Adults In England Research Articles

The medical impact of hypochondroplasia by age among adults in England between 1998 and 2019: a matched cohort study using electronic medical records from the clinical practice research datalink

The medical impact of hypochondroplasia by age among adults in England between 1998 and 2019: a matched cohort study using electronic medical records from the clinical practice research datalink

Falls and subsequent cognitive function in older adults in England and the USA, 2010-2020: a population-based, cross-nationally harmonized, longitudinal study.

The understanding of the long-term cognitive consequences of falls remains insufficient. Our research aims to explore the association between falls and both global and domain-specific cognitive decline, utilizing nationally representative aging cohorts. We studied 13,652 individuals from the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS). Falls were assessed based on self-reported incidents, categorized as no falls, a single fall, and multiple falls. Global cognitive z scores were calculated based on memory (immediate and delayed recall tests), executive function (animal fluency, serial sevens, and counting-backward tests), and orientation (date orientation test). Linear mixed-effects models examined associations between falls and cognitive outcomes after adjusting for potential confounders. Individuals with a single fall (pooled β = -0.006; 95% CI, -0.012 to -0.001; P = 0.033) and those with multiple falls (pooled β = -0.021; 95% CI, -0.026 to -0.015; P <0.001) experienced a faster decline in global cognitive z scores compared to those with no falls. Similar patterns were observed across memory, executive function, and orientation. In this combined cohort study, including samples from ELSA and HRS, we discerned a marked association between the falls and both global and domain-specific cognitive decline.

Can social prescribing reach patients most in need? Patterns of (in)equalities in referrals in a representative cohort of older adults in England.

Social prescribing (SP) is a mechanism of care referring people to non-clinical forms of support and services in local communities to improve health and wellbeing. But there is much contention over whether SP is provided disproportionately more to individuals who are less disadvantaged. A comprehensive analysis of who is receiving SP from both medical and non-medical referral routes has never been undertaken. We used data from 7283 adults aged 50+ in the English Longitudinal Study of Ageing (ELSA), incorporating novel questions on SP into Wave 10. Multiple logistic regression models were used to explore predictors of self-reported referrals to SP. A total of 495 adults (6.8%) reported receiving an SP referral and 435 (88%) accepted. Referrals were more likely among older adults (odds ratio (OR) = 1.02, confidence interval (CI) = 1.01-1.03), those with chronic pain (OR = 1.78, CI = 1.40-2.27), those who were lonely (OR = 2.20, CI = 1.63-2.97), those from the lowest wealth tertile (OR = 1.59, CI = 1.17-2.18) and those receiving benefits (OR = 2.02, CI = 1.52-2.69). Diagnosed psychiatric conditions and depressive symptoms, sedentary behaviours, cardiovascular conditions, diabetes, and physical inactivity predicted referrals only in minimally adjusted models. But those with multiple long-term conditions were more likely to be referred (OR = 2.02, CI = 1.00-4.08). There is promising initial evidence that SP referrals are occurring among older adults in England, with high uptake among those referred. Promisingly, those with the highest socio-economic need and most long-term health conditions particularly appear to be receiving support. Mental health appears more of a secondary rather than a primary referral predictor.

Early impact of RSV vaccination in older adults in England

Early impact of RSV vaccination in older adults in England

The association of loneliness and social isolation with multimorbidity over 14 years in older adults in England: A population-based cohort study.

