Widowed Individuals Research Articles

MULTIMORBIDITY AND ITS ASSOCIATION OF WIDOWHOOD, RACE, AND ETHNICITY IN OLDER ADULTS

Abstract Living with chronic disease is common in later life and over 60% of adults 65+ have two or more conditions. Spousal loss, also common in late adulthood, is linked to chronic diseases, like heart attacks, cardiovascular disease, and strokes. This study examines the associations between widowhood, race/ethnicity, and onset of multiple chronic conditions (i.e., cancer, diabetes, heart disease, stroke) among 4,187 Americans aged 60+. Using the RAND HRS Longitudinal File 2018, we analyzed how married/partnered adults without major chronic conditions in 2010 experienced widowhood and developed cancer, diabetes, and/or cardiovascular disease during the subsequent eight years. We used ordinal logistic regressions to examine the associations between marital status, race/ethnicity, and multimorbidity onset, controlling for age, gender, birthplace, living conditions, income, education, smoking habits, physical activities, self-reported BMI, and Medicaid enrollment. Among participants, 69.41% were non-Hispanic White, 13.04% were non-Hispanic Black, 14.19% were Hispanic (any race), and 3.37% were non-Hispanic other. The mean age was 70.33 years, more than half (54.79%) were female, and 83.85% were married or partnered in 2018. Older widowed group were more likely to be non-Hispanic White women without smoking habits nor multimorbidity. The onset of multimorbidity at follow-up was elevated among divorced or separated non-White/Hispanic participants (OR = 1.83, 95%, CI 0.896, 3.744) unlike widowed non-White individuals (OR = 0.71, 95%, CI 0.433, 1.152). Age, previous smoking behavior, BMI, and birth in the South were all significantly associated with increased multimorbidity risk (p<0.017). The association of widowhood and health outcomes may vary by race and ethnicity.

Life Span Development of Self-Continuity in late Adulthood: The Impact of Chronological Age, Loss of Partner and Aversive Childhood Events

ABSTRACT Self-continuity is a central process of identity that connects one’s past and present. Research is limited regarding the life-course determinants of self-continuity and its development in later life. We used multilevel hierarchical models to investigate how the occurrence of life-course adversity (e.g., childhood adversity or partner loss) and the accumulation of resources shapes the perception of self-continuity in mid and later life, with respect to both their levels and changes over time. A three-wave longitudinal data set was used. The sample consisted of divorcees (n = 396), widows and widowers (n = 319), and married individuals (control; n = 513) in the second half of life. The divorcees had the lowest levels of self-continuity compared to the married and widowed individuals. Self-continuity increased with age for all marital status groups but followed differential trajectories. The divorcees were the most vulnerable group regarding their level and development of self-continuity. More childhood adversity was associated with less self-continuity for all groups, showing the influence of distal adversity on later life identity processes. Our findings illustrate that self-continuity changes as a function of age but differs based on the adverse events experienced across the life course.

Prevalence of Loneliness and Its Association with Marital Status in Korean Adults: Analysis of the Korean Welfare Panel Study Data in 2021

Objectives: Loneliness poses a serious health risk. However, little is known about the state of loneliness in the Korean population. This study analyzes the prevalence of and risk factors for loneliness with a particular focus on marriage status in Korean adults using nationwide survey data. Methods: Using individual-level data from the 16th Korean Welfare Panel Study in 2021, this study analyzed 9,422 participants aged 30 years and older, who responded to a question, “how many days during the past week did you feel lonely as if you were alone in the world?”. Multiple logistic regression analysis was conducted to examine the likelihood of feeling lonely at least once a week according to marital status and other sociodemographic characteristics (gender, education level, household income status, employment status). Multivariate-adjusted odds ratio (OR) and 95% confidence intervals (CI) were calculated. Subgroup analysis was conducted by sex. Results: 20.2% of the study population were estimated to have felt lonely at least one day a week. 52.4% of widowed individuals and 47.6% of the divorced reported being lonely. Widowed and single people were more than two times as likely to feel lonely as the married (OR=2.60 for the widowed; OR=2.43 for the single; <i>p</i><0.001). Divorce and separation increased the odds of feeling lonely (OR=4.02; 95% CI, 3.20-5.04; <i>p</i><0.001). ORs for loneliness for all non-married statuses (widowed, divorced/separated, single) were greater in men than in women. Conclusions: Loneliness is a highly prevalent public health problem in Korean adults. Marital status was strongly associated with increased risk for loneliness. Public health policies should consider targeting individuals who are more susceptible to the risk of loneliness.

