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Depressive Symptoms, Cognitive Functioning, Frailty, Multimorbidity and Loneliness among Older Population

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Aging".

Deadline for manuscript submissions: closed (30 April 2022) | Viewed by 32449

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Prof. Dr. André Hajek

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Guest Editor

Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Interests: gerontology; geriatrics; quality of life; loneliness
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Hans-Helmut König

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Guest Editor

Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Interests: health economics; health services research; quality of life; old age; public mental health
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

There is ongoing demographic aging taking place in various high-income countries. Since there is a strong positive association between age and, among other things, multiple chronic diseases, dementia, and frailty, it is expected that the number of individuals suffering from these conditions will rise markedly over the next few decades.

Moreover, the geographical distance to family members gradually increases and many individuals lose their friends and relatives in old age. Furthermore, social distancing is an important issue due to the COVID-19 pandemic. All of these factors are associated with loneliness, social isolation, and depressive symptoms in late life. Thus far, limited evidence has been obtained regarding the link between factors such as cognitive functioning, frailty, or multimorbidity and depressive symptoms or loneliness in old age. Therefore, the aim of this Special Issue is to collect novel findings in this research area. Interdisciplinary research is particularly welcome.

We particularly welcome the submission of original research articles, systematic reviews, meta-analyses, and short communications on any of these topics.

Dr. André Hajek
Prof. Dr. Hans-Helmut König
Guest Editors

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Keywords

multimorbidity;
frailty;
depressive symptoms;
depression;
mental health;
cognitive functioning;
loneliness;
social isolation;
dementia;
cognitive decline;
multiple chronic diseases;
social exclusion.

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Published Papers (7 papers)

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Research

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11 pages, 860 KiB

Open AccessArticle

Relationship between Frailty and Depression in a Population from North-Eastern Romania

by Alexandra Maștaleru, Irina Mihaela Abdulan, Ramona Ștefăniu, Nicoleta Lefter, Ioana Alexandra Sandu, Anca Iuliana Pîslaru, Maria Magdalena Leon-Constantin, Ioana Dana Alexa and Adina Carmen Ilie

Int. J. Environ. Res. Public Health 2022, 19(9), 5731; https://doi.org/10.3390/ijerph19095731 - 8 May 2022

Cited by 9 | Viewed by 2485

Abstract

(1) Background: In the older population, depression often affects people with chronic medical illnesses, cognitive impairment, or disability. Frailty is another important issue affecting older adults, being difficult to clinically distinguish from frailty in advanced old age. Well-designed interventional studies and clinical strategies targeting both frailty and depression are rare or nonexistent. (2) Methods: We realized a retrospective study in which we included a total of 411 patients that were admitted to the Geriatric Clinic from “Dr. C. I. Parhon” Hospital from Iasi for a period of 13 months. The aim of our study was to investigate the relationship between depression and frailty in a geriatric population due to the fact that the quality of life is negatively influenced by both frailty and depression. (3) Results: The prevalence of the depressive symptoms screened by the GDS-15 was 66.7%, with women being more depressed than men. Furthermore, an obvious relationship between depression and the dependence degree in performing daily activities has been observed. In addition, the mean MMSE score decreased with an increasing degree of depression. (4) Conclusions: Our study demonstrates the association between frailty and depression, one of them being a risk factor in the development of the other. A poor acknowledgment of the problem and an underdiagnosis of these conditions are important public health concerns due to the high healthcare costs. Thus, an active primary prevention would be imperiously needed in order to diagnose frailty and depression at an early stage, increasing the quality of life of the elderly and also their successful aging. Full article

(This article belongs to the Special Issue Depressive Symptoms, Cognitive Functioning, Frailty, Multimorbidity and Loneliness among Older Population)

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14 pages, 356 KiB

Open AccessArticle

Predictors of Cognitive Function in Community-Dwelling Older Adults by Age Group: Based on the 2017 National Survey of Older Korean Adults

by Jinheum Kim and Eunjeong Cha

Int. J. Environ. Res. Public Health 2021, 18(18), 9600; https://doi.org/10.3390/ijerph18189600 - 12 Sep 2021

Cited by 4 | Viewed by 2475

Abstract

Owing to a growing older adult population, dementia is emerging as an important health issue. Given that maintaining cognitive functions is crucial for the prevention of dementia, this study aimed to identify the predictors of cognitive function in community-dwelling older adults, through a secondary data analysis of the 2017 National Survey of Older Koreans. A total of 9836 participants were classified into three age groups—young-old (65–74 years), old-old (75–84 years), and oldest-old (≥85 years)—and were separately analyzed using multiple linear regression models. The final model explained 28.0%, 35.0%, and 37.0% of variance in cognitive function in the three age groups, respectively. The most potent predictors of cognitive function in the young-old were electronic device-based activities, instrumental activities of daily living (IADL), and nutrition management; the predictors for the old-old group were electronic device-based activities, IADL, and dementia screening, and those for the oldest-old group were frequency of contact with acquaintances, traveling, and religion. Thus, age group-specific interventions are needed to effectively promote cognitive function among older adults. Digital literacy education, use of community-based elderly welfare programs, opportunities for social interactions, and physical activities can help older adults in maintaining a functional status and muscle strengthening. Full article

