed three types of AFC: Underdeveloped, developing, and developed. Regression results showed older adults living in underdeveloped and developing communities are less likely to AIP compared to those in the developed community. These results show a positive impact of AFC on intention to AIP. Policymakers should consider expanding AFC initiatives for the growing number of older adults., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction and Hypothesis: The world including Iran is facing population aging. Urinary incontinence (UI) is one of the most common health concerns of older women that can be accompanied by an increased sense of loneliness, social restrictions, and disruption in activities of daily living in addition to the regular challenges of old age. This study was aimed at explaining the concerns of community-dwelling older women living with UI., Methods: This study used the conventional, qualitative, content analysis approach with purposive sampling. Twenty interviews were conducted with 18 participants, including 15 community-dwelling older women with UI and three family members (a husband and two daughters), over the span of 14 months (from August 2021 to October 2022). The data were collected via semi-structured, face-to-face interviews until data saturation was achieved, and were analyzed using Graneheim and Lundman's method., Results: The findings revealed that the concerns of older women with UI include the impasse of UI, being powerless in life, distorted social identity, and marital frustration, which fell under the main theme of sense of inadequacy., Conclusions: Recognizing the concerns of older women with UI can make health care teams more sensitive to the importance of resolving these concerns and can offer some insight into how best to provide targeted training, support, and counseling services at individual, family, and society levels, to eventually resolve the older adult's sense of inadequacy., (© 2024. The International Urogynecological Association.)

COVID-19 person-place disruptions may dislocate enabling resources and affect the short- and long-term wellbeing of individuals ageing-in-place. However, outcomes may vary according to individuals' personal experiences and capabilities to put in place adaptive strategies. Underpinned by the Conservation of Resources (COR) Theory, this study aimed to identify shifts in older people's relationships to place during the pandemic and to gain a deeper understanding of their adaptive strategies. We analysed data collected between April-May and October-November 2021 from the [Details omitted for double-blind reviewing], a qualitative investigation of community-dwellers based in Ireland and aged 65 years or over. Participants (n = 57) completed written submissions, narrative interviews and/or go-along interviews detailing their experiences during the pandemic. The mean age of participants was 74.9 years, 53% were female, 46% lived alone, and 86% lived in areas with high urban influence. Our framework analysis identified three thematic categories: 1) Characterization of individuals experiencing flow or disruption of place-resources; 2) Effects of place-resource disruptions; and 3) Adaptive strategies to manage disruption. Findings suggest that during the pandemic individuals ageing-in-place experienced trajectories of resistant flow, resilient flow, chronic disruption, or delayed disruption of place-resources, Participants' health and wellbeing was influenced in diverse ways by the threat of- and actual loss of material, social and affective resources. To compensate for disruptions, participants developed multiple adaptive strategies that highlight older people's potential to transform themselves, others, and their environments during times of adversity. These findings showcase the processes by which health enabling places may be maintained and generated, and present areas of opportunity for public health interventions seeking to support ageing populations during public health emergencies and beyond., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To characterize the effect of the actual and potential ability to get rides from others on older adults' driving reduction at 3-year follow-up in the United States., Methods: We analyzed National Health and Aging Trends Study data from community-dwelling drivers in 2015 (unweighted n = 5,102). We used weighted logistic regression models to estimate whether getting rides from others in 2015 was associated with older adults increasing the number of driving behaviors they avoided, decreasing the frequency with which they drove, or not driving at 3-year follow-up after adjusting for biopsychosocial variables. We also measured presence of social network members living nearby including household and non-household members and estimated associated odds of driving reduction at 3-year follow-up., Results: Older adults who got rides from others in 2015 had greater odds of reporting no longer driving at 3-year follow-up compared to those who did not get rides (adjusted odds ratio [aOR] = 1.53, 95% confidence interval [CI]: 1.11-2.11). We found no statistically significant association between older adults living with others or having more nearby confidantes outside their household and their odds of reducing driving at 3-year follow-up., Discussion: These findings suggest that getting rides from others plays an important role in the transition to non-driving for older adults. Future research should examine whether other aspects of social networks (e.g., type, quality, and closer proximity) might also be key modifiable coping factors for older adults transitioning to non-driving., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objectives: This study provides one of the first national longitudinal studies of the association between caring for grandchildren (i.e., grandparenting) and the risk of dementia in the United States, with a focus on gender-specific