Previous longitudinal studies have linked multimorbidity to loneliness (feeling alienated) and social isolation (having reduced social contact). However, the nature of these associations over time is unclear. To examine bidirectional associations of multimorbidity with loneliness and social isolation over a 14-year follow-up in a nationally representative cohort of adults aged ≥ 50 years. This retrospective cohort study used seven waves of data (collected between 2004/2005 and 2018/2019) from adults in the English Longitudinal Study of Ageing. Multimorbidity was defined as the presence of ≥2 long-term conditions. Loneliness was measured using the 3-item University of California Los Angeles (UCLA) scale. Social isolation was derived based on cohabitation status, frequency of contact with children, relatives, and friends, and social organisation membership. We used Cox proportional hazards models adjusted for social isolation or loneliness, demographic and health behaviour variables. The cohort consisted of 6031 adults with baseline and follow-up data on loneliness, social isolation, multimorbidity, and other covariates. Loneliness was associated with increased risk of incident multimorbidity [aHR (95 % CI): 1.38 (1.15-1.65)], whereas social isolation was not [aHR (95 % CI): 0.97 (0.81-1.16)]. Multimorbidity was associated with increased risk of incident loneliness [aHR (95 % CI): 1.55 (1.30-1.84)], but not significantly associated with subsequent risk of incident social isolation [aHR (95 % CI): 1.09 (0.92-1.28)]. An independent bidirectional association exists between loneliness and multimorbidity. Interventions targeting loneliness may prevent or delay multimorbidity and also improve wellbeing for people with multimorbidity.

Pornography Use Among Adults in Britain: A Qualitative Study of Patterns of Use, Motivations, and Stigma Management Strategies.

Pornography use is common but stigmatized. In this study, we present a qualitative analysis of the patterns of, and motivations for, using pornography and how the stigma of using pornography manifests in participants' accounts. We draw on Meisenbach's (2010) theory of stigma management communication (SMC) to deepen our understanding of how participants managed potential stigma. Data come from 40 semistructured interviews with a diverse sample of adults from across Britain (aged 18-64years) on the role of digital technologies in their sexual lives. Despite not being a criterion for recruitment, all participants except six women had used pornography and 18 were regular users at time of interview. Pornography was used primarily to facilitate arousal during solo masturbation, and also for mood control, "me time," or exploration of one's sexual identity. Some participants also used pornography with a partner to facilitate arousal and experimentation. An understanding of pornography use as stigmatized was evident in participants' accounts. In terms of SMC theory, "avoiding" strategies were most commonly employed including: hiding pornography use from others; distancing oneself from the stigma of pornography use; and making favorable comparisons between oneself and other users. Other less frequently employed strategies included: "denying" the existence of stigma, reducing the stigma's offensiveness through "minimization" (emphasizing that one's pornography use does not harm others), and "transcendence" (highlighting that pornography use can be a means to a valuable end). The stigma surrounding pornography use may act as a barrier to education interventions addressing pornography and seeking help for problematic use.

Assessing and ensuring fidelity of the nationally implemented English NHS diabetes prevention programme: lessons learned for the implementation of large-scale behaviour change programmes

This article consists of a citation of a published article describing research funded by the Health and Social Care Delivery Research programme under project number 16/48/07, and is provided as as part of the complete record of research outputs for this project. The original publication is available at: https://doi.org/10.1080/21642850.2022.2077205 Background Health services interventions are typically more effective in randomised controlled trials than in routine healthcare. One explanation for this ‘voltage drop’, i.e. reduction in effectiveness, is a reduction in intervention fidelity, i.e. the extent to which a programme is implemented as intended. This article discusses how to optimise intervention fidelity in nationally implemented behaviour change programmes, using as an exemplar the National Health Service Diabetes Prevention Programme (NHS-DPP); a behaviour change intervention for adults in England at increased risk of developing Type 2 diabetes, delivered by four independent provider organisations. We summarise key findings from a thorough fidelity evaluation of the NHS-DPP assessing design (whether programme plans were in accordance with the evidence base), training (of staff to deliver key intervention components), delivery (of key intervention components), receipt (participant understanding of intervention content), and highlight lessons learned for the implementation of other large-scale programmes. Results NHS-DPP providers delivered the majority of behaviour change content specified in their programme designs. However, a drift in fidelity was apparent at multiple points: from the evidence base, during programme commissioning, and on to providers’ programme designs. A lack of clear theoretical rationale for the intervention contents was apparent in design, training, and delivery. Our evaluation suggests that many fidelity issues may have been less prevalent if there was a clear underpinning theory from the outset. Conclusion We provide recommendations to enhance fidelity of nationally implemented behaviour change programmes. The involvement of a behaviour change specialist in clarifying the theory of change would minimise drift of key intervention content. Further, as loss of fidelity appears notable at the design stage, this should be given particular attention. Based on these recommendations, we describe examples of how we have worked with commissioners of the NHS-DPP to enhance fidelity of the next roll-out of the programme. Funding This publication was funded by the Health and Social Care Delivery Research programme as a part of award number 16/48/07. This article reports on one component of the research award Evaluating the NHS Diabetes Prevention Programme (NHS DPP): the DIPLOMA research programme (Diabetes Prevention Long term Multimethod Assessment). For more information about this research please view the award page [https://fundingawards.nihr.ac.uk/award/16/48/07] DOI https://doi.org/10.1080/21642850.2022.2077205

