Does social activity decrease risk for institutionalization and mortality in older people?

OBJECTIVES: Social inactivity predicts adverse health events, but less is known about how different dimensions of social activity are related to health. The aim of this study was to investigate collective (e.g., cultural and organizational activities) and productive (e.g., helping others) social activity as predictors of risk for mortality and institutionalization in old age. METHOD: A total of 1,181 community-living people aged 65-84 years at baseline were interviewed face to face as part of the Evergreen project, in Jyväskylä, Finland in 1988. Time to institutionalization and mortality were analyzed in separate models for proportional hazard regression on mortality and competing risks analysis on institutionalization and mortality. RESULTS: At follow-up, approximately 17 years later, 22% of persons were institutionalized and 71% had died. When sociodemographics, health, functioning, and intensity of physical activity were controlled for, collective social activity reduced risk for mortality and initially for institutionalization although this latter effect diminished over time. DISCUSSION: Collective social activity may be associated with a reduced risk for mortality and institutionalization in older people. Further studies on the mechanisms underlying the association between social activity and health are needed.

Cohort differences in health, functioning and physical activity in the young-old Finnish population.

BACKGROUND AND AIMS: A mixed picture emerges from the international literature about secular and cohort changes in the health and functioning of older adults. We conducted a repeated population based cross-sectional study to determine trends in health, functioning and physical activity in the young old Finnish population. METHODS: Representative samples of community-dwelling people aged 65-69 years in 1988 (n=362), 1996 (n=320) and 2004 (n=292) were compared in socio-economic status, self-rated health, chronic diseases, memory problems, ability to carry out instrumental activities of daily living, physical activity, and five-year mortality. RESULTS: Significant improvement in all the investigated modalities, except that of chronic diseases, was observed in the newer cohorts. In logistic regression analysis, after controlling for socioeconomic status and gender, cohort effects remained significant for memory problems, IADL difficulties and physical activity. Cox regression analyses showed significant improvement in survival when later cohorts were compared with the earlier ones. CONCLUSIONS: This study provides evidence of improving levels of socio-economic status, self-rated health, functioning, physical activity, and lower risk of mortality in the newer cohorts of the Finnish young-old, but this was not accompanied by a parallel diminution in chronic diseases.

Mental well-being: a 16-year follow-up among older residents in Jyväskylä.

This study investigated changes in perceived depression, anxiety and loneliness during a 16-year follow-up among elderly Jyväskylä residents born in 1914-1923. A further concern was with how perceived atmosphere in the formative environment was reflected in depression, anxiety and loneliness in old age. The first phase of the study took place in 1988 when interviews were conducted with 635 persons (241 men and 394 women). Depression and anxiety were assessed using the Finnish modified version of Beck's 13-item depression scale (RBDI), which was completed fully by 74% of the interviewees. Loneliness was assessed with a single four category item. In the second phase of the study in 1996, interviews were conducted with 410 persons, of whom 94% filled the RBDI questionnaire. In the third phase in 2004, the number of interviewees was 220 and the response rate 82%. There were no significant changes in the number of people with depressive symptomatology and anxiety, except in 1996 when the proportion of men with mild and moderate depression almost doubled. The number of men and women who felt lonely increased significantly during the 16-year follow-up. People who said they were lonely also had more depression and anxiety than others. People who had grown up in warm and safe environment were the most balanced mentally. The presence or absence of warmth and safety in the formative environment is reflected in mental well-being even at a very old age.

Social relations in older adults: Secular trends and longitudinal changes over a 16-year follow-up.

Drawing on population studies in Finland, we investigated secular trends and longitudinal changes in social relations. The cohort comparison data comprised on 974 persons aged 65-69 years from three cohorts born between 1919 and 1939 and interviewed in 1988, 1996 and 2004. Longitudinal analyses were conducted for 635 persons aged 65-74 years over a 16-year follow-up at three measurement points. Social relations were studied on the basis of frequency seeing one's offspring, perceptions of the sufficiency of these contacts, and by asking whom the participants considered as their closest person and how often and in how many tasks they helped someone. The cohort comparisons showed that the frequency of seeing one's offspring had decreased in the most recent cohort and that the number of contacts was considered more inadequate. Longitudinal analyses showed that although the proportion of children as the closest persons increased, meetings with them became fewer. Helping others was more common in the last cohort, but in the longitudinal analyses it decreased with age. Finnish people at retirement help others more than before, but they do not meet their offspring as often as they would like. Measures are needed for action to promote intergenerational exchange in older adults on both individual and societal level.

Perceived social support and mortality in older people.

OBJECTIVES: This study examines the effect of perceived social support on all-cause mortality at a 10-year follow-up as well as the plausible mediating factors in this association. METHODS: We measured perceived social support in 206 Finnish men and women aged 80 years old by using the Social Provision Scale, which consists of six dimensions: attachment, social integration, opportunity for nurturance, reassurance of worth, reliable alliance, and guidance. RESULTS: By using a theoretical framework that divided perceived social support into assistance-related and non-assistance-related support, we found that the risk of death was almost 2.5 times higher in women in the lowest tertile of non-assistance-related social support (comprising infrequent experiences of reassurance of worth, emotional closeness, sense of belonging and opportunity for nurturance) than in women in the highest tertile. The risk remained strong even when we controlled for the indicators of baseline sociodemographics and psychological and physiological health and functioning. Among men, none of the perceived social support dimensions showed a significant association with mortality. DISCUSSION: The results of this study present a challenge for society to find and develop new social innovations and interventions in order to promote a sense of emotional social support in older people, thereby contributing to their health and welfare.