The Clinical Characteristics and Epidemiology of Extramedullary Multiple Myeloma over the Past Two Decades

Background Extramedullary multiple myeloma (EMM) represents a rare and aggressive manifestation of multiple myeloma (MM) in which plasma cells survive outside of the bone marrow microenvironment, arising from a non-medullary site. EMM affects approximately 30% of MM patients and can be present at diagnosis or develop at any timepoint during the disease course [1,2]. Prior studies have demonstrated a higher incidence of high-risk cytogenetics in patients with EMM including gain 1q, translocation (4;14), translocation (14;16) and deletion 17p [3]. There is a paucity of data on clinical characteristics and overall epidemiology of EMM. The purpose of this study is to evaluate the clinical characteristics of patients with EMM over the past 2 decades, and to identify epidemiologic characteristics that may impact overall prognosis. Methods A population-based retrospective cohort study of patients with EMM was conducted using the publicly available Surveillance, Epidemiology, and End Results (SEER) database. In addition, 18 registries in the November 2020 submission database were also utilized (http://www.seer.cancer.gov). All patient-specific information within the databases have been de-identified, and therefore IRB approval was not needed to conduct this study. A total of 858 patients diagnosed with EMM, between 2000 and 2017, were ultimately enrolled in our study. We analyzed demographics, clinical characteristics, and overall mortality (OM) as well as cancer-specific mortality (CSM) of EMM. Variables with a p-value < 0.1 in the univariate Cox regression were incorporated into the multivariate Cox model to determine the independent prognostic factors, with a hazard ratio (HR) of greater than 1 representing adverse prognostic factors. All tests were two-sided, with a confidence interval set as 95% and p value <0.05 deemed statistically significant. All statistical tests were performed by using Software STATA 16.1. Results From a sample of 858 patients with EMM, male gender (63.25%), age range 60-79 years (51.05%) and non-Hispanic whites (66.78%) were the most represented. Central Nervous System (which includes leptomeningeal, intracranial and intraparenchymal involvement) and vertebral column was the most affected site (33.10%). Multivariate cox proportional hazard regression analyses only revealed higher overall mortality (OM) in age group over 80 years (HR = 9.792, 95% CI 4.403-21.774, p=0) and widowed individuals (HR = 1.609, 95% CI 1.101-2.35, p = 0.014). Multivariate cox proportional hazard regression analyses of cancer specific mortality (CSM) also revealed higher mortality of the same groups. Eyes, mouth, and ENT involvement had the lowest CSM in the multivariate analysis. Conclusions EMM is a relatively rare entity that presents in a minority of patients diagnosed with MM [1]. To our knowledge, there is scarcity of data on the clinical characteristics and epidemiology of patients with EMM. This study found that non-Hispanic whites were the most affected population, which contrasts with the overall epidemiology of Multiple Myeloma without extramedullary disease in which the black population is the most affected [4]. Patients were primarily in the 60-79-year age range, and the most commonly affected sites were CNS/vertebral column (33%), bones/soft tissues of the trunk (12.6%) and pelvis/sacrum (11.3%), and eyes/mouth/ears/nose/throat (11.7%). We found that age was the single most important prognostic factor, with older patients having worse outcomes (Table 2). Marital status and tumor location were also found to be independent prognostic factors, with widowed patients having higher mortality rates and patients with EMM affecting eyes/mouth/ears/nose/throat faring better than those with other sites affected (Table 2). We hope that the results of this study will enhance our overall understanding of the clinical presentation of this rare and aggressive manifestation of MM. In better understanding EMM, we hope to inspire larger prospective studies on the management of this subset of patients, which is particularly important in the era of novel agents including immunomodulatory agents, proteasome inhibitors, monoclonal antibodies, and, more recently, the advent of chimeric antigen receptor T-cell therapy (CAR-T) and bispecific agents.

