Social Decline Research Articles

How to understand the time we are living through

The article seeks to understand the long wave of neoliberal economic policies over the last thirty years and its impact on social conditions and the political situation in the West. The financial crisis of 2007-8 marks the end of this long wave, when some of the basic theories imploded, particularly the financial deregulation and the trickle down theories. The end of this wave opened an “empty room”, a period without direction and destiny. Governments and political leaders have been stuck in “unfettered globalization” and austerity policies, unprepared to present new policies for widely shared prosperity. The insecurity and the growing inequalities have been exploited by political forces inside and outside the leading political parties, offering simple solutions in the form of building walls and “taking back control”. Thus, in the absence of a strong progressive policy response from the established parties, the “empty room” has become “an explosive empty room” of neo-nationalism and regressive policies. While our societies have moved to the right in terms of economic and social policy, they have moved left in terms of values such as gender equality and individual rights. A combination of economic stagnation and social decline, “insecurity in times of change”, and progress in civil rights and gender equality, has triggered the kind of political and populist revolts that we now see in the US and in many parts of Europe, exploited by conservatives and far-right parties. This can be described as “discontent of declining expectations”. Democracy and democratic institutions are at risk.

M44. Remediating Higher Order Social Cognitive Deficits in Psychosis

Background: Social cognitive deficits play an important role in social functioning in adults with established psychosis (schizophrenia), young adults recently diagnosed with schizophrenia in the last 2 years (first episode psychosis; FEP), and teenagers at clinical high risk for developing psychosis (CHR). In particular, the ability to infer other people’s mental states has been shown to be compromised in those with psychosis, albeit less so in earlier stages. Recent studies have shown that processing speed (PS) may be upstream to social cognitive abilities in psychosis. If such were the case, remediating PS may in turn have beneficial effects on social cognition. This study examined whether improving PS would lead to subsequent improvements in social cognition in individuals with schizophrenia, FEP, and/or CHR. We examined whether (a) improving PS was related to improvements in social cognition, and (b) if so, whether these social cognitive improvements would in turn lead to fewer symptoms and better social function. Methods: Participants were 36 adults with schizophrenia (18–55 yo), 18 young adults with FEP (18–26 yo), and 17 teenagers at CHR (12–18 yo), enrolled in a 3-month PS training program. Assessments of PS, social cognition, and symptoms were administered at baseline and post-treatment. Results: Improvement in PS from baseline to post was related to improvement in the ability to determine other people’s mental states in CHR and FEP but not in schizophrenia. This improvement in higher order social cognitive performance was related to fewer negative symptoms and less avoidance of new social situations in the CHR group. No relationship between improvement in PS and symptoms or social function was noted in schizophrenia. Conclusion: Information processing speed deficits may be an important therapeutic target in remediating social cognitive deficits in psychosis, especially at the prodromal stages where there perhaps is more neural plasticity for change and the possibility of mitigating the trajectory of social decline in psychosis.

ETNIS MARITIM DAN PERMASALAHANNYA

As a maritime country with vast territorial waters and abundant marine resources, Indonesia, a country with diverse ethnics and peculiarities, has a chance to become a great nation. Its natural and human resources are the basis capital to build the nation abreast with other nations in the world. Indonesia was once also known as a victorious maritime country with strong influence to the neighboring countries. Hence, it is an ironic that the maritime ethnic as the “guardian of the sea” has to live in backwardness, deterioration, social and economic adversity, and even social and cultural decline. Support and aid both from the government and the people with commitment toward the advancement of this maritime ethnic are greatly needed. Forcing the maritime ethnic like Suku Bajo or “the Sea People” to stay away from the sea is a futile act. In fact, it will only lead to prolonged conflict. Conversely, involving them in such a program of preserving the sea and its biota is not something that is impossible, even though it is also not easy. Along with recent changes and demands, the “Sea People” or Suku Bajo eventually has to live more open and have the ability to interact with modern life.

The Pathophysiology of Perceived Social Isolation: Effects on Health and Mortality.