Experienced health in older women with rheumatoid arthritis.

This study explored how older women with chronic illness and disability experience their own health. Data were collected in in-depth interviews with ten older women with rheumatoid arthritis. Data analysis and interpretation was carried out within a phenomenological- hermeneutic frame of understanding, which revealed five major themes: health as coping with everyday life, health as freedom, health as absence of inconvenience, health as togetherness and health as mental well-being. For older people with chronic illness and disability, good health found expression in general well-being. It was perceived as a state of equilibrium that the respondents sought to maintain through their own active choices.

Depressive symptoms in late life: a 10-year follow-up.

The objectives of this study were to describe the changes occurring in depressive symptomatology over a 10-year period among 75-year-old residents of Jyväskylä, Finland. It also addressed the question of whether the mood disturbances detected were a permanent phenomenon or whether they had a more episodic nature. In addition, various associations with and predictors of low mood were studied. Depressive symptoms were screened with the Center for Epidemiologic Studies Depression Scale (CES-D).The cut-off point of 16 was used to distinguish depressed individuals from those classified as non-depressed. A baseline study was carried out in 1989 (n = 337). A 5-year follow-up was carried out with the same cohort in 1994 (n = 222) and a 10-year follow-up in 1999 (n = 131). The permanent versus episodic nature of depressed mood was studied by comparing the three-wave longitudinal depression score findings of different individuals. In the follow-up settings, multivariate logistic regression models adjusted for sex were used to find predictors of depressiveness. Looking at the prevalence of depressiveness we found a statistically significant increase in the figures for women particularly from age 80 to 85 years. The much lower mean scores recorded for men in earlier measurements reached the same level as for women at age 85 years. Loneliness, a large number of chronic diseases, poor self-rated health, poor functional capacity, poor vision and perceived negative changes in life predicted depressive symptomatology. It seemed that minor depression among the elderly was most typically an episodic phenomenon.

The impact of structural and functional characteristics of social relations as determinants of functional decline.

OBJECTIVES: This study examines whether aspects of social relations at baseline are related to functional decline at 5-year follow-up among nondisabled old men and women. METHODS: The investigation is based on baseline and follow-up data on 651 nondisabled 75-year-old persons in Jyväskylä (Finland) and Glostrup (Denmark). The analyses are performed separately for men and women. Possible selection problems were considered by using three outcome measures: first, functional decline among the survivors (n = 425); second, functional decline, including death, assuming that death is part of a general decline pattern (n = 565); and third, mortality (n = 651). Social relations were measured at baseline by several items focusing on the structure and function of the social network. RESULTS: In men, no weekly telephone contact was related to functional decline and mortality. Among women, less than weekly telephone contact, no membership in a retirement club, and not sewing for others were significantly related to functional decline and mortality. The associations were stronger when the dead were included in the outcome measure. DISCUSSION: The results point to the importance of social relations in the prevention of functional decline in older adults.

Depressed mood: changes during a five-year follow-up in 75-year-old men and women in three Nordic localities.

The aim of the study was to look firstly at the changes that occurred in depressive symptomatology over a 5-year period among originally 75-year-old residents in three Nordic localities: Glostrup in Denmark, Göteborg in Sweden and Jyväskylä in Finland, and secondly, at some selected variables if they predicted depressed mood in this study. The study is a part of a 5-year follow-up of the Nordic comparative NORA study on functional capacity. A 5-year follow-up was carried out with the survivors in 1994. Depressive symptomatology was assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). The number of survivors was 277 in Glostrup, 226 In Göteborg and 250 in Jyväskylä. The proportion of respondents with depressive symptoms was highest in Jyväskylä; this was true for both men and women at baseline and at the follow-up. In the baseline study, minor depression was more common among women than men in all three localities, and at the follow-up in Göteborg and Glostrup. In the follow-up study, men and women in Jyväskylä scored higher means on the CES-D scale than did the groups in Göteborg and Glostrup. During the follow-up, there was no significant change in the mean score describing depressed mood (CES-D total scale) in any locality in either men or women. The mean score of those who died during the follow-up period differed significantly from the score of survivors among women in Göteborg and in Glostrup. The most clear predictors for depressed mood in this Nordic 5-year follow-up study were chronic diseases, feelings of loneliness, and self-rated health.

Changes in social relations in old age. Are they influenced by functional ability?

The aims of this article were to describe changes in social relations from ages 75 to 80, and analyze whether changes in social relations are influenced by functional ability at age 75. The study includes data from the NORA follow-up study of 75-80 year-old men and women in Jyväskylä (Finland), Göteborg (Sweden) and Glostrup (Denmark). The present analyses include the 743 persons who participated in both studies and who answered the questions about social relations. The structure of social relations was measured by: 1) frequency of contacts with children, grand/greatgrandchildren, relatives, close friends, acquaintances, and neighbors; 2) diversity of social relations (number of types of social contacts); 3) telephone contacts; and 4) social participation. The function of social relations was measured by instrumental social support. Functional ability was measured by tiredness and need for help in Physical Activities of Daily Living (PADL). Depressive symptoms, living alone and locality were included as covariates in the multivariate analyses. There were large changes in social relations in old age, but the changes included widely varying patterns of losses and gains among the participants. Women who felt tired in their daily activities had more sustained little contact with children [OR=4.2 (1.4-12.1)] and more sustained little diversity in social relations [OR=2.2 (0.95-5.3)]. Both men and women in need of help had more sustained little diversity in social relations compared to the well-functioning persons [men: OR=4.4 (1.3-15.0); women: OR=3.0 (0.93-9.6)].