Estimating healthcare expenditures after becoming divorced or widowed using propensity score matching.

Becoming divorced or widowed are stressful life events experienced by a substantial part of the population. While marital status is a significant predictor in many studies on healthcare expenditures, effects of a change in marital status, specifically becoming divorced or widowed, are less investigated. This study combines individual health claims data and registered sociodemographic characteristics from all Dutch inhabitants (about 17 million) to estimate the differences in healthcare expenditure for individuals whose marital status changed (n = 469,901) compared to individuals who remained married, using propensity score matching and generalized linear models. We found that individuals who were (long-term) divorced or widowed had 12-27% higher healthcare expenditures (RR = 1.12, 95% CI 1.11-1.14; RR = 1.27, 95% CI 1.26-1.29) than individuals who remained married. Foremost, this could be attributed to higher spending on mental healthcare and home care. Higher healthcare expenditures are observed for both divorced and widowed individuals, both recently and long-term divorced/widowed individuals, and across all age groups, income levels and educational levels.

Sociodemographic characterisation of antibiotic heavy users in the Danish elderly population.

The development of effective interventions to reduce inappropriate use of antibiotics in the elderly population requires knowledge on who can benefit from such interventions. Thus, we aimed to identify and characterise antibiotic heavy users among elderly patients in general practice with respect to sociodemographic variables. We conducted a retrospective nationwide register-based study on all Danish elderly citizens (⩾65 years) who redeemed an antibiotic prescription in 2017. Heavy users were defined as the 10% with the highest excess use, that is, their recorded use minus the average use for their sex, age group and comorbidity level as estimated from a linear regression model. Comparative analyses of sociodemographic characteristics (civil status, employment status, urbanity, educational level and country of origin) of heavy users and non-heavy users were performed using logistic regression models. The study population consisted of 251,733 elderly individuals, who in total redeemed 573,265 prescriptions of antibiotics. Heavy users accounted for 68% of all excess use of antibiotics. In multivariable analyses, individuals with an educational level above basic schooling, non-retired, residing in an urban municipality and being born in a country outside Scandinavia all had lower odds of being a heavy user. Widowed, divorced or single individuals had higher odds of being a heavy user compared with married individuals. Relative importance analyses showed that civil status and educational level contributed considerably to the explained variance. This study found an association between sociodemographic characteristics and risk of being a heavy user, indicating that sociodemographic variation exists with regard to antibiotic prescribing.

Contribution of insurance status to the association between marital status and cancer-specific survival: a mediation analysis

ObjectivesTo evaluate the extent to which marriage influences cancer-specific survival (CSS) by influencing the insurance status among patients with common solid cancers and the feasibility of reducing the survival gap...

Spatial distribution and determinants of HIV prevalence among adults in urban Ethiopia: Findings from the Ethiopia Population-based HIV Impact Assessment Survey (2017–2018)

The design and evaluation of national HIV programs often rely on aggregated national data, which may obscure localized HIV epidemics. In Ethiopia, even though the national adult HIV prevalence has decreased, little information is available about local areas and subpopulations. To inform HIV prevention efforts for specific populations, we identified geographic locations and drivers of HIV transmission. We used data from adults aged 15-64 years who participated in the Ethiopian Population-based HIV Impact Assessment survey (October 2017-April 2018). Location-related information for the survey clusters was obtained from the 2007 Ethiopia population census. Spatial autocorrelation of HIV prevalence data were analyzed via a Global Moran's I test. Geographically weighted regression analysis was used to show the relationship of covariates. The finding indicated that uncircumcised men in certain hotspot towns and divorced or widowed individuals in hotspot woredas/towns might have contributed to the average increase in HIV prevalence in the hotspot areas. Hotspot analysis findings indicated that, localized, context-specific intervention efforts tailored to at-risk populations, such as divorced or widowed women or uncircumcised men, could decrease HIV transmission and prevalence in urban Ethiopia.