Perceived social isolation (PSI) is a deficit in normal human social interaction, which has been associated with negative health outcomes. However, the precise mechanisms through which PSI influences human health are not fully known. This review aims at bringing out what is known about these pathways through which social isolation affects human health. We searched PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Psychological Information Database (PsycINFO), and Cochrane Library in addition to secondary references from primary journal articles for the most relevant and recent information concerning the research topic. The keywords used were perceived social isolation, loneliness, health outcomes, cardiovascular effects, neuroendocrine effects, depression, and cognitive decline, in animal and human populations. There are clear linkages between PSI and the cardiovascular system, neuroendocrine system, and cognitive functioning. PSI also leads to depression, cognitive decline, and sleep problems. The mechanisms through which PSI causes these effects are neural, hormonal, genetic, emotional, and behavioral. The effects of PSI on health are both direct and indirect. There is a complex interconnected network of pathways through which PSI negatively influences health. These hypothetical pathways using which the effects of PSI have been explained form the base on which further analyses can be carried out.

A cross-sectional study on the factors related to cognitive decline in community-dwelling elderly.

The aim of this study was to examine the relationship between cognitive decline and physical activity, sitting time, and social participation among elderly people living independently in a local community. In January 2015, 1,133 independently-living elderly individuals from a local Japanese community completed self-administrated questionnaires. A total of 929 participants completed the questionnaire (valid response rate: 82.0%). A multiple logistic regression analysis was conducted to examine the relationship between cognitive decline, physical activity, sitting time, and social participation. The factors related to cognitive decline were examined using three statistical models: (1) Model 1 was not adjusted for any factors; (2) Model 2 was adjusted for age, education level, smoking status, and drinking status; and (3) Model 3 was adjusted for the covariates in Model 2, plus depression. Cognitive decline was observed in 33% of men and 26% of women. The results indicated that decreased social participation was significantly related to cognitive decline in Models 1 and 2. For men, local community activity and political/economic activity were significantly associated with cognitive decline in Models 1 and 2. Among women, physical activity was significantly related to cognitive decline in Model 1. There was also a significant association between social participation and cognitive decline in Models 1 and 2; decreased volunteer activity was significantly related to cognitive decline in all three models. The results of the present study indicated that attending volunteer activities was significantly related to cognitive decline in women.

Background characteristics and clinical features of elderly patients with hyperglycemic hyperosmolar syndrome.

Few reports have described the characteristics of hyperglycemic hyperosmolar syndrome (HHS) in the elderly. We investigated the background characteristics and clinical features of 14 elderly patients with HHS. HHS was diagnosed based on a blood glucose level of >600 mg/dL and an effective plasma osmolality [2 (Na) + glu/18] of >320 mOsm/kg. For 14 cases of HHS, we investigated the medical and social backgrounds of the patients, their clinical findings, and the outcomes. The mean patient age was 83 years, and the mean body mass index was 17.8 kg/m2. Half had a history of either cerebral infarction or hip fracture. The mean duration of diabetes was 14 years, but 4 diabetes cases were newly diagnosed. There was a high prevalence of acute infection (79%) in HHS patients, especially urinary tract infection and pneumonia, with a seasonal peak in winter. Patients who had been treated with steroids, tube feeding, or both numbered 1, 2, and 1, respectively. Most HHS patients had a history of dementia. More than half of such patients were living alone or only with their spouse, and their activities of daily living showed marked deterioration. The mean blood glucose level, HbA1c, effective serum osmolality, and pH were 881 mg/dL, 10.3%, 353 mOsm/kg, and 7.39, respectively. One patient died during hospitalization, and 9 were discharged to nursing homes or other hospitals. The mean length of hospitalization was 55 days. In most cases, the insulin secretion capacity was preserved, and 9 patients were treatable with oral hypoglycemic agents alone. Many cases of HHS in the elderly are associated with infection, a shortage of social support, cognitive impairment, or ADL decline. Although the survival rate in our series was high, the functional prognosis was impaired.

