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Social connections have a significant impact on health across age groups, including older adults. Loneliness and social isolation are known risk factors for Alzheimer’s disease and related dementias (ADRD). Yet, we did not find a review focused on meta-analyses and systematic reviews of studies that had examined associations of social connections with cognitive decline and trials of technology-based and other social interventions to enhance social connections in people with ADRD.
Study design:
We conducted a scoping review of 11 meta-analyses and systematic reviews of social connections as possible determinants of cognitive decline in older adults with or at risk of developing ADRD. We also examined eight systematic reviews of technology-based and other social interventions in persons with ADRD.
Study results:
The strongest evidence for an association of social connections with lower risk of cognitive decline was related to social engagement and social activities. There was also evidence linking social network size to cognitive function or cognitive decline, but it was not consistently significant. A number of, though not all, studies reported a significant association of marital status with risk of ADRD. Surprisingly, evidence showing that social support reduces the risk of ADRD was weak. To varying degrees, technology-based and other social interventions designed to reduce loneliness in people with ADRD improved social connections and activities as well as quality of life but had no significant impact on cognition. We discuss strengths and limitations of the studies included.
Conclusions:
Social engagement and social activities seem to be the most consistent components of social connections for improving cognitive health among individuals with or at risk for ADRD. Socially focused technology-based and other social interventions aid in improving social activities and connections and deserve more research.
It is well-known that marital status is an important predictor for life expectancy. However, non-married individuals are often misclassified as singles which ignores the heterogeneity within the group. This paper shows the importance of distinguishing between types of singles, and in particular whether they are cohabiting, when predicting life expectancies. We use unique and detailed longitudinal register data to track marital status throughout the individual's lifetime. We find that all types of singles consistently benefit from living with a spouse, i.e., after divorce, becoming widower or being never married. This result holds for both men and women. For certain types of cohabiting singles we reject significant differences in life expectancy compared to married individuals. Finally, we use a case study to show that, like married individuals, all types of singles that cohabit also serve as informal caregivers and have the potential to limit the end-of-life long-term care expenditure levels.
Immigrants commonly report difficulties with developing social connections post-transition, which can lead to social isolation as they age. Understanding what factors promote/hinder the social integration of immigrants is an important public health objective. We tested the public health model of social integration of Berkman et al. in a sample of older immigrants. This model calls for considering both the social conditions in which social networks are embedded (upstream influences) and the levels of social support offered by different types of networks (downstream influences). First, we derived an empirical typology of social networks of older immigrants. Next, we tested associations of social networks with upstream and downstream influences. Data came from the New Zealand Health, Work and Retirement Study. The sample included 568 older adults (54% male) who immigrated as adults (mean length of stay = 28.5 years, standard deviation = 12.5). Latent profile analysis was employed on responses to the Practitioner Assessment of Network Type to identify social networks. Associations with upstream and downstream correlates were tested using logistic and multiple regression. Four network configurations emerged: ‘private-restricted’ (43.4%), ‘family-dependent’ (35.8%), ‘locally integrated’ (10.9%) and ‘wider community-based’ (9%). Having shorter length of residence and individualistic cultural background was predictive of being in a restricted network (private-restricted, family-dependent). Being in a restricted network was associated with lower levels of social support. Network type interacted with partner status: having a partner buffered the negative impact of having a restricted network on social support. Although restricted networks are common among older immigrants, they do not necessarily result in compromised social support. While we may see differences across countries regarding the impact of specific upstream and downstream influences, our findings highlight that both contextual and individual-level resources need to be considered alongside network structure to promote social integration of immigrants as they age.
This study aims to identify factors associated with divorce following breast cancer diagnosis and measures the impact of divorce on the quality of life (QoL) of patients.