(This article belongs to the Special Issue Depressive Symptoms, Cognitive Functioning, Frailty, Multimorbidity and Loneliness among Older Population)

9 pages, 371 KiB

Open AccessArticle

Prevalence of High Resilience in Old Age and Association with Perceived Threat of COVID-19—Results from a Representative Survey

by Elena Caroline Weitzel, Margrit Löbner, Susanne Röhr, Alexander Pabst, Ulrich Reininghaus and Steffi G. Riedel-Heller

Int. J. Environ. Res. Public Health 2021, 18(13), 7173; https://doi.org/10.3390/ijerph18137173 - 5 Jul 2021

Cited by 20 | Viewed by 3507

Abstract

Little is known about resilience in old age and its manifestation during the COVID-19 pandemic. This study aims to estimate the prevalence of high resilience in the German old age population. We further examine the socio-demographic correlates and whether high resilience reflects on older adults’ perception of the threat posed by COVID-19. The data were derived from a representative telephone survey of n = 1005 older adults (≥65 years) during the first COVID-19 lockdown. Assessments included socio-demographic variables, the perceived threat of COVID-19, and high resilience (Brief Resilience Scale; cutoff: ≥4.31). The association between high resilience and threat from COVID-19 was analyzed using ordinal logistic regression. The study sample had a mean age (SD) of 75.5 (7.1) years, and n = 566 (56.3%) were female. The estimated prevalence of high resilience was 18.7% (95% CI = [16.3; 21.2]). High resilience was more prevalent in the younger age group and participants with higher education levels. High resilience was significantly associated with a lower perception of threat from COVID-19. The results of the representative survey in the German old age population showed that one out of five adults aged 65 years and older had high resilience. Older adults with high resilience tended to feel less threatened by COVID-19. Further research on resilience in old age is needed to support vulnerable groups in the context of care. Full article

(This article belongs to the Special Issue Depressive Symptoms, Cognitive Functioning, Frailty, Multimorbidity and Loneliness among Older Population)

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12 pages, 724 KiB

Open AccessArticle

The Role of Social Isolation and the Development of Depression. A Comparison of the Widowed and Married Oldest Old in Germany

by Franziska Förster, Melanie Luppa, Alexander Pabst, Kathrin Heser, Luca Kleineidam, Angela Fuchs, Michael Pentzek, Hanna Kaduszkiewicz, Carolin van der Leeden, André Hajek, Hans-Helmut König, Anke Oey, Birgitt Wiese, Edelgard Mösch, Dagmar Weeg, Siegfried Weyerer, Jochen Werle, Wolfgang Maier, Martin Scherer, Michael Wagner and Steffi G. Riedel-Heller Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2021, 18(13), 6986; https://doi.org/10.3390/ijerph18136986 - 29 Jun 2021

Cited by 21 | Viewed by 3901

Abstract

Widowhood is common in old age, can be accompanied by serious health consequences and is often linked to substantial changes in social network. Little is known about the impact of social isolation on the development of depressive symptoms over time taking widowhood into account. We provide results from the follow-up 5 to follow-up 9 from the longitudinal study AgeCoDe and its follow-up study AgeQualiDe. Depression was measured with GDS-15 and social isolation was assessed using the Lubben Social Network Scale (LSNS-6). The group was aligned of married and widowed people in old age and education through entropy balancing. Linear mixed models were used to examine the frequency of occurrence of depressive symptoms for widowed and married elderly people depending on the risk of social isolation. Our study shows that widowhood alone does not lead to an increased occurrence of depressive symptoms. However, “widowed oldest old”, who are also at risk of social isolation, have significantly more depressive symptoms than those without risk. In the group of “married oldest old”, women have significantly more depressive symptoms than men, but isolated and non-isolated do not differ. Especially for people who have lost a spouse, the social network changes significantly and increases the risk for social isolation. This represents a risk factor for the occurrence of depressive symptoms. Full article

(This article belongs to the Special Issue Depressive Symptoms, Cognitive Functioning, Frailty, Multimorbidity and Loneliness among Older Population)

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11 pages, 342 KiB

Open AccessArticle

Social Isolation and Loneliness during COVID-19 Lockdown: Associations with Depressive Symptoms in the German Old-Age Population

by Felix Müller, Susanne Röhr, Ulrich Reininghaus and Steffi G. Riedel-Heller

Int. J. Environ. Res. Public Health 2021, 18(7), 3615; https://doi.org/10.3390/ijerph18073615 - 31 Mar 2021

