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Sleep, Stress, and Symptoms Among People With Heart Failure During the COVID-19 Pandemic.
O'Connell, M, Jeon, S, Conley, S, Linsky, S, Redeker, NS
The Journal of cardiovascular nursing. 202301;38(2):E55-E60
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COVID-19 pandemic raised concerns about the effects of stress on mental health and sleep deficiency. Cognitive behavioural therapy for insomnia (CBT-I) has been shown to improve sleep quality and insomnia severity, as well as anxiety and depression, and may be protective during times of stress, including the COVID-19 pandemic. The aim of this study was to examine changes in sleep, sleep-related cognitions, stress, anxiety, and depression among people with heart failure (HF). This study was a randomised controlled trial of the effects of CBT-I compared with HF self-management education (attention-control condition), the “HeartSleep Study.” Results showed that improvements in insomnia severity, sleep quality, latency, and efficiency, sleep-related cognitions and stress, anxiety, and depression after participation in CBT-I or an HF self-management class were sustained during the pandemic. Authors conclude that their findings confirm the clinical benefits of CBT-I for people with HF and comorbidities and also suggest the potential benefits of HF self-management education.
Abstract
BACKGROUND The COVID-19 pandemic raised concerns about the effects of stress on sleep and mental health, particularly among people with chronic conditions, including people with heart failure (HF). OBJECTIVE The aim of this study was to examine changes in sleep, sleep-related cognitions, stress, anxiety, and depression among people with HF who participated in a randomized controlled trial of cognitive behavioral therapy for insomnia before the COVID-19 pandemic. METHODS Participants self-reported sleep characteristics, symptoms, mood, and stress at baseline, 6 months after cognitive behavioral therapy for insomnia or HF self-management education (attention control), and during the pandemic. RESULTS The sample included 112 participants (mean age, 63 ± 12.9 years; 47% women; 13% Black; 68% New York Heart Association class II or III). Statistically significant improvements in sleep, stress, mood, and symptoms that occurred 6 months post treatment were sustained during the pandemic. CONCLUSIONS Improving sleep and symptoms among people with HF may improve coping during stressful events, and cognitive behavioral therapy for insomnia may be protective.
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Yoga or Mindfulness on Diabetes: Scoping Review for Theoretical Experimental Framework.
Cangelosi, G, Acito, M, Grappasonni, I, Nguyen, CTT, Tesauro, M, Pantanetti, P, Morichetti, L, Ceroni, E, Benni, A, Petrelli, F
Annali di igiene : medicina preventiva e di comunita. 2024;36(2):153-168
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Diabetes is a prevalent chronic disease affecting millions of people worldwide. With the predicted rise in diabetes cases, alternative approaches to managing this condition are essential. This study aimed to evaluate yoga or mindfulness interventions on diabetic subjects. This study was a scoping review analysing qualitative-quantitative data from selected randomised controlled trials (12 on mindfulness, 9 on yoga, and 1 combining both disciplines). Results showed that yoga and mindfulness showed strong potential not only for stress management but also for improving clinical-metabolic parameters. In fact, practicing yoga was associated with better glycaemic control, lipid profiles, and overall body composition in adult diabetic patients. Authors concluded that alternative practices such as yoga and mindfulness could support traditional treatments and promote a holistic approach to self-care of diabetes.
Abstract
BACKGROUND About one in 11 adults worldwide suffers from diabetic disease with constantly increasing prevalence; from the 529 million patients registered in 2021, the number of people with diabetes was predicted to rise to approximately 1.31 billion in 2050. In Italy, 5.9% of the population is diabetic, with a higher prevalence with increasing age and in the South of the country. Yoga and Mindfulness could represent a valid support for the care of diabetic subjects especially in a stressful caring context such as the Covid-19 pandemic. STUDY DESIGN A scoping review was conducted to achieve the goals of the study. Yoga or Mindfulness interventions on diabetic subjects were specifically analyzed and qualitative-quantitative data collected in the selected randomized controlled trials were extensive for possible meta-analysis. METHODS The review was conducted by two independent practitioners and a third one was consulted in case of conflict. The PRISMA method was used for both the selection and reporting of the studies to be included. Specific PICOS and search strategies have been developed on PubMed, Embase and PsycINFO databases. Included in the review were: randomised controlled trials, full dissertation articles and papers in English with a time limit on May 31, 2022. RESULTS The Review included 22 studies; 12 on Mindfulness, 9 on Yoga and one about both disciplines; among these, one studied patients with Type 1 Diabetes, 14 with Type 2 Diabetes, 6 with both and one with Gestational Diabetes. Only one paper studied adolescent subjects while the other 21 focused on a range of adult subjects. The studies showed that Yoga and Mindfulness have strong potential not only on stress management, but also on clinical-metabolic parameters. CONCLUSIONS The recent Covid-19 pandemic has certainly redesigned a new way of treating and managing chronic diseases, such as diabetes. An increasingly fragile population, and with the growing need to reduce overall stress levels, could find alternative practices in Yoga and Mindfulness to support conventional therapies.