Methods
We used cross-sectional survey data collected at breast cancer outpatient clinics in South Korea from November 2018 to April 2019. Adult breast cancer survivors who completed active treatment without any cancer recurrence at the time of the survey (N = 4,366) were included. The participants were classified into two groups: “maintaining marriage” and “being divorced,” between at the survey and at the cancer diagnosis. We performed logistic regression and linear regression to identify the factors associated with divorce after cancer diagnosis and to compare the QoL of divorced and nondivorced survivors.
Results
Approximately 11.1/1,000 of married breast cancer survivors experienced divorce after cancer diagnosis. Younger age, lower education, and being employed at diagnosis were associated with divorce. Being divorced survivors had significantly lower QoL (Coefficient [Coef] = −7.50; 95% CI = −13.63, −1.36), social functioning (Coef = −9.47; 95% CI = −16.36, −2.57), and body image (Coef = −8.34; 95% CI = −6.29, −0.39) than survivors who remained married. They also experienced more symptoms including pain, insomnia, financial difficulties, and distress due to hair loss.
Conclusion
Identifying risk factors of divorce will ultimately help ascertain the resources necessary for early intervention.
Few studies have reported real-life data on socio-economic functioning in patients with bipolar disorder and their unaffected first-degree relatives.
Methods
We used Danish nation-wide population-based longitudinal register linkage to investigate socio-economic functioning in 19 955 patients with bipolar disorder, their 13 923 siblings and 20 sex, age and calendar-matched control individuals from the general population. Follow-up was from 1995 to 2017.
Results
Patients with a diagnosis of bipolar disorder had lower odds of having achieved the highest educational level [OR 0.75 (95% confidence interval (CI) 0.73–0.77)], being employed [OR 0.16 (95% CI 0.159–0.168)], having achieved the 80% highest quartile of income [OR 0.33 (95% CI 0.32–0.35)], cohabitating [OR 0.44 (95% CI 0.43–0.46)] and being married [OR 0.54 (95% CI 0.52–0.55)] at first contact to hospital psychiatry as inpatient or outpatient compared with control individuals from the general population. Similarly, siblings to patients with bipolar disorder had a lower functioning within all five socio-economic areas than control individuals. Furthermore, patients and partly siblings showed substantially decreased ability to enhance their socio-economic functioning during the 23 years follow-up compared to controls.
Conclusions
Socio-economic functioning is substantially decreased in patients with bipolar disorder and their siblings and does not improve during long-term follow-up after the initial hospital contact, highlighting a severe and overlooked treatment gap.
Many studies demonstrate that marriage protects against risky alcohol use and moderates genetic influences on alcohol outcomes; however, previous work has not considered these effects from a developmental perspective or in high-risk individuals. These represent important gaps, as it cannot be assumed that marriage has uniform effects across development or in high-risk samples. We took a longitudinal developmental approach to examine whether marital status was associated with heavy episodic drinking (HED), and whether marital status moderated polygenic influences on HED. Our sample included 937 individuals (53.25% female) from the Collaborative Study on the Genetics of Alcoholism who reported their HED and marital status biennially between the ages of 21 and 25. Polygenic risk scores (PRS) were derived from a genome-wide association study of alcohol consumption. Marital status was not associated with HED; however, we observed pathogenic gene-by-environment effects that changed across young adulthood. Among those who married young (age 21), individuals with higher PRS reported more HED; however, these effects decayed over time. The same pattern was found in supplementary analyses using parental history of alcohol use disorder as the index of genetic liability. Our findings indicate that early marriage may exacerbate risk for those with higher polygenic load.
According to the literature, schizophrenia begins in men earlier than in women. It has been argued that the gender-bound age difference is due to the protective antidopaminergic effect of estrogens in women. However, the effect of gender on the age of onset may vary between different types of schizophrenias, and can also be modulated by marital status and by age at onset of illness. Comprehensive data were collected on 3306 DSM IIR schizophrenia patients, aged 15–64 years, who had been discharged from psychiatric hospitals in Finland in 1982, 1986 and 1990. The age of onset of illness (AOI) was defined by the age at the first admission (AFA). Male patients were admitted earlier than female patients, and a small second peak in women appeared at the age of 40–44. However, there were no gender differences in AFA within diagnostic subgroups, except in paranoid schizophrenia in which AFA was lower in men than in women even when marital status was taken into account. Within paranoid schizophrenia, this effect of gender was significant only in those of the patients whose AFA was higher than 30 years. It is suggested that there is no gender difference in AOI in early onset schizophrenia. In later onset, paranoid schizophrenia, the illness seems to manifest in women later than in men.