A New Territory to Chart in History: On the Production of a Cultural History of Imagery in China: A Hundred-Volume Work

The cognitive paradigm of the “homology between writing and imagery” has long existed in China. Such a cultural mode of “homology between writing and imagery” or even “homogeneity between writing and imagery” led to the creation of the grand system of Chinese civilization. Prior to the invention of characters, the civilization of imagery single-handedly undertook the task of recording history and symbolizing the external world. After the maturation of the writing system, it harmoniously coexisted with and complemented the writings. “Imagery is (defined by) its terseness,” while “writing (boasts of) its broadness.” Hence, the rich history and tradition of “images on the left and historical records on the right” came into being in Chinese culture. Only in the modern times did imagery’s social function decline. At present, studies on Chinese cultural history by focusing on writings have abounded. By comparison, those focusing on imagery as the vehicle of Chinese culture are still lacking. I have not seen works on culture of imagery in China with detailed materials and complete structure. There are few research articles in this regard, too. “As (one) intends to know the great Way, (one) must work on history first.” In the process of bringing about a great rejuvenation of the Chinese nation, it is vital to revive Chinese culture first to present the whole world an unbroken system of civilization with tens of thousands or even hundreds of thousands of years. Such a visual or graphical historical heritage and cultural mode are different from the phonetic system in Euro-American countries, because they transcend the linguistic cognitive mode and logic and thus contributed to the making of the unique civilizational form, wisdom, and a distinctive cultural lineage of imagery in China.

The effect of modifiable healthy practices on higher-level functional capacity decline among Japanese community dwellers.

This study aimed to clarify the effects of the accumulation of 8 modifiable practices related to health, including smoking, alcohol drinking, physical activity, sleeping hours, body mass index, dietary diversity, ikigai (life worth living), and health checkup status, on higher-level functional capacity decline among Japanese community dwellers. Data were derived from the National Institute for Longevity Sciences - Longitudinal Study of Aging. Subjects comprised 1269 men and women aged 40 to 79 years at baseline (1997–2000) who participated in a follow-up postal survey (2013). Higher-level functional capacity was measured using the Tokyo Metropolitan Institute of Gerontology Index of Competence (total score and 3 subscales: instrumental self-maintenance, intellectual activity, and social role). The odds ratio (OR) and 95% confidence interval (CI) for a decline in higher-level functional capacity in the follow-up study according to the total number of healthy practices were analyzed using the lowest category as a reference. Multivariate adjusted ORs (95% CIs) for the total score of higher-level functional capacity, which declined according to the total number of healthy practices (0–4, 5–6, 7–8 groups) were 1.00 (reference), 0.63 (0.44–0.92), and 0.54 (0.31–0.94). For the score of social role decline, multivariate adjusted ORs (95% CIs) were 1.00 (reference), 0.62 (0.40–0.97), and 0.46 (0.23–0.90), respectively (P for trend = 0.04). Having more modifiable healthy practices, especially in social roles, may protect against a decline in higher-level functional capacity among middle-aged and elderly community dwellers in Japan.

Social interaction and cognitive decline: Results of a 7-year community intervention

IntroductionThere are few intervention studies that demonstrated linking social participation to lower risk of cognitive decline. We examined prospectively the protective effect of a community intervention program promoting social participation on the incidence of cognitive disability. MethodsThe baseline was established in a survey of community-dwelling older people aged 65 years old or more in July 2006 (2793 respondents, response rate 48.5%). The setting was Taketoyo town in Japan, where municipal authorities launched an intervention that was based on the establishment of community-based centers called “salons,” where the town's senior residents could congregate and participate in social activities, ranging from arts and crafts, games, and interactive activities with preschool children. Three salons were established in May 2010, and a total of 10 salons were in operation by 2013. We recorded the frequency of salon participation among survey respondents till 2013 and conducted two follow-up surveys (in 2010 and 2013) to collect information about health status and behaviors. The onset of cognitive disability was followed from May 2007 to January 2014. We used the marginal structural models to evaluate the effect of program. ResultsThe range of prevalence of cognitive disability was from 0.2% to 2.5% during the observation period. The proportion of respondents who participates to salons increased over time to about 11.7%. The frequency of salon participation was protectively associated with cognitive decline, even after adjusting for time-dependent covariates and attrition (odds ratio = 0.73, 95% confidence interval: 0.54–0.99). DiscussionOur study suggests that operating community salons that encourage social interactions, light physical activity, and cognitive activities among older participants may be effective for preventing cognitive decline. In future studies, we need to understand what sorts of activities (e.g., those involving light physical activity vs. purely intellectual activities) are most effective in maintaining cognitive function.