variations., Methods: We estimated discrete-time event history models, drawing upon data from the Health and Retirement Study (2000-2016). The analytic sample included 10,217 community-dwelling White and Black grandparents aged 52 years and older at baseline., Results: Noncoresident grandparenting was associated with a lower risk of dementia for both women and men compared to grandparents who did not take care of grandchildren. However, the cognitive advantage showed different patterns based on gender and the combination of care intensity and family structure. Grandmothers had a lower risk of dementia than noncaregiving grandmothers when providing a light level of noncoresident grandparenting, whereas grandfathers who provided intensive noncoresident grandparenting had a reduced risk of dementia compared to their noncaregiving counterparts. Grandparenting experiences within multigenerational households and skipped-generation households were not associated with dementia risk., Discussion: Intergenerational caregiving plays a pivotal role in shaping cognitive health during later life; however, the impact is nuanced, depending on factors such as gender, care intensity, and family structure., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objectives: Some research conceptualizes routineness of daily life as an indicator of cognitive vulnerability that would lead to lower well-being in older age, whereas other research expects routineness to give rise to more meaning and stability in life and thus to higher well-being. Further research is needed to understand routineness in older adults in relation to cognitive abilities and well-being. This study examined routineness of social interactions., Methods: We examined data from an event-contingent experience sampling study with 103 Swiss community-dwelling older adults (aged 65 to 84 years). Participants completed in-lab cognitive assessments (reasoning, episodic memory, speed, and vocabulary) and reported their well-being (positive affect, negative affect, and life satisfaction). For more than 21 days, participants reported the time and context of their social interactions (including modality, partner type, and location). Routineness of social interactions was defined as social interactions that occurred at the same time of day over the study period. It was calculated using recurrence quantification analysis., Results: Linear regressions showed that higher routineness of social interaction in general, of social interaction through the same modality, and of social interaction with the same partner type were associated with higher positive affect. Higher routineness of social interaction in general was associated with lower negative affect. Routineness of social interactions was not associated with life satisfaction or cognitive abilities., Discussion: A routine social life may increase older adults' affective well-being. Results are discussed in the context of activity engagement and time use in older age., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Purpose: The aim of this study was to investigate the mediating effects of health literacy on the relationship between frailty and health-related quality of life (HRQOL) among community-dwelling older adults., Methods: This study used the Korean Frailty and Aging Cohort Database (KFACD) for secondary data analysis. We selected data from 1,631 people without missing main variable values for analysis. Frailty was determined based on the modified Fried's phenotype [MFP], and HRQOL was measured using the Korean version of the 5-level EuroQol questionnaire (EQ-5D-5L). Health literacy was assessed using the questions on the Behavioral Risk Factor Surveillance System (BRFSS) used by the U.S. Center for Disease Control and Prevention. To examine the mediating role of health literacy in the relationship between frailty and HRQOL, Baron & Kenny's three-step mediating effect verification method was utilized., Results: The participants had a mean frailty score of 1.37±1.02, health literacy score of 8.56±2.59, and HRQOL score of 0.84±0.10. Frailty was negatively correlated with health literacy (r = -0.27, p < .001) and HRQOL (r = -0.32, p < .001), while health literacy was positively correlated with HRQOL (r = 0.34, p < .001). We observed that health literacy played a partial mediating role in the relationship between frailty and HRQOL., Conclusion: To increase older adults' HRQOL, measures that directly prevent and manage frailty as well as interventions that target the enhancement of health literacy are needed., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This research aimed to explore factors associated with the fear of falling (FOF) among community-dwelling older adults in Vietnam. A cross-sectional study was conducted in five communes in Soc Son, Hanoi, Vietnam, from March to June 2017. We recruited a total of 487 participants, which provided sufficient data for analysis. The outcome variable was fear of falling. Several covariates, including demographics, medical history, general health status, geriatric syndromes, eye diseases, assessment of fall risk environment, timed up-and-go test, and number of standing up in 30 s, were collected. A multivariable logistic regression model was performed to determine predictors associated with FOF. The results showed that 54.6% of the participants had FOF. Furthermore, the logistic multivariable regression model revealed several factors associated with FOF among participants in the research sites, including polypharmacy status (OR: 1.79; 95%CI 1.07-2.99), higher scores in quality of life according to the EQ-5D-5L index (OR:6.27; 95%CI: 2.77-14.17), and having fallen during the past 12 months (OR:4.4; 95%CI: 2.39-8.11). These findings contribute to a comprehensive understanding of the intricate relationship between FOF and several associated factors, notably polypharmacy status, quality of life, and having a fall during the past 12 months.