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Effectiveness of Sports Nutrition Education Based on Self-Determination Theory for Male University Rowing Athletes: A Randomized Controlled Trial.
Enatsu, N, Seino, J, Tsuji, T, Ogata, M
Nutrients. 2024;16(6)
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Rowing is a competitive sport that requires both anaerobic and aerobic capacity. Although a race lasts only 6–8 min, daily practice sessions are long. In addition, there are lightweight and heavyweight categories, which require different body masses and compositions, requiring individualised nutritional strategies and plans. This study aimed to assess the effectiveness of sports nutrition education based on self-determination theory (SDT). This study was a randomised controlled trial that enrolled male athletes. Participants were randomly assigned to one of the two groups: the intervention group (SDT group) or the control group. Results showed that overall, there were no significant differences between the two groups. However, within the SDT group, participants showed improved knowledge related to protein intake, and increased consumption of green and yellow vegetables, fruits, and dairy products. Authors concluded that SDT-informed sports nutrition education, through improvement in nutrition knowledge, can potentially lead to the practice and continuation of improved eating behaviours.
Abstract
To resolve problems in the dietary life of university athletes, education is essential to enable athletes to change their own dietary behavior. The purpose of this research was to verify the effectiveness of sports nutrition education based on self-determination theory (SDT). The participants were 36 male university rowers. A stratified randomized comparison test was conducted by student year (SDT group and control group). Sports nutrition education was held three times, via an Internet conferencing system. Furthermore, group work over social media was used for the SDT group. Four evaluations were carried out based on anthropometric measurements, a brief self-administered diet history questionnaire (BDHQ), sports nutrition knowledge test (SNK), and treatment self-regulation questionnaire (TSRQ). The results showed no differences between the two groups. However, for the intragroup factor, "Protein", a significant difference was evident in the self-determination theory group (50.0 ± 28.5, 78.6 ± 28.1, 81.0 ± 21.5, p < 0.000, units: %) and improved knowledge (p = 0.002, p = 0.002). And for the BDHQ, the self-determination theory group also showed significant differences and increased their intake of green and yellow vegetables, fruits, and dairy products (159.1 ± 74.2-126.7 ± 70.6, p = 0.009, 306.0 ± 196.2-195.2 ± 146.1, p = 0.020, 257.0 ± 147.0-183.3 ± 167.9, p = 0.040, units: g). In conclusion, sports nutrition education based on SDT improved dietary knowledge and increased food requirements for athletes.
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The Impact of Daytime Napping Following Normal Night-Time Sleep on Physical Performance: A Systematic Review, Meta-analysis and Meta-regression.
Boukhris, O, Trabelsi, K, Suppiah, H, Ammar, A, Clark, CCT, Jahrami, H, Chtourou, H, Driller, M
Sports medicine (Auckland, N.Z.). 2024;54(2):323-345
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In order to attain peak performance, optimisation of the recovery process is important, with sleep being one of the crucial components, especially for athletes. Indeed, while healthy adults are encouraged to sleep 7–9 h per night, it has been recommended that athletes obtain 9–10 h of sleep per night for optimal recovery. This study aimed to evaluate the effect of daytime napping following normal night-time sleep on physical performance in physically active individuals and athletes. This study was a systematic review, meta-analysis, and meta-regression of sixteen articles. Results showed that napping improved performance in the 5-m shuttle run test (5MSRT), with increases in highest distance and total distance, and a decrease in fatigue index. However, napping had no significant effect on muscle force and showed mixed results for sprint performance, jump performance, and upper-body power performance. Authors concluded that daytime napping following normal night-time sleep can enhance certain aspects of physical performance, particularly in the 5MSRT. However, its effects on other performance measures remain inconclusive due to the limited number of studies.