Separation Anxiety Disorder in School-Age Children: What Health Care Providers Should Know

Separation anxiety disorder (SAD) is the most common childhood anxiety disorder, and it has many consequences, particularly for school-age children. These consequences include excessive worry, sleep problems, distress in social and academic settings, and a variety of physical symptoms that, left untreated, can cause social and academic decline. Pediatric providers routinely see children in the primary care office and have the unique opportunity to diagnose, treat, and manage children with SAD. Despite this, SAD continues to be underdiagnosed and undertreated because of a gap in the literature regarding evidence-based practice guidelines for pediatric providers. The purpose of this article is to discuss the diagnosis and management of SAD in school-age children and highlight the role of pediatric providers in managing separation anxiety.

The Social Transformation of Large Housing Estates in Poland at the Turn of the 21st Century

Large housing estates make up an essential portion of the housing stock in the urban structure of Polish cities. It was expected that large housing estates in Poland might experience social decline in the 1990s, but several research projects conducted in the estates did not identify any increase in social degradation. This article examines the social structure of the residents of large housing estates in Poland and identifies the main trends in current social changes. The time frame of ongoing transformations in the social structure was set around the turn of the 21st century. This analysis is based on Polish 1988 and 2002 National Census data, the Polish PESEL population database (2011), and the author's survey data (2010-2012). Research was conducted in seven housing estates in fi ve Polish cities or towns (Poznań, Kraków, Tarnów, Dzierżoniów, and Żyrardów) and focused on analysing the sizes and types of households and their economic situation and the social structure of the estates. Results showed that large housing estates continue to have a heterogeneous social structure and to resist social deprivation processes. Depending on the period when a particular estate was built it is possible to observe distinctive features of housing estates, such as social structure renewal in housing estates from the 1950s and 1960s, residential ageing in those from the 1970s, and the risk of an exodus of young residents from estates from the 1980s. Those shared problems may soon become decisive for the future development of large estates.

Physical, social, psychological and existential trajectories of loss and adaptation towards the end of life for older people living with frailty: a serial interview study.

BackgroundThe experiences of people with cancer and organ disease have been described across different dimensions of need as they approach death. Such information is lacking for frail older people approaching death, but could highlight how a palliative approach might be relevant for this population.MethodsCognitively intact, community dwelling adults considered to be moderately or severely frail were recruited from a medical day hospital. Those recruited nominated an informal carer and case-linked professional. Qualitative in-depth serial interviews with older people and their informal carers were conducted over an 18 month period, and single interviews with case-linked healthcare professionals. Interviews were recorded, transcribed and narrative analytical techniques were used to compile case studies.ResultsThirty-four participants (13 patients, 13 informal carers and 8 healthcare professionals) completed 40 individual, 14 joint and 8 professional interviews. Five patients died during the study. The analysis highlighted a dynamic balance between losses and adaptations. Three typical patterns of multi-dimensional change emerged. 1) Maintenance of psychological and existential well-being with a gradual social decline mirroring the physical deterioration. 2) a gradual reduction in both psychological and existential well-being. 3) a marked downturn in social, psychological and existential well-being before death. Frail older people sustained their well-being through maintaining a sense-of-self, garnering support from carers and community structures, and focusing on living from day to day. Their well-being lessened when they lost their sense-of-self, feeling alienated from the world, and confused over the cause of their circumstances. Death remained distant and ‘undiagnosed’. Social and community frameworks were essential for supporting their well-being.ConclusionsMultidimensional end-of-life trajectories for frail older people differed from those with other conditions. Alleviating psychological, social and existential distress should be a priority of care as frail older people reach the end of life. The current palliative care model is problematic for this group. Care should address future concerns and not necessarily involve a focus on death or place of death.