Prevalence and Predictors of Self-medication Practice among Adults Residing in the Rural Field Practice Area of a Tertiary Care Hospital in Chandigarh

Introduction : Self-medication is a harmful practice. There is a need to document its prevalence and educate people about its numerous dangers. This study assessed the prevalence of self-medication practice and its associated factors among adults. Method: This community based cross-sectional study was conducted among 1090 adults. A simple random sampling technique was used to select the study participants. A pre-tested interview schedule was used to collect data regarding self-medication practice and its associated factors. The data was analysed using Epi-info software for windows (CDC Atlanta). Results:The prevalence of self-medication was 18.6%. The most common symptom for which study participants practised self-medication was fever (58.6%). Previous experience was the most common reason for practising self-medication (59.0%). The bivariate analysis revealed that the self-medication practice was significantly more among those aged 50 years and above and widowed individuals; as compared to their counterparts. Conclusion: Nearly one-fourth of the adults practised self-medication. Interventions should be designed to discourage self-medication practice among adults, with a particular focus on those aged above 50 years and widowed individuals.

Spousal loss and cognitive function: the importance of gender and multiple dimensions of marital quality

Objectives: Research suggests that the death of a spouse has an adverse effect on a widow(er)’s cognition. However, little research has examined how the marital context before widowhood and gender influence this association. Guided by the social ambivalence and disease (SAD) model, this study examined the associations between spousal loss and cognition , with moderating effects of gender and pre-loss marital quality. Method: We analyzed a national longitudinal data, Midlife in the United States (MIDUS), specifically MIDUS 2 (2004-2005) and MIDUS 3 (2013-2014). The analytic sample consisted of (1) 146 participants who experienced the death of their spouse between MIDUS 2 and MIDUS 3 and (2) 144 age- and gender-matched comparison participants who did not lose their spouse during the period. Results: Adverse influence of widowhood on cognition was more pronounced among bereaved men than bereaved women. Widowed individuals whose relationships with their deceased spouse were ambivalent had poorer cognition than widowed individuals who had aversive relationships with their deceased spouse. Conclusion: Findings suggest that the influence of spousal death on cognitive functioning depends on gender and pre-loss marital quality, emphasizing the importance of considering pre-loss marital relationship and gender dynamics in developing efficient interventions for the widowed.

Marital Status and Subclinical Coronary Atherosclerosis in Asymptomatic Individuals.

BackgroundData are limited on the association between marital status and subclinical coronary atherosclerosis. This study investigated the influence of marital status on subclinical coronary atherosclerosis detected by coronary computed tomographic angiography in an asymptomatic population.Methods and ResultsThis retrospective study analyzed 9288 asymptomatic individuals (mean age, 53.7±8.0 years; 6041 [65%] men) with no history of coronary artery disease who voluntarily underwent coronary computed tomographic angiography during a general health examination. Marital categories were married (n=8481) versus unmarried (n=807), comprising never married (n=195), divorced (n=183), separated (n=119), and widowed (n=310) individuals. The degree and extent of subclinical coronary atherosclerosis were evaluated by coronary computed tomographic angiography; ≥50% diameter stenosis was defined as significant. Logistic regression and propensity score matching analyses were used to determine the association between marital status and subclinical coronary atherosclerosis. After adjustment for cardiovascular risk factors, no significant differences were observed in the adjusted odds ratio (OR) of unmarried status for any coronary plaque (OR, 1.077; 95% CI, 0.899–1.291), calcified plaque (OR, 1.058; 95% CI, 0.881–1.271), noncalcified plaque (OR, 0.966; 95% CI, 0.691–1.351), mixed plaque (OR, 1.301; 95% CI, 0.884–1.917), and significant coronary artery stenosis (OR, 1.066; 95% CI, 0.771–1.474). Similarly, in the 2:1 propensity‐score matched population (n=2398), no statistically significant differences were observed for the OR of marital status for any subclinical coronary atherosclerosis (P>0.05 for all).ConclusionsIn this large cross‐sectional study, marital status was not associated with an increased risk of subclinical coronary atherosclerosis.

Exploring the Effects of Gender Differences and Widowhood Status on the Days Spent in Poor Health: A Secondary Data Analysis from India.