Trends in single and multiple non-combustible nicotine product use: a population study in England.

Non-combustible nicotine products are commonly used and are used alone or in combination. This study aimed to provide up-to-date estimates of the prevalence of single and multiple non-combustible nicotine product use among adults in England in 2023 and to estimate trends between 2013 and 2023. Data were drawn from repeated cross-sectional surveys of adults (≥18y) in England conducted between January 2013 and December 2023. Single non-combustible nicotine product use was defined as current use of one of: nicotine replacement therapy (NRT), e-cigarettes, nicotine pouches, or heated tobacco products. Multiple use was defined as current use of two or more of these products. We used logistic regression to estimate monthly time trends in the prevalence of single and multiple product use across the study period and provided descriptive data by smoking status and sociodemographic characteristics. The proportion of adults using any single non-combustible nicotine product increased non-linearly from 5.4% (95%CI=5.1-5.9) in January 2013 to 14.3% (13.6-15.0) in December 2023. The prevalence of multiple non-combustible nicotine product use was 0.7% (95% CI 0.6-0.9) in January 2013 and stable until 2020 before increasing to 1.4% by December 2023 (95% CI 1.2-1.7). Most single and multiple non-combustible nicotine product users were individuals who currently (44.7% [43.1-47.6] and 70.6% [64.2-76.1], respectively) or had formerly smoked (41.2% [39.1-43.4 and 25.5% [19.4-31.5). Use of non-combustible nicotine products has increased substantially among adults in England over the past decade. While most use only one product, a growing minority (predominantly individuals who currently smoke) use multiple non-combustible nicotine products. Over recent years, the proportion of adults in England reporting single and multiple non-combustible nicotine product use has risen, with the prevalence of single product use almost tripling and multiple product use doubling. It will be important to continue monitoring product use patterns as the market continues to evolve rapidly. There is also a need for further research to understand how different patterns of non-combustible nicotine use may affect people's motivation to stop smoking or success in quitting.

Smoking, and to a lesser extent non-combustible nicotine use, is associated with higher levels of alcohol consumption and risky drinking

This study aimed to estimate differences in alcohol consumption, receipt of alcohol brief intervention, and alcohol reduction attempts by smoking status and use of non-combustible nicotine (including e-cigarettes, nicotine replacement therapy, heated tobacco products, or nicotine pouches). Data were from a representative household survey of adults in England (n = 188,878). Participants who reported former or current smoking scored approximately 1 point higher, on average, on the AUDIT-C (which measures alcohol consumption) than those who had never regularly smoked (Badj=0.97 [95%CI 0.93–1.00] and 0.92 [0.87–0.96], respectively) and had double the odds of risky drinking (AUDIT-C ≥ 5: ORadj=2.04 [1.98–2.10] and 2.03 [1.97–2.10], respectively), while differences for those who did versus did not use non-combustible nicotine use were less pronounced (AUDIT-C: Badj=0.14 [0.08–0.21]; AUDIT-C ≥ 5: ORadj=1.09 [1.04–1.13]). Among participants who engaged in risky drinking, those who smoked (vs. not) were more likely to report receiving alcohol brief interventions, and those attempting to quit smoking (vs. not) were more likely to report alcohol reduction attempts. Overall, combustible and - less so - non-combustible nicotine use is associated with higher levels of alcohol consumption and risky drinking.

Trends and patterns of dual use of combustible tobacco and e-cigarettes among adults in England: A population study, 2016-2024.