Sustainable Design, Cultural Landscapes and Heritage Parks; the Case of the Mondego River

AbstractOver the past few decades, in both the USA and Europe, many cultural landscapes (CLs) facing social and economic decline have been revitalized through processes embracing planning, design, touristic ideas, heritage resources, local administrations and communities, resulting in cultural or heritage parks (HPs). This paper forms part of the debate on CLs and highlights their rehabilitation via HPs. The research raises the question of the role HPs have played within the restoration of CLs while aiming to bring the discussion into the current sustainable planning and land design debate. As a case study, it takes the experience of the Mondego River Heritage Park (MRHP), located in the central region of Portugal. The MRHP builds upon the European Landscape Convention, HPs' accomplishments and academic studies. Conclusions suggest heritage to be an effective driving force for sustainable development and the HP as an operative concept in the planning, land design and management of the territory. Copyright © 2016 John Wiley & Sons, Ltd and ERP Environment

Climate change and social vicissitudes in China over the past two millennia

The relation between climate change and historical rhythms has long been discussed. However, this type of study still faces the lack of high-resolution data concerning long-term socio-economic processes. In this study, we collected 1586 items of direct and proffered evidence from 29 Chinese history books. We used semantic analysis to reconstruct a quantitative series of the social vicissitudes of the past 2000 yr with a 10-yr resolution to express the phase transition of the social vicissitudes of the dynasties in China. Our reconstruction demonstrates that social vicissitudes have clear cyclical features on multiple time scales. Analysis of the association of social rise and fall with climate change indicates that temperature displayed more significant effects on social vicissitudes in the long term, while precipitation displayed more significant effects on the social vicissitudes in the short term. There are great overlaps between social and climatic variables around the predominant or periodic bands. Social rise mostly occurred in the centennial-scale warm periods, whereas social decline mostly occurred in the centennial-scale cold periods. Under warm-wet conditions, social rise occurred over 57% of the time; under cold-dry conditions, the social decline occurred over 66% of the time.

THE ROLE OF SUSTAINABLE ARCHITECTURE IN VALUABLE HISTORICAL DISTRICTS OF TEHRAN (A CASE STUDY OF SUSTAINABLE RESIDENTIAL DEVELOPMENT IN SANGLAJ DISTRICT)

In this paper we study the role sustainable architecture in valuable historical districts of sangalj in city of Tehran. Different aspects of architecture were studied in this paper. Results show that contemporary architecture has an important effect on the face of building in Tehran. Furthermore the modern architecture in valuable city textures is one of challengeable issues in modern architecture and renovation in Iran. The old textures of Tehran are faced to severe structural erosion and social decline because of backwardness from city evolution and development. Social problems that are the result of these erosions cause the escape of local residents and replaced with other citizens that not believe there as their living place.

Presbycusis - Age Related Hearing Loss

Presbycusis or age related hearing loss can be defined as a progressive, bilateral and symmetrical sensorineural hearing loss due to age related degeneration of inner ear structures. It can be considered a multifactorial complex disorder with environmental and genetic factors. The molecular, electrophysiological and histological damage at different levels of the inner ear cause a progressive hearing loss, which usually affects the high frequencies of hearing. The resulting poor speech recognition has a negative impact on cognitive, emotional and social function in older adults. Recent investigations revealed an association between hearing impairment and social isolation, anxiety, depression and cognitive decline in elderly. These findings emphasize the importance of diagnosis and treating hearing loss in the elderly population. Hearing aids are the most commonly used devices for treating presbycusis. The technical progress of implantable hearing devices allows an effective hearing rehabilitation even in elderly with severe hearing loss. However, most people with hearing impairments are not treated adequately.

Telomere Attrition in Human Lens Epithelial Cells Associated with Oxidative Stress Provide a New Therapeutic Target for the Treatment, Dissolving and Prevention of Cataract with N-Acetylcarnosine Lubricant Eye Drops. Kinetic, Pharmacological and Activity-Dependent Separation of Therapeutic Targeting: Transcorneal Penetration and Delivery of L-Carnosine in the Aqueous Humor and Hormone-Like Hypothalamic Antiaging Effects of the Instilled Ophthalmic Drug Through a Safe