The majority of research in India has focused on the impact of widowhood on health status and health care use, while little emphasis has beenpaid to the number of days spent in poor health among widowed population compare to other marital categories. Thus, the current study explores the relationship between widowhood and days spent with poor health outcomes among adultsin India. Additionally, gender differences in the relationship between widowhood and days with poor health outcomes are further studied.The research employed nationally representative cross-sectional data from the 75th round (2017-2018) of the National Sample Survey (NSS). To investigate the associations of marital status (married vs widowed) and other factors with days spent in poor health, a negative binomial regression model was used. Additionally, the interaction model of age and widowhood was estimated separately for men and women.The findings suggest that widowed individuals had consistently prolonged days with an illness, limited activity, and confinement to bed. After adjusting for socioeconomic and demographic characteristics, the findings suggested that widowed women (IRR = 1.141, 95% Confidence interval = 1.01-1.29) were more likely to spend days with limited acitivitiesthan married women. The marital status-age interaction indicated that older widowed women were more likely to have days of restricted activity and confinement to bed than married women, but such link is absent for men.In India, the elderly widow often spends her days confined to bed and prolonged days with limited activity. Policymakers and practitioners in public health should develop effective policies and programmes to enhance the health and well-being of widowed women, particularly those from socioeconomically disadvantaged backgrounds.

Social Isolation, Social Support, and Loneliness Profiles Before and After Spousal Death and the Buffering Role of Financial Resources.

ObjectivesWe provide new evidence on the profiles of social isolation, social support, and loneliness before and after spousal death for older widows. We also examine the moderating effects of gender and financial resources on changes in social health before and after widowhood.MethodsWe use 19 waves of data from the Household, Income and Labour Dynamics in Australia Survey, including 749 widowed individuals and a comparison group of around 8,000 married individuals. We apply coarsened exact matching weights and control for age and time trends. Local polynomial smoothed plots show the profiles of social health from 3 years pre- to 3 years postspousal death. All analyses were stratified by gender.ResultsSpousal death was strongly associated with increased loneliness for women and men, but also an increase in interactions with friends and family not living with the bereaved. For men, financial resources (both income and asset wealth) provided some protection against loneliness. Spousal death was not associated with changes in social support or participation in community activities.DiscussionWe demonstrate that loneliness is a greater challenge of widowhood than social isolation or a lack of social support. Our findings suggest that interventions focusing only on increasing social interactions are unlikely to alleviate loneliness following spousal death. Moreover, policies that reduce the cost of formal social participation may have limited effectiveness in tackling loneliness, particularly for women. Alternative strategies, such as helping the bereaved form a new sense of identity and screening for loneliness around widowhood by health care workers, could be beneficial.

Keeping up with the Wangs: individual and contextual influences on mental wellbeing and depressive symptoms in China

BackgroundIn recent decades, China has experienced dramatic changes to its social and economic environment, which has affected the distribution of wellbeing across its citizens. While several studies have investigated individual level predictors of wellbeing in the Chinese population, less research has been done looking at contextual effects. This cross-sectional study looks at the individual and contextual effects of (regional) education, unemployment and marriage (rate) on individual happiness, life satisfaction and depressive symptomatology.MethodsData were collected from over 29,000 individuals (aged 18 to 110, 51.91% female) in the China Family Panel Studies, and merged with county level census data obtained from the 2010 China Population Census and Statistical Yearbook. To explore contextual effects, we used multilevel models accounting for the hierarchical structure of the data.ResultsWe found that a one-year increase in education was associated with a 0.17% increase in happiness and a 0.16% decrease in depressive symptoms. Unemployed men were 1% less happy, 1% less satisfied with life and reported 0.84% more depressive symptoms than employed men while minimal effects were seen for women. Single, divorced and widowed individuals had worse outcomes than married individuals (ranging from 2.96 to 21% differences). We found interaction effects for education and employment. Less educated individuals had greater happiness and less depressive symptoms in counties with higher average education compared to counterparts in less educated counties. In contrast, more educated individuals were less satisfied with life in more educated counties, an effect that is possibly due to social comparison. Employed individuals had lower life satisfaction in areas of high unemployment, while levels were constant for the unemployed. A 1% increase in county marriage rate was associated with 0.33 and 0.24% increases in happiness and life satisfaction respectively, with no interactions. We speculate that this effect could be due to greater social cohesion in the neighbourhood.ConclusionsOur results show that policies designed to improve employment and marriage rates will be beneficial for all, while interventions to encourage positive social comparison strategies may help to offset the negative effects of increasing neighbourhood average education on the highly educated.