Objective: This study aimed to examine the mediation role of perceived social support in the relationship between functional limitations, depressive symptoms and quality of life among older people in Malaysia., Setting: The Malaysian National Health Morbidity Survey 2018: Elderly Health was a cross-sectional health community survey among adults aged 50 and above., Participants: 3977 community-dwelling older Malaysians aged 60 and above., Outcome Measures: Functional limitations were defined as personal activities of daily living (PADL) and instrumental activities of daily living (IADL), tested in separate paths in all analyses. PADL was measured using the Barthel Index, while IADL was measured using the Lawton and Brody scale. Perceived social support, depressive symptoms and quality of life were measured using the Duke Social Support Index, Geriatric Depression Scale-14 and Control, Autonomy, Self-Realisation and Pleasure-19 tools. We used mediation analysis through structural equation modelling to explore the role of perceived social support., Results: Perceived social support mediated the relationship between PADL and IADL with depressive symptoms, with the indirect effects at -0.079 and -0.103, respectively (p<0.001). Similarly, perceived social support mediated the relationship between PADL and IADL with quality of life, with the indirect effects at 0.238 and 0.301, respectively (p<0.001). We performed serial multiple mediation analysis and found that perceived social support and depressive symptoms mediated the path between PADL and IADL with quality of life, with the indirect effects at 0.598 and 0.747, respectively (p<0.001). The relationship between functional limitations and all outcomes remained significant in all mediation analyses., Conclusion: The present study provides evidence that perceived social support relieves the influence of functional limitations on depressive symptoms and declining quality of life among older people. Therefore, it is imperative to establish a social support system to improve the overall well-being of older people., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The high prevalence of multimorbidity in aging societies has posed tremendous challenges to the healthcare system. The aim of our study was to comprehensively assess the association of multimorbidity patterns and health-related quality of life (HRQOL) among rural Chinese older adults., Methods: This was a cross-sectional study. Data from 4,579 community-dwelling older adults aged 60 years and above was collected by the clinical examination and questionnaire survey. Information on 10 chronic conditions was collected and the 3-Level EQ-5D (EQ-5D-3L) was adopted to measure the HRQOL of older adults. An exploratory factor analysis was performed to determine multimorbidity patterns. Regression models were fitted to explore the associations of multimorbidity patterns with specific health dimensions and overall HRQOL., Results: A total of 2,503 (54.7%) participants suffered from multimorbidity, and they reported lower HRQOL compared to those without multimorbidity. Three kinds of multimorbidity patterns were identified including cardiovascular-metabolic diseases, psycho-cognitive diseases and organic diseases. The associations between psycho-cognitive diseases/organic diseases and overall HRQOL assessed by EQ-5D-3L index score were found to be significant (β = - 0.097, 95% CI - 0.110, - 0.084; β = - 0.030, 95% CI - 0.038, - 0.021, respectively), and psycho-cognitive diseases affected more health dimensions. The impact of cardiovascular-metabolic diseases on HRQOL was largely non-significant., Conclusion: Multimorbidity was negatively associated with HRQOL among older adults from rural China. The presence of the psycho-cognitive diseases pattern or the organic diseases pattern contributed to worse HRQOL. The remarkable negative impact of psycho-cognitive diseases on HRQOL necessiates more attention and relevant medical assistance to older rural adults., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Social support (SS) has been widely recognized to have a protective effect influencing older adults' emotional and psychological well-being. This study aimed to determine the relationships of structural SS and functional SS on depression and quality of life among the community-dwelling older adults in the rural and Asian context. A cross-sectional study was conducted among 2324 community older adults aged 60 years and above in Kuala Pilah, Malaysia. Participants were recruited via multistage sampling and interviewed face-to-face. The relationships were analyzed using structural equation modeling. Structural SS was associated with functional SS (β = 0.05). Only functional SS (having a role, knowing what is going on, and having a confidant) was found to be significantly associated with depression (β = -0.07) and quality of life (physical component [β = 0.08], mental component [β = 0.31]). In summary, functional SS and familial SS should be addressed to reduce depression and improve quality of life among older adults. Community initiatives to increase awareness in optimizing social support should be conducted for quality of life among community older adults., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Depression and anxiety are common mental disorders among older adults, but they are frequently underdiagnosed. Attitudes towards seeking professional mental health care is one of the barriers to access to treatment. This study was aimed at assessing the attitudes towards seeking psychological help among older adults who are enrolled in primary care in Chile, and to determine the associated factors., Methods: This cross-sectional study recruited 233 primary care users aged 65 or more years. The Attitudes Towards Seeking Professional Psychological Help was used. Reliability and factor analysis of this scale were carried out. The average scores of the scale and factors were calculated and compared, by selected variables. Multivariate linear regression was estimated to determine factors associated with attitudes towards seeking psychological help., Results: Three factors were identified in the attitudes towards seeking psychological help: confidence in psychologists, coping alone with emotional problems, and predisposition to seek psychological help. On average, participants had a favorable attitude towards seeking psychological help, compared with previous research. Lower level of education, and risk of social isolation were inversely associated with these attitudes., Conclusion: Strategies to improve mental health literacy and social connection among older adults, could have an impact on factors that mediate the access to mental health care, such as attitudes towards seeking psychological help, among people who have a lower level of education or are at risk of social isolation., (© 2024. The Author(s).)