E-cigarettes are frequently used by people who smoke. This study measured how the prevalence and patterns of smoking and vaping ('dual use') in England have changed as the vaping market has rapidly evolved. Representative monthly cross-sectional survey, July 2016 to April 2024. England. 128 588 adults (≥18y). Logistic regression estimated associations between survey wave and dual use. Descriptive statistics were used to analyse patterns of smoking and vaping, overall and by sociodemographic, smoking and vaping characteristics and harm perceptions of e-cigarettes vs. cigarettes. Across the period, the overall prevalence of dual use increased non-linearly from 3.5% to 5.2% of adults [prevalence ratio (PR) = 1.49 (1.25-1.76)]. Among adults who smoked, the proportion who also vaped was relatively stable up to mid-2021, at an average of 18.6% between July 2016 and May 2021, then increased rapidly to 34.2% by April 2024 [PR = 1.76 (1.48-2.09)]. This increase was greatest at younger ages [e.g. from 19.6% to 59.4% among 18- to 24-year-olds; PR = 3.04 (2.28-4.23)]. The most common pattern of dual use across the period was daily cigarette smoking with daily vaping [49.0% (47.3-50.8%)]. Over time, the proportion of dual users reporting daily cigarette smoking with non-daily vaping decreased [from 35.2% to 15.0%; PR = 0.43 (0.29-0.63)], offset primarily by an increase in the proportion reporting non-daily cigarette smoking with daily vaping [from 7.6% to 21.5%; PR = 2.84 (1.71-4.72)]. Daily cigarette smoking with daily vaping was more common (and non-daily cigarette smoking with daily vaping less common) among dual users who were older, less advantaged, mainly smoked hand-rolled cigarettes, had stronger urges to smoke and had been vaping for ≤6months. Daily vaping was more common among dual users who thought e-cigarettes were less/equally harmful as cigarettes, or were unsure. In England, vaping prevalence has increased rapidly among adults who smoke since 2021, which was when disposable e-cigarettes started to become popular. Since 2016, patterns of dual use have shifted away from more frequent smoking towards more frequent vaping. This may be the result of increasing prevalence of dual use among younger adults, who are more likely than older dual users to smoke non-daily and vape daily.

Differential Impact of Risk Factors for Cognitive Decline in Heterosexual and Sexual Minority Older Adults in England.

Sexual minority older adults (SMOAs) report greater subjective cognitive decline (SCD) than heterosexual older adults (HOAs). This study aimed to compare the impact of multiple psycho-social risk factors on objective and subjective cognitive decline in HOAs and SMOAs. Two samples of self-identified HOAs and SMOAs were selected from the English Longitudinal Study of Ageing. Reliable change indices for episodic and semantic memory were created to assess cognitive decline. SCD was self-reported for memory and general cognition. Depressive symptoms, loneliness, marital status and socio-economic status were investigated as risk factors. No between-group differences were found in cognitive decline. Higher depression was associated with greater SCD risk and worse semantic memory decline. The latter effect was stronger in SMOAs. The findings were largely replicated in the sensitivity analysis. Poor mental health may represent the strongest driver of cognitive decline in SMOAs and to a greater extent than in HOAs.

Foundation dentists’ attitudes and experiences in providing dental care for dependant older adults resident in care home settings

IntroductionThere is a continued increase of older dependant adults in England. Foundation Dentists (FDs) are often the dental workforce being tasked with providing dental care to dependant older adults resident in care home settings. This study explores whether FDs have the experience and confidence to deliver this.AimThis service evaluation aimed to explore FDs’ attitudes, perceptions and experiences delivering dentistry to dependant older adults’ resident in care home settings; to help inform workforce and service delivery planning.MethodsAll North West England (NW) FDs were invited to complete a semi-structured questionnaire at a regional study session. Results were analysed using descriptive and thematic analysis.ResultsThere were 93 (80.1%) respondents, with the majority aged 20–24 years old (56, 60.2%), female (57, 61.3%) and with an United Kingdom undergraduate dental degree (88, 94.6%). Most respondents had no experience in delivering care in a care home setting at either undergraduate (85, 91.4%) or FD level (84, 90.3%). Only 14 respondents (15.1%) reported confidence to deliver dentistry in a care home setting.ConclusionTo deliver dental care for dependant older adults resident in care home settings, FDs require additional training and clinical support. There is a need to review the undergraduate dental curriculum and NHS postgraduate training programmes to increase knowledge and skills for this vulnerable group.