Cited by 86 | Viewed by 7264

Abstract

Lockdowns during the COVID-19 pandemic increase the risk of social isolation and loneliness, which may affect mental wellbeing. Therefore, we aimed to investigate associations between social isolation and loneliness with depressive symptoms in the German old-age population during the first COVID-19 lockdown. A representative sample of randomly selected individuals at least 65 years old (n = 1005) participated in a computer-assisted standardized telephone interview in April 2020. Sociodemographic data, aspects of the personal life situation, attitudes towards COVID-19 and standardized screening measures on loneliness (UCLA 3-item loneliness scale), depression (Brief Symptom Inventory/BSI-18), and resilience (Brief Resilience Scale/BRS) were assessed. Associations were inspected using multivariate regression models. Being lonely, but not isolated (β = 0.276; p < 0.001) and being both isolated and lonely (β = 0.136; p < 0.001) were associated with higher depressive symptoms. Being isolated, but not lonely was not associated with depressive symptoms. Thus, the subjective emotional evaluation, i.e., feeling lonely, of the social situation during lockdown seems more relevant than the objective state, i.e., being isolated. Normal (β = −0.203; p < 0.001) and high resilience (β = −0.308; p < 0.001) were associated with lower depressive symptoms across groups. Therefore, strengthening coping skills may be a support strategy during lockdowns, especially for lonely older individuals. Full article

(This article belongs to the Special Issue Depressive Symptoms, Cognitive Functioning, Frailty, Multimorbidity and Loneliness among Older Population)

Review

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12 pages, 467 KiB

Open AccessReview

Multimorbidity, Loneliness, and Social Isolation. A Systematic Review

by André Hajek, Benedikt Kretzler and Hans-Helmut König

Int. J. Environ. Res. Public Health 2020, 17(22), 8688; https://doi.org/10.3390/ijerph17228688 - 23 Nov 2020

Cited by 57 | Viewed by 5443

Abstract

No systematic review has appeared so far synthesizing the evidence regarding multimorbidity and loneliness, social isolation, or social frailty. Consequently, our aim was to fill this gap. Three electronic databases (PubMed, PsycINFO, and CINAHL) were searched in our study. Observational studies examining the link between multimorbidity and loneliness, social isolation, and social frailty were included, whereas disease-specific samples were excluded. Data extraction included methods, characteristics of the sample, and the main results. A quality assessment was conducted. Two reviewers performed the study selection, data extraction, and quality assessment. In sum, eight studies were included in the final synthesis. Some cross-sectional and longitudinal studies point to an association between multimorbidity and increased levels of loneliness. However, the associations between multimorbidity and social isolation as well as social frailty remain largely underexplored. The quality of the studies included was rather high. In conclusion, most of the included studies showed a link between multimorbidity and increased loneliness. However, there is a lack of studies examining the association between multimorbidity and social isolation as well as social frailty. Future studies are required to shed light on these important associations. This is particularly important in times of the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Depressive Symptoms, Cognitive Functioning, Frailty, Multimorbidity and Loneliness among Older Population)

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Other

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12 pages, 658 KiB

Open AccessSystematic Review

Informal Caregiving, Loneliness and Social Isolation: A Systematic Review

by André Hajek, Benedikt Kretzler and Hans-Helmut König

Int. J. Environ. Res. Public Health 2021, 18(22), 12101; https://doi.org/10.3390/ijerph182212101 - 18 Nov 2021

Cited by 45 | Viewed by 6095

Abstract

Background: Several empirical studies have shown an association between informal caregiving for adults and loneliness or social isolation. Nevertheless, a systematic review is lacking synthesizing studies which have investigated these aforementioned associations. Therefore, our purpose was to give an overview of the existing evidence from observational studies. Materials and Methods: Three electronic databases (Medline, PsycINFO, CINAHL) were searched in June 2021. Observational studies investigating the association between informal caregiving for adults and loneliness or social isolation were included. In contrast, studies examining grandchild care or private care for chronically ill children were excluded. Data extractions covered study design, assessment of informal caregiving, loneliness and social isolation, the characteristics of the sample, the analytical approach and key findings. Study quality was assessed based on the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Each step (study selection, data extraction and evaluation of study quality) was conducted by two reviewers. Results: In sum, twelve studies were included in our review (seven cross-sectional studies and five longitudinal studies)—all included studies were either from North America or Europe. The studies mainly showed an association between providing informal care and higher loneliness levels. The overall study quality was fair to good. Conclusion: Our systematic review mainly identified associations between providing informal care and higher loneliness levels. This is of great importance in assisting informal caregivers in avoiding loneliness, since it is associated with subsequent morbidity and mortality. Moreover, high loneliness levels of informal caregivers may have adverse consequences for informal care recipients. Full article

(This article belongs to the Special Issue Depressive Symptoms, Cognitive Functioning, Frailty, Multimorbidity and Loneliness among Older Population)

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