To establish predictors of insight in patients with schizophrenia with regard to symptoms severity, executive functioning, level of education, marital status, age, and number of hospitalizations.
Subjects and methods
A cross-sectional study was conducted on 60 consecutive outpatients with schizophrenia. Positive symptoms were established with 4-item Positive Symptom Ranking Scale (PSRS), and negative symptoms with Brief Negative Symptoms Assessment (BNSA). The level of insight was established with Self-Appraisal of Illness Questionnaire (SAIQ). Executive functions were established with Wisconsin card sorting test, and three verbal subtests from Wechler's Intelligence Test: information, similarities, and calculating. All neuropsychological tests were administered by psychologist educated in administration of these and other neuropsychological tools.
Results
Predictive statistical model identifies age and illness duration as negative, and higher level of education, and being married as a positive predictors of insight with 38.5% variance explained. Scores on subscales “Similarities” and “Calculating” had positive association with insight score. Model explains 24.7% of variance. When model was adjusted on alpha 5% level of concluding only three significant positive predictors appears: higher level of education, higher score on “Similarities” subscale, and being married. Model explains 38.5% of variance.
Conclusion
Level of education and marital status, among all other factors, have important impact on level of insight in patients with schizophrenia.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Challenging current ideas in mainstream scholarship on differences between female labour force participation in southern and north-western Europe and their impact on economic development, this article shows that in Portugal, neither marriage nor widowhood prevented women from participating in the labour market of mid-eighteenth-century. Our research demonstrates that marriage provided women with the resources they needed to work in various capacities in all economic sectors.
This article also argues that single Portuguese women had an incentive to work and did so mostly as wage earners. Finally, the comparison of our dataset on female occupations from tax records with other European cases calls for a revision of the literature and the development of a more nuanced picture of the north-south divide.
Leading up to the 2016 election, single women were heralded as the “hot” new constituency. With unmarried women posed to comprise approximately half of the population of adult women and 23% of the electorate (Traister 2016), pundits claimed that the rising number of single women could transform American politics. Building on this recent enthusiasm about single women, this study provides one of the first systematic analyses of how contemporary women's organizations represent single women by analyzing 1,021 comments that women's organizations submitted to rule makers between 2007 and 2013. Using automated text analyses and a series of statistical analyses, it shows that despite the rising numbers of American single women, women's organizations only very rarely explicitly refer to single women during their comment writing campaigns, preferring to highlight the experiences of married mothers instead. Moreover, it shows that the political context unexpectedly has little to no effect on the degree to which women's organizations focus on single women, possibly because they so rarely mention them at all. Altogether, the results suggest that for single women to become politically powerful, they will need more than just large numbers; they may also need niche organizations that can help them organize and articulate their broader policy needs.
The aim of this paper is to investigate the role that the marital status of children has in shaping the living arrangements of their widowed mothers and themselves and to explain the increase in the proportion of elderly widows living alone, which grew by 23.2% in the USA between 1970 and 1990. We propose a model where living arrangements are determined as the outcome of a game between the mother and her child, and where the fundamentals of the model depend on children's marital status. We estimate the model using 1970 data. We calculate the accuracy of the estimation and we obtain an excellent fit. Using the same measure of accuracy, the estimated model predicts that changes in the incomes of both the widow and her offspring and changes in the children's marital status generate more than the 83% of the increase in the number of widows living alone.