Association Between Digital Front Doors and Social Care Use for Community-Dwelling Adults in England: Cross-Sectional Study.

Requests for public social care support can be made through an online portal. These digital "front doors" can help people navigate complex social care systems and access services. These systems can be set up in different ways, but there is little evidence about the impact of alternative arrangements. Digital front-door systems should help people better access services, particularly low-intensity services (high-intensity care is likely to require a full in-person assessment). This study aimed to investigate the association between 2 primary digital front door arrangements, easy-read information, and self-assessment tools provided on official websites, and the type of social care support that is offered: ongoing low-level support (OLLS), short-term care (STC) and long-term care (LTC). Information on front door arrangements was collected from the official websites of 152 English local authorities in 2021. We conducted a cross-sectional analysis using aggregated service use data from official government returns at the local authority level. The independent variables were derived from the policy information collected, specifically focusing on the availability of online digital easy-read information and self-assessment tools for adults and caregivers through official websites. The dependent variables were the rates of using social care support, including OLLS, STC, and LTC, across different age groups: the adult population (aged 18 and older), younger population (aged between 18 and 64 years), and older population (aged 65 and older). Multivariate regression analysis was used to examine the association between digital front door arrangements and access to social care support, controlling for population size, dependency level, and financial need factors. Less than 20% (27/147) of local authorities provided an integrated digital easy-read format as part of their digital front door system with about 25% (37/147) adopting digital self-assessment within their system. We found that local authorities that offered an integrated digital easy-read information format showed higher rates of using OLLS (β coefficient=0.54; P=.03; but no statistically significant association with LTC and STC). The provision of an online self-assessment system was not associated with service use in the 1-year (2021) cross-sectional estimate, but when 2 years (2020 and 2021) of service-use data were analyzed, a significant positive association was found on OLLS rates (β coefficient=0.41; P=.21). Notably, these findings were consistent across different age groups. These findings are consistent with our hypothesis that digital systems with built-in easy-read and self-assessment may make access to (low-intensity) services easier for people. Adoption of these arrangements could potentially help increase the uptake of support among those who are eligible, with expected benefits for their care-related well-being. Given the limited adoption of the digital front door by local authorities in England, expanding their use could improve care-related outcomes and save social care costs.

A qualitative study to examine hidden care burden for older adults with overweight and obesity in England.

The study aimed to explore the phenomena related to formal and informal social care needs among overweight and obese older adults living in England. Despite the rising prevalence of obesity among older adults, its impact on social care needs remains underexplored. Existing research highlights significant unmet social care needs among older adults, yet the specific challenges faced by those who are overweight or obese have received limited attention. This study addresses this gap by exploring and understanding the social care experiences and needs of older adults in England who are overweight or obese. Participants were recruited from a local National Health Service (NHS) health centre in London England using a purposive sampling strategy to the point of analytical saturation. A total of 45 participants were invited and of these 33 participants were eligible to take part. All participants in this study are either of British origin or immigrants to the UK from various nationalities. A semi-structured interview was conducted, and a qualitative structural narrative analysis was undertaken. The study found that older adults, who are overweight or obese, were more likely to have physical health problems and problems with mobility. They were more likely to have informal voluntary care and support rather than formal social care support. They also had a weaker social support network, were more isolated and frustrated, lacked housing adaptations, felt unsafe, felt they were a burden to their families and felt discriminated against by the wider community. Care and support needs if not met, then these are likely to generate or widen health inequalities over time. This study provides a unique perspective on unmet care needs among overweight and obese older adults in England. It highlights the compounded challenges faced by this population, emphasising the importance of holistic social care approaches that address both health and psychosocial needs. Findings suggest that minimal yet targeted interventions, such as accessible support networks and public health policies promoting social engagement, could significantly improve wellbeing and reduce long-term health inequalities.