Visual impairment broadly impacts the ability of affected people to maintain their function and to remain independent during their daily occupations as they grow older. Visual impairment affects survival of older patients, quality of life, can affect a person's self-ranking of health, may be associated with social and functional decline, use of community support services, depression, falls, nursing home placement, and increased mortality. It has been hypothesized that senile cataract may serve as a marker for generalised tissue aging, since structural changes occurring in the proteins of the lens during cataract formation are similar to those which occur elsewhere as part of the aging process. The published analysis revealed a strong age-dependent relationship between undergoing cataract surgery and subsequent mortality. Nuclear opacity, particularly severe nuclear opacity, and mixed opacities with nuclear were significant predictors of mortality independent of body mass index, comorbid conditions, smoking, age, race, and sex. The lens opacity status is considered as an independent predictor of 2-year mortality, an association that could not be explained by potential confounders. Telomeres have become important biomarkers for aging as well as for oxidative stress-related disease. The lens epithelium is especially vulnerable to oxidative stress. Oxidative damage to the cuboidal epithelial cells on the anterior surface of the lens mediated by reactive oxygen species and phospholipid hydroperoxides can precede and contribute to human lens cataract formation. The erosion and shortening of telomeres in human lens epithelial cells in the lack of telomerase activity has been recognized as a primary cause of premature lens senescence phenotype that trigger human cataractogenesis. In this study we aimed to be focused on research defining the mechanisms that underlie linkages among telomere attrition in human lens epithelial cells associated with oxidative stress, biology of the lens response to oxidative damages, aging and health, cataract versus neuroendocrine regulation and disease. The cumulative results demonstrate that carnosine, released ophthalmically from the patented 1% Nacetylcarnosine prodrug lubricant eye drops, at physiological concentration might remarkably reduce the rate of telomere shortening in the lens cells subjected to oxidative stress in the lack of efficient antioxidant lens protection. Carnosine promotes the protection of normal cells from acquiring phenotypic characteristics of cellular senescence. The data of visual functions (visual acuity, glare sensitivity) in older adult subjects and older subjects with cataract treated with 1% N-acetylcarnosine lubricant eye drops showed significant improvement as compared, by contrast with the control group which showed generally no improvement in visual functions, with no difference from baseline in visual acuity and glare sensitivity readings. N-acetylcarnosine derived from the lubricant eye drops may be transported into the hypothalamic tuberomammillary nucleus (TMN) histamine neurons and gradually hydrolyzed. The resulting L-histidine may subsequently be converted into histamine, which could be responsible for the effects of carnosine on neurotransmission and hormone-like antiaging and anti-cataract physiological function. The research utilizing the N-acetylcarnosine lubricant eye drops powerful therapeutic platform provides the findings related to the intraocular uptake exposure sources as well as a timing dosage and duration systemic absorption of said preparation from the conjunctional sac reaching the hypothalamus with activities transfer into the hypothalamic-neuroendocrine pathways affecting across the hypothalamus metabolic pathway the telomere biology and cataract disease occurrence, reversal and prevention and the average expected lifespan of an individual. Such findings can be translated into clinical practice and may provide a basis for personalized cataract disease and aging prevention and treatment approaches.

Giving voice to older adults living with frailtyand their family caregivers: engagement of older adults living with frailty in research, health care decision making, and in health policy.