Purpose: Providing support for older adults after spousal bereavement is crucial for psychological recovery through the grieving process and for promoting a healthy and happy remainder of life. The current study aimed to understand factors influencing well-being among Japanese community-dwelling older adults who experienced spousal bereavement by evaluating how their roles and activities affected their psychological well-being following the loss., Method: We conducted a cross-sectional, anonymous, self-administered questionnaire survey of 332 older adults who had experienced death of a spouse in later adulthood., Results: Identified factors that affected well-being after spousal loss were sex, ability to go out without assistance from others, long duration since spousal loss, having a hobby, and adopting a life-oriented approach to cope with bereavement. Well-being following spousal loss was influenced by participants' activities and roles., Conclusion: Findings of the current study provide potentially valuable suggestions for surviving spouses and their supporters when coping with grief following spousal loss. [ Research in Gerontological Nursing, 17 (3), 121-130.].

Background: The problem of loneliness has garnered increased attention from policymakers, payors, and providers due to higher rates during the pandemic, particularly among seniors. Prior systematic reviews have in general not been able to reach conclusions about effectiveness of interventions., Methods: Computerized databases were searched using broad terms such as "loneliness" or "lonely" or "social isolation" or "social support" from Jan 1, 2011 to June 23, 2021. We reference mined existing systematic reviews for additional and older studies. The Social Interventions Research & Evaluation Network database and Google were searched for gray literature on Feb 4, 2022. Eligible studies were RCTs and observational studies of interventions to reduce loneliness in community-living adults that used a validated loneliness scale; studies from low- or middle-income countries were excluded, and studies were excluded if restricted to populations where all persons had the same disease (such as loneliness in persons with dementia)., Results: A total of 5971 titles were reviewed and 60 studies were included in the analysis, 36 RCTs and 24 observational studies. Eleven RCTs and 5 observational studies provided moderate certainty evidence that group-based treatment was associated with reduced loneliness (standardized mean difference for RCTs =  - 0.27, 95% CI - 0.48, - 0.08). Five RCTs and 5 observational studies provided moderate certainty evidence that internet training was associated with reduced loneliness (standardized mean difference for RCTs =  - 0.22, 95% CI - 0.30, - 0.14). Low certainty evidence suggested that group exercises may be associated with very small reductions in loneliness. Evidence was insufficient to reach conclusions about group-based activities, individual in-person interactions, internet-delivered interventions, and telephone-delivered interventions., Discussion: Low-to-moderate certainty evidence exists that group-based treatments, internet training, and possibly group exercises are associated with modest reductions in loneliness in community-living older adults. These findings can inform the design of supplemental benefits and the implementation of evidence-based interventions to address loneliness., Systematic Review Registration Number: PROSPERO ( CRD42021272305 )., (© 2023. The Author(s).)

Aim: To explore the prevalence of social isolation among Japanese community-dwelling older adults before and during the COVID-19 pandemic as well as determine how family and friend connections before and during the pandemic affected frail older adults during the pandemic., Design: A cross-sectional study., Methods: A total of 852 community-dwelling older adults in Hokkaido and Tokyo, Japan were surveyed conducted between April and November 2021 using convenience sampling. The Lubben social network scale-6, frailty screening index, and geriatric depression scale were used to assess social isolation, frailty and depression, respectively. A path analysis was conducted to evaluate the effect of social isolation on frailty., Results: Participants had a mean age of 76.8 ± 6.6 years. Overall, 46% and 59% of participants were socially isolated before and during the COVID-19 pandemic, respectively. Frailty was found in 19% of participants during the pandemic. Friends and family connectedness before the pandemic had no direct relationship with frailty; only friend connectedness affected frailty indirectly via depression. Family connectedness during the pandemic had a significant, negative and direct relationship with frailty., Conclusion: The findings show that connectedness with family and friends is critical for older people's physical and mental health., Impact: Nurses in the community should consider these findings to reduce mental health problems and physical decline among older adults. It is important to identify older adults who are socially isolated from their families or friends and provide resources to help them build relationships within their communities., Patient or Public Contribution: Community centre staff and community volunteers assisted in data collection. The public was not involved in data analysis, interpretation or manuscript preparation., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)