Psoriasis and dementia: A population-based matched cohort study of adults in England.

Evidence for an association between psoriasis and dementia is limited and conflicting. We aimed to investigate the association using large and representative population-based data and describe risk by dementia subtype and over time. We compared dementia risk between people with and without psoriasis using an age-, sex- and primary care practice-matched cohort of adults aged ≥40 years from the Clinical Practice Research Datalink Aurum in England (1997-2021) linked to hospital admissions data, analysed with stratified Cox regression. Among 360,014 individuals with psoriasis and 1,799,617 without, psoriasis was associated with a small increased risk of all-cause dementia (adjusted hazard ratio [aHR] 1.06, 95% CI 1.04-1.08; absolute rate difference 24 per 100,000 person-years). Strength of association increased with time since psoriasis diagnosis (e.g. aHR 0.99, 0.96-1.03 within 0 to 5 years; 1.20, 1.05-1.37 within 20 to 25 years). The association was stronger for vascular dementia (aHR 1.10, 1.06-1.14) than Alzheimer's dementia (aHR 1.03, 1.00-1.06). Hazard ratios were larger for severe psoriasis (all-cause aHR 1.32, 1.25-1.39; vascular aHR 1.58, 1.44-1.74; Alzheimer's aHR 1.11, 1.02-1.21). Long-term risk of all-cause dementia and vascular dementia, but not Alzheimer's dementia, was slightly higher in people with psoriasis, but absolute risk differences were small. Risks were more substantially raised with time since psoriasis diagnosis and in severe psoriasis compared to mild to moderate psoriasis, suggesting a potential dose-response relationship.

EXPLORING THE RELATIONSHIP BETWEEN LONELINESS, RELIGION, AND SPIRITUALITY FOR OLDER ADULTS IN ENGLAND

Abstract Although there is evidence linking the prevalence of loneliness with religion and/or spirituality in north America, this topic is rarely researched in the UK. This study explored the relationship between measures of religious affiliation, attendance, and practice with loneliness for older adults in England. We generated an analytic sample of 6225 adults aged 50+ who took part in wave 9 of the English Longitudinal Study of Ageing (ELSA). The exposure variables of religious affiliation, attendance and practice were measured by questions on religious identity; frequency of attendance at places of worship in the last year; and 4-point Likert scales of agreement or disagreement with religious importance, meaning and purpose, prayer and meditation, and activity. Loneliness outcome was measured using the three item University of California Los Angeles loneliness scale. The majority of our analytic sample were Christian (77%), 22% had no religion and 49% had not attended a place of worship in the last year. The prevalence of loneliness (score 6+ on UCLA scale) was 19%. Religious attendance was significantly associated with loneliness (OR =.73 CI.62-.85, p &amp;lt;.001), with attendance protective against feeling lonely. However, this relationship was not significant after adjustment. No relationship was observed between loneliness and religious affiliation or spirituality. Religious identity remains prevalent in older adults in England, but attendance and practice less so. Further studies in diverse populations, using validated measures of loneliness and religion, are necessary to investigate whether loneliness can be moderated or mediated by religion/spirituality alongside other determinants.

THE IMPACT OF ENVIRONMENTAL EXPOSURES ON DEMENTIA, PHYSICAL, COGNITIVE, AND MENTAL HEALTH OF OLDER ADULTS

Abstract The proposed symposium will delve into crucial environmental factors affecting physical health, cognitive and mental health, in older populations. The first talk will explore urban environments’ impact on cognitive health, highlighting evidence gaps and concentrated areas of existing research, such as air pollution and social environment influences on dementia and Alzheimer’s disease. Another presentation will examine the association between long-term air pollution exposure and dementia risk in Denmark, identifying the most vulnerable groups based on socioeconomic status and comorbidities. The third talk will focus on the relationship between air pollution exposure over a decade and cognitive performance in older individuals in England, emphasizing the detrimental effects of industry emissions on cognition. A different study will discuss the findings on outdoor light at night and its lack of association with depressive symptoms in older adults in England. Lastly, the symposium will present research on extreme heat exposure’s effects on epigenetic aging and its potential to increase morbidity and mortality risks, underscoring the need for mitigating these biological changes.