Factors Contributing to Persistent Frequent Attendance in Primary Care Among the Oldest Old: Longitudinal Evidence From the AgeCoDe-AgeQualiDe Study.

ObjectiveSince there is a lack of longitudinal studies in this area, our aim was to identify the determinants of persistent frequent attendance in primary care among the oldest old in Germany.MethodsLongitudinal data (follow-up wave 7–9) were taken from the multicenter prospective cohort “Study on needs, health service use, costs, and health-related quality of life in a large sample of oldest-old primary care patients (85+)” (AgeQualiDe), covering primary care patients ≥ 85 years (FU7 n = 741, mean age 88.9 years (SD 2.9; 85–100)). Persistent frequent attenders of general practitioner (GP) services (the patients in the top decile of the number of GP consultations in two or more consecutive waves) were our main outcome of interest. Logistic random-effects models were used.ResultsOur analysis included 1,891 observations (766 individuals). Across three waves, we identified 56 persistent frequent attenders. Results of random-effects logistic regressions showed that the odds of being persistent frequent attender were higher for widowed individuals (OR = 4.57; 95% CI [1.07–19.45]). Moreover, a one-point increase in the frailty score and having one more chronic condition increased the odds of being a persistent frequent attender by 68% (OR =1.68; 95% CI [1.05–2.69]) and 23% (OR=1.23, 95% CI [1.05–1.44]), respectively.ConclusionOur study stressed the longitudinal association between frailty and widowhood as well as chronic diseases and persistent frequent attendance among the oldest old in Germany.

Widowhood and Life Satisfaction Among Chinese Elderly Adults: The Influences of Lifestyles and Number of Children.

Our study examined how lifestyle and number of children influence the relationship between widowhood and life satisfaction based on self-regulation theory. A sample of 2,968 elderly respondents (male = 1,515, female = 1,453, mean age = 69.12 years, SD = 7.24) participated in Chinese General Social Survey. Our findings suggest that lifestyle is positively related to life satisfaction, and number of children is positively associated with life satisfaction but negatively related to lifestyle. The moderated mediation model demonstrated that lifestyle partly mediated the relationship between widowhood and life satisfaction. Moreover, number of children moderated the relationship between widowhood and lifestyle and between lifestyle and satisfaction with life. Widowed elderly individuals who have more children are likely to show a higher level of satisfaction with life. The present study has significance in practice because it provides empirical implications obtained from a national survey on the universal two-child policy in China as two children might decrease the negative impacts of widowhood on life satisfaction.

Psychosocial trajectories before and after spousal loss: Does gender matter?

RationalePrior studies have suggested that spousal loss can have negative impacts on widowed persons’ lives. However, few studies have examined whether time since spousal loss is related to changes in psychosocial outcomes and there are gender differences in psychosocial trajectories in response to spousal loss. ObjectiveThis study examines the psychosocial trajectories (depressive symptoms and social engagement) of widowed individuals before and after spousal death. This study also investigates whether psychosocial adjustment trajectories, among individuals who experienced spousal loss, are gendered. MethodsThis study uses data from 685 middle- and older-aged adults over seven waves (4284 person-observations) of the Korean Longitudinal Study of Ageing spanning 12 years between 2006 and 2018. This study estimates fixed effects models to account for observed and unobserved individual-level heterogeneity. Gender-stratified fixed effects regression models are used to investigate whether psychosocial changes associated with spousal loss differ by gender. ResultsPsychosocial adjustment to spousal loss is strikingly gendered. Among men, depressive symptoms began to increase within the first year following spousal loss and continued through the fourth and subsequent years. In contrast, depressive symptoms among widows did not change significantly during and after bereavement. Similar patterns were found for social engagement. Among men, a decrease in frequency of social interactions and participation in social activities was found from the first year of spousal loss to the fourth and subsequent years. No such patterns were found for women. ConclusionSpousal loss is a life event that spurs tremendous psychosocial changes for widowed people. This study suggests that spousal loss-associated psychosocial changes occur over a long period of time and are greater in men than in women.