Older adults represent the highest proportion of gamblers (Ontario Lottery and Gaming Corporation [OLG], 2012). Unpartnered older adults may be more socially isolated and lonely (Dykstra & de Jong Gierveld, 2004), thus more likely to be at risk for problem gambling (McQuade & Gill, 2012). We examined whether gambling to socialize or from loneliness and going to the casino with friends/family mediate the relation between marital status and problem gambling. Data from a random sample of older adults at gambling venues across Southwestern Ontario indicated that gambling with family/friends and gambling due to loneliness mediated the relationship between marital status and problem gambling. Relative to those married, unpartnered older adults were less likely to gamble with family/friends, more likely to gamble due to loneliness, and had higher problem gambling. Prevention and treatment initiatives should examine ways to decrease loneliness and social isolation among older adults and offer alternative social activities.
The prevalence of overweight and obesity is growing rapidly in many countries. Socioeconomic inequalities might be important for this increase. The aim of this study was to determine associations of body mass index (BMI), overweight and obesity with educational level and marital status in Chinese twins. Participants were adult twins recruited through the Chinese National Twin Registry (CNTR), aged 18 to 79 years, and the sample comprised 10,448 same-sex twin pairs. Current height, weight, educational attainment, and marital status were self-reported. Regression analyses and structural equation models were conducted to evaluate BMI, overweight, and obesity associated with educational level and marital status in both sexes. At an individual level, both educational level and marital status were associated with higher BMI and higher risk of being overweight and obesity in men, while in women the effects of educational level on BMI were in the opposite direction. In within-Monozygotic (MZ) twin-pair analyses, the effects of educational level on BMI disappeared in females. Bivariate structural equation models showed that genetic factors and shared environmental confounded the relationship between education and BMI in females, whereas marital status was associated with BMI on account of significant positive unique environmental correlation apart in both sexes. The present data suggested that marital status and BMI were associated, independent of familiar factors, for both sexes of this study population, while common genetic and shared environmental factors contributed to education-associated disparities in BMI in females.
Aging is accompanied by cognitive decline that is escalated in older adults reporting extreme sleep duration. Social relationships can influence health outcomes and thus may qualify the association between sleep duration and cognitive function. The present study examines the moderating effects of marital status, household size, and social network with friends and relatives on the sleep–cognition association among older adults.
Methods:
Data (N = 4,169) came from the Social Isolation, Health, and Lifestyles Survey, a nationally representative survey of community-dwelling older Singaporeans (≥ 60 years). Sleep duration and social relationships were self-reported. Cognitive function was assessed with the Short Portable Mental Status Questionnaire.
Results:
Regression analysis revealed that the inverted U-shaped association between sleep duration and cognitive function was less profound among older adults who were married (vs. unmarried) and those who had stronger (vs. weaker) social networks. In contrast, it was more prominent among individuals who had more (vs. fewer) household members.
Conclusions:
Being married and having stronger social networks may buffer against the negative cognitive impact of extreme sleep duration. But larger household size might imply more stress for older persons, and therefore strengthen the sleep duration–cognitive function association. We discuss the potential biological underpinnings and the policy implications of the findings. Although our findings are based on a large sample, replication studies using objective measures of sleep duration and other cognitive measures are needed.
This study examined engagement in leisure activities among older adults, specifically focusing on how life transition factors in later life, including retirement and marital status, are associated with leisure activity engagement using a national sample of older American men and women. We conducted multiple regression analyses with a sample of 5,405 individuals (2,318 men; 3,087 women) from the Consumption and Activities Mail Survey, a supplementary sample of the Health and Retirement Study. We analysed activity engagement in each of four domains of leisure activities: mental, physical, social and religious. Retirement status was categorised into three groups: working (referent), completely retired and partly retired. Marital status was categorised into four groups: married (referent), divorced or separated, widowed and never married. We found an overall trend of a positive relationship between retirement and leisure activity engagement, which suggests that retirement provides a chance for older adults to participate in leisure activities after withdrawal from the labour force. The overall trend of a negative relationship between non-married status and leisure activity engagement suggests that the loss or absence of a spouse may serve as a barrier to participate in leisure activities. Nevertheless, variation among retirees and non-married individuals suggests future studies should compare completely and partly retired individuals or those who are widowed, divorced or separated, or never married to elucidate distinguishable leisure activity profiles.