EXPLORING THE RELATIONSHIP BETWEEN RELIGION, SPIRITUALITY, LONELINESS, SOCIAL ISOLATION, AND AGING

Abstract The importance of social engagement, connections, and participation as we age and the negative impact of loneliness and social isolation on health are well recognized. Religion and/or spirituality has social, emotional, and existential dimensions and are linked to concepts of belonging, meaning, and purpose. As part of the drive to build meaningful social and emotional connections in contemporary society, religion and/or spirituality are proposed as potential solutions to loneliness/social isolation. The theoretical mechanism proposed is that affiliation, attendance, practice, or belief can offer support, social capital, meaning and a sense of belonging. This interdisciplinary symposium uses data from both the US and Europe to explore the relationship between religion, spirituality, loneliness, and social isolation. Leavey using longitudinal data from Ireland explores depression and anxiety and their relationship with loneliness, social networks, religious practice, and long-term illness. Victor &amp; Seetal, also using longitudinal data set out the relationship between measures of religious affiliation, attendance, and practice with loneliness for older adults in England. Taylor uses the HRS to examine the association between religious service attendance and spirituality on social isolation and loneliness among older adults in the United States. Finally, Hampton Jarmon, using data from the Healthy Aging in Neighborhoods of Diversity Across the Life Span study, explores the relationship between spirituality (connectedness, prayer fulfilment, and universality) and cognition within Black and White adult participants. Lubben, as discussant, will reflect on the key themes and the symposium’s overarching focus - can religion and/or spirituality provide protection from loneliness and social isolation?

Patterns of Social Connection Among Older Adults in England

Issues related to social connection are increasingly recognized as a global public health priority. However, there is a lack of a holistic understanding of social connection and its health impacts given that most empirical research focuses on a single or few individual concepts of social connection. To explore patterns of social connection and their associations with health and well-being outcomes. This cohort study included participants aged 50 years and older from the fourth wave of the English Longitudinal Study of Aging (2008-2009). Machine learning cluster analysis and regression analysis were used. The analyses were performed from January to July 2024. Social connection clusters informed by the cluster analysis. This study considered outcomes related to mental health (depression), hedonic (life satisfaction, pleasure) and eudaimonic (self-realization) well-being, general health (self-reported health), and health behavior (moderate or vigorous physical activity). Key confounders, identified using directed acyclic graphs, including age, sex, ethnicity, education, social class, and wealth, were controlled for. Among 7706 participants aged 50 years and older (mean [SD] age, 64.7 [9.6] years; 4248 [55.1%] female; 7536 [97.8%] White), 5 clusters were identified, including disconnected (974 [12.6%]), gapped structure/poor function (1109 [14.4%]), gapped structure/high function (1582 [20.5%]), poor function/mixed quality (1501 [19.5%]), and highly connected (2540 [33.0%]). All clusters had poorer outcomes compared with the highly connected cluster (eg, depression among individuals in disconnected vs highly connected clusters: odds ratio [OR], 2.73; 95% CI, 2.24 to 3.33), many of which persisted after controlling for baseline outcome (eg, depression among individuals in disconnected vs highly connected clusters: OR, 1.95; 95% CI, 1.57 to 2.43). The difference was smallest between the highly connected and gapped structure/high function clusters across most outcomes (eg, depression among individuals in gapped structure/high function vs highly connected: OR, 1.34; 95% CI, 1.10-1.64; after controlling for baseline outcome: OR, 1.28; 95% CI, 1.03-1.59). This cohort study highlights the importance of considering multidimensional measures of social connection and understanding the nuance of its heterogenous patterns. Understanding the typologies of social connection has substantial implications for exploring modifiable risk factors for social disconnection and for understanding the mechanisms linking social connection to health-related outcomes.

Psoriasis and dementia: a population‐based matched cohort study of adults in England

Psoriasis and dementia: a population‐based matched cohort study of adults in England