Plain English summaryThe paper discusses engaging older adults living with frailty and their family caregivers. Frailty is a state that puts an individual at a higher risk for poor health outcomes and death. Understanding whether a person is frail is important because treatment and health care choices for someone living with frailty may be different from someone who is not (i.e., who is fit). In this review, we discuss strategies and hurdles for engaging older adults living with frailty across three settings: research, health and social care, and policy. We developed this review using published literature, expert opinion, and stakeholder input (including citizens). Engaging frail older individuals will be challenging because of their vulnerable health state - but it can be done. Points of consideration specific to engaging this vulnerable population include:In any setting, family caregivers (defined to include family, friends, and other social support systems) play an important role in engaging and empowering older adults living with frailtyEngagement opportunities need to be flexible (e.g., location, time, type)Incentivizing engagement for researchers and citizens (financial and otherwise) may be necessaryThe education and training of citizens, health and social care providers, and researchers on engagement practicesPatient-centered care approaches should consider the specific needs of individuals living with frailty including end-of-life care and advanced care planningInfluencing policy can occur in many ways including participating at institutional, regional, provincial or national committees that relate to health and social care. Older adults are the fastest growing segment of Canada’s population resulting in an increased number of individuals living with frailty. Although aging and frailty are not synonymous the proportion of those who are frail increases with age. Frailty is not defined by a single condition, but rather a health state characterized by an increased risk of physical, mental, or social decline, deterioration of health status, and death. Recognizing frailty is important because earlier detection allows for program implementation focused on prevention and management to reduce future hospitalization, improve outcomes, and enhance vitality and quality of life. Even though older adults living with frailty are significant users of health care resources, their input is under-represented in research, health care decision making, and health policy formulation. As such, engaging older adults living with frailty and their family caregivers is not only an ethical imperative, but their input is particularly important as health and social care systems evolve from single-illness focused to those that account for the complex and chronic needs that accompany frailty. In this review, we summarize existing literature on engaging older adults living with frailty and their family caregivers across three settings: research, health and social care, and policy. We discuss strategies and barriers to engagement, and ethical and cultural factors and implications. Although this review is mainly focused on Canada it is likely to be broadly applicable to many of the health systems in the developed world where aging and frailty pose important challenges.

Social relationships and cognitive decline: a systematic review and meta-analysis of longitudinal cohort studies.

Although poor social relationships are assumed to contribute to cognitive decline, meta-analytic approaches have not been applied. Individual study results are mixed and difficult to interpret due to heterogeneity in measures of social relationships. We conducted a systematic review and meta-analysis to investigate the relation between poor social relationships and cognitive decline. MEDLINE, Embase and PsycINFO were searched for longitudinal cohort studies examining various aspects of social relationships and cognitive decline in the general population. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using random effects meta-analysis. Sources of heterogeneity were explored and likelihood of publication bias was assessed. We stratified analyses according to three aspects of social relationships: structural, functional and a combination of these. We identified 43 articles. Poor social relationships predicted cognitive decline; for structural (19 studies): pooled OR: 1.08 (95% CI: 1.05-1.11); functional (8 studies): pooled OR: 1.15 (95% CI: 1.00-1.32); and combined measures (7 studies): pooled OR: 1.12 (95% CI: 1.01-1.24). Meta-regression and subgroup analyses showed that the heterogeneity could be explained by the type of social relationship measurement and methodological quality of included studies. Despite heterogeneity in study design and measures, our meta-analyses show that multiple aspects of social relationships are associated with cognitive decline. As evidence for publication bias was found, the association might be overestimated and should therefore be interpreted with caution. Future studies are needed to better define the mechanisms underlying these associations. Potential causality of this prognostic association should be examined in future randomized controlled studies.

Social Participation and Cognitive Decline Among Community-dwelling Older Adults: A Community-based Longitudinal Study.

To examine whether social participation (SP) by older individuals is associated with cognitive decline (CD). Participants were community-dwelling older adults aged 65 or older with both independent activities of daily living and normal cognitive performance at baseline (2,768 men and 3,325 women). CD was evaluated using the Cognitive Performance Scale. Logistic regression analysis stratified by gender was used to examine CD in relation to SP, with nonparticipation as reference. Age, family, body mass index, pensions, comorbidities, medications, alcohol, smoking, depression, self-rated health, and instrumental activities of daily living were used as covariates. During the 3-year follow-up, 16.7% of eligible participants reported CD. After covariate adjustments, greater social group participation was associated with CD prevention for women only. Lessened negative CD effects were found in respondents active in these particular types of social outlets: neighborhood associations (odds ratio = 0.81, 95% confidence interval = 0.66-0.99) and local event groups (0.79, 0.63-0.99) for men, and hobby groups (0.70, 0.54-0.91) and volunteer groups (0.66, 0.45-0.96) for women. Our results suggest that greater social group participation prevents CD in women, while the beneficial effect of each type of SP on cognition differs between genders. Determining which types of social groups are best for community-dwelling older people's participation based on gender may help them maintain their cognitive functioning abilities.