Gender and age are the top two risk factors considered in pricing life insurance products. Although it is believed that mortality rates are also related to other factors (e.g. smoking, overweight, and especially marriage), data availability and marketing often limit the possibility of including them. Many studies have shown that married people (particularly men) benefit from the marriage, and generally have lower mortality rates than unmarried people. However, most of these studies used data from a population sample; their results might not apply to the whole population. In this study, we explore if mortality rates differ by marital status using mortality data (1975–2011) from the Taiwan Ministry of the Interior. In order to deal with the problem of small sample sizes in some marital status groups, we use graduation methods to reduce fluctuations in mortality rates. We also use a relational approach to model mortality rates by marital status, and then compare the proposed model with some popular stochastic mortality models. Based on computer simulation, we find that the proposed smoothing methods can reduce fluctuations in mortality estimates between ages, and the relational mortality model has smaller errors in predicting mortality rates by marital status. Analyses of the mortality data from Taiwan show that mortality rates differ significantly by marital status. In some age groups, the differences in mortality rates are larger between marital status groups than between smokers and non-smokers. For the issue of practical consideration, we suggest modifications to include marital status in pricing of life insurance products.
Being married reduces the mortality risk of older persons. More generally, living arrangements that include co-residence with a source of support and a close care-giver are associated with a lower mortality risk. We build a detailed typology of private and collective living arrangements, including marital status, and check its association with mortality risks, controlling for health status. Using administrative data from the population register, we identify the living arrangement of all individuals aged 65 years and over living in Belgium as at 1 January 2002, and their survival during the year 2002. Data on health status are extracted from the 2001 census. We use binary logistic regression with the probability to die as outcome and living arrangement, health, age and gender as covariates. Our results show that mortality is more closely associated with actual living arrangements than with marital status. This association is age and gender-specific and remains even at very old ages. Living with a spouse is confirmed to be beneficial for survival but in older age living alone becomes more favourable. Of all living arrangements, older persons living in religious communities experience the lowest mortality risk whereas those living in nursing homes experience the highest risk.
Despite evidence of increasing diversification of family structures, little is known regarding implications of marital and parental status for access to social support in later life. Using data from Statistics Canada’s 2007 General Social Survey, this study assessed the impact of marital and parental status intersections on social support among adults aged 60 and older (n = 11,503). Two-stage probit regression models indicated that among those who were currently married or separated/divorced, childless individuals were more likely to report instrumental (domestic, transportation) and emotional support from people outside the household. Conversely, among never-married or widowed older adults, being childless was associated with reduced domestic support but without differences in other support domains. Findings suggest that marital and parental status intersections are not uniformly positive, neutral, or negative regarding implications for extra-household social support. Future work should address complexities of these relationships in order to better understand rapidly changing family structures.
Marriage has been identified as a protective factor in relation to suicide among older adults. The current study aimed to investigate whether sense of belonging mediated the marital status–suicidal ideation relationship, and whether gender moderated the mediation model. It was hypothesized that the relationship between being widowed and lower levels of sense of belonging, and between lower levels of belonging and higher levels of suicidal ideation, would be stronger for older men than older women.
Methods:
A community sample of Australian men (n = 286) and women (n = 383) aged from 65 to 98 years completed the psychological subscale of the Sense of Belonging Instrument and the suicide subscale of the General Health Questionnaire.
Results:
The results supported the moderated mediation model, with gender influencing the marital status–sense of belonging relation. For men, widowhood was associated with lower levels of belongingness, whereas for women, marital status was unrelated to sense of belonging.
Conclusions:
It would appear crucial to develop and implement interventions which assist older men to find new ways to feel important and valued after the death of their spouse.