Online Gaming and Well-Being in the English Longitudinal Study of Ageing

Play is considered an important contributor to healthy ageing. Using data from 3,067 participants aged 50+ from the English Longitudinal Study of Ageing, we explored online gaming assessed at wave 6 (2012/13) and quality-of-life, loneliness, and depression at wave 9 (2018/19). Covariates were age, sex, marital status, education, work status, depression, self-rated health, physical activity, smoking and alcohol consumption. We found that 22% of respondents engaged in gaming. Interaction analyses indicated that for younger individuals (<65 years), gaming predicted lower scores in the self-realization sub-scale of the quality-of-life scale in comparison to older gamers. Furthermore, there was a significant association between gaming and lower quality-of-life for widowed individuals only, particularly in terms of autonomy, self-realization, and pleasure. There were non-significant associations between gaming and loneliness and depression. Online gaming might be independently associated with lower levels of quality of life, especially for younger and widowed adults.

Sleep, Lifestyle, and Socioeconomic Markers of Mental Aging and Well-Being: Lessons From England, China, and Japan

Healthy ageing has become a popular topic worldwide. We investigated the role of sleep, leisure activities, and socioeconomic inequalities in relation to cognitive decline, wellbeing, and quality of life in data from the English Longitudinal Study of Ageing (ELSA), Chinese Health and Retirement Longitudinal Study (CHARLS), and Japanese Study of Aging and Retirement (JSTAR), national representative samples of England, China and Japan, respectively. We found an inverted U-shaped association between sleep quality and memory in English adults and a positive dose-response association in Chinese older adults (Brocklebank). In another examination, we found that younger English individuals playing games had lower quality-of-life than older participants who game, and this association is more pronounced for widowed individuals than others (Almeida-Meza). Cognitive impairment and dementia represent significant challenges worldwide. In a cross-country investigation, we found that the prevalence of MCI was twice as great in England compared with Japan, but that the two nations differ slightly across socioeconomic correlates (Gireesh). In another cross-country comparison between England and China, we found that the rate of memory change appeared socioeconomically patterned, primarily by education and area-based characteristics (urban vs. rural), with a more substantial impact on rural China inequalities compared to England (Cadar). Our results indicate more robust educational and geographical disparities in China and increased occupational impact among English and Japanese participants. Our findings highlight the imperative need for policy interventions and tailored strategies to protect those particularly disadvantaged in England and China.

Factors Leading to Institutionalization among the Oldest Old: Longitudinal Findings from the AgeCoDe-AgeQualiDe Study

Introduction: Due to the strong association between old age and the need for long-term care, the number of individuals in need for care is projected to increase noticeably. The aim of this study was to examine the determinants of institutionalization among the oldest old longitudinally. Methods: Longitudinal data (follow-up [FU] wave 7–9) were gathered from a multicenter prospective cohort study (“Study on needs, health service use, costs and health-related quality of life in a large sample of oldest old primary care patients [85+],” AgeQualiDe). At FU wave 7, in 2014, complete measures were available for 763 individuals. The average age was 88.9 (standard deviation 2.9) years (range 85–100), and 68% were female. Sociodemographic and health-related independent variables (e.g., depressive symptoms or functioning) were included in the regression model. Institutionalization (admission to assisted living home or nursing home) was used as an outcome measure. Logistic random-effects models were used. Results: Regressions revealed that among oldest old, the odds of being institutionalized were lower for men (odds ratio [OR] = 0.03; 95% confidence interval [CI] 0.00–0.16). Institutionalization was associated with an increased age (OR = 1.27; 95% CI 1.04–1.55). Additionally, widowed individuals (ref. non-widowed) had higher odds of being institutionalized (OR = 8.95; 95% CI 1.61–49.81). Institutionalization was also associated with functional decline (OR = 0.16; 95% CI 0.11–0.23), whereas it was not significantly associated with cognitive decline, depressive symptoms, and social support. Conclusion: Our findings stress the importance of gender, age, widowhood, and functional decline for institutionalization among the oldest old. Preventing or at least postponing functional decline might help to delay institutionalization as far as possible.