Abstract
BACKGROUND Daytime napping is used by athletes as a strategy to supplement night time sleep and aid physical performance. However, no meta-analytical overview regarding the impact of napping following a night of normal sleep (7-9 h) on physical performance is available. OBJECTIVE The aim of this study was to evaluate the effect of daytime napping following normal night-time sleep on physical performance in physically active individuals and athletes. METHODS This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Seven electronic databases (i.e., PubMed, Web of Science, Scopus, SPORTDiscus, CINAHL, SCIELO, and EBSCOhost) were used to search for relevant studies that investigated the impact of daytime napping, following normal night-time sleep, on physical performance in physically active individuals and athletes, published in any language, and available before September 01, 2022. Studies that included assessments of any physical performance measures were included. QualSyst was used to assess the methodological quality of the studies. RESULTS Of 18 selected articles, 15 were of strong quality and 3 were of moderate quality. Compared with no-nap conditions, physically active individuals and athletes who napped experienced an increase in highest distance (effect size [ES] 1.026; p < 0.001) and total distance (ES 0.737; p < 0.001), and a decrease in fatigue index (ES 0.839, p = 0.008) during the 5-m shuttle run test (5MSRT). However, napping yielded no effect on muscle force (ES 0.175; p = 0.267). No effect of napping was found in one study that measured sprint performance and in two studies that measured performance during the 30-s Wingate test. Two of three studies reported an increase in jump performance after napping. Two of three studies reported an increase in repeated sprints after napping. One study reported an increase in upper-body power performance after napping, and napping was beneficial for endurance performance in one of two studies. CONCLUSION Following normal sleep, napping is beneficial for the performance of the 5MSRT, with no significant effect on muscle force. No firm conclusions can be drawn regarding other physical performance measures due to the limited number of studies.
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Thyroid function spectrum in Cushing's syndrome.
Yu, P, Yuan, H, Chen, H, Li, X
BMC endocrine disorders. 2024;24(1):80
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Cortisol is a hormone that is essential for health, but too much can be detrimental to health. Cushing’s syndrome (CS) can result from too much cortisol and may affect thyroid function. This cross-sectional study of 129 individuals aimed to determine thyroid function in individuals with CS. The results showed that up to 48.6% of individuals had lower than normal thyroid hormone levels and that cortisol levels correlated with thyroid hormone levels. It was concluded that thyroid hormone levels are suppressed in individuals with CS, which may be due to the possibility that thyroid hormone and cortisol levels are related. This study could be used by healthcare professionals to understand that there is a close relationship between CS and poor thyroid function and there may be some merit to test for both conditions simultaneously.
Abstract
PURPOSE Thyroid disorders have been reported in hypercortisolism patients. Endogenous Cushing's syndrome (CS) potentially complicates its metabolic sequelae. We investigated thyroid function in CS patients to determine this relationship. METHODS In this cross-sectional study, we screened CS patients from 2016 to 2019 at our hospital. Patient demographic, medical history, and laboratory data were collected. Additionally, we performed a meta-analysis to demonstrate the prevalence of thyroid dysfunction in patients with CS. RESULTS Among 129 CS patients, 48.6% had triiodothyronine (TT3), 27.9% had thyroxine (TT4), 24.6% had free T3 (FT3), 27.7% had free T4 (FT4), and 6.2% had thyroid-stimulating hormone (TSH) levels below the reference values. Those with clinical CS showed more pronounced thyroid suppression than did those with subclinical CS. Cortisol levels were markedly greater in patients with pituitary hypothyroidism (P < 0.001). Serum cortisol levels throughout the day and post low-dose dexamethasone-suppression test (LDDST) results correlated with thyroid hormone levels, particularly in ACTH-independent CS. Correlations varied by thyroid status; FT3 and TSH were linked to cortisol in euthyroid individuals but not in those with low T3 or central hypothyroidism. TSH levels notably halved from the lowest to highest cortisol tertile post-LDDST. Finally, meta-analysis showed 22.7% (95% CI 12.6%-32.9%) central hypothyroidism in 528 CS patients of nine studies. CONCLUSION Thyroid hormone levels are significantly correlated with cortisol levels and are impaired in patients with CS. However, the physiological adaptation and pathological conditions need further study.
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Treatment of functional bowel disorders in an integrative medicine clinic resulting in improved digestive tract symptoms.
Wagner, LE, Bridges, KM, Hinman, JM, He, J, Buckles, D, Dunn, W, Drisko, J, Sullivan, DK, Carlson, SE
JGH open : an open access journal of gastroenterology and hepatology. 2024;8(1):e13022
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Functional bowel disorders (FBDs), including irritable bowel syndrome (IBS), are conditions without a physically identifiable cause and as a result, are difficult to treat, require more physician time and impact patients' quality of life. They are linked to disordered gut-brain interactions, and diagnosis is based on patient-reported gastrointestinal symptoms in the absence of detectable physical abnormalities. The holistic approach of integrative medicine (IM) presents an interesting avenue for FBD management. This retrospective review assessed the outcome of 57 IM clinic patients, who were diagnosed with FBDs (constipation or diarrhoea-dominant IBS, mixed IBS, functional diarrhoea/constipation/ bloating). Characteristic of IM approaches the interventions were tailored specifically to the individual needs, deploying a group of therapies, including elimination diets, vitamin or mineral supplementation, magnesium supplementation, GI-related supplementation, fermented foods, hydration, non-diet lifestyle modification, referrals and GI-related medication. Symptoms were measured using a medical symptom questionnaire (MSQ). Post-intervention (average 8.75 months) most patients (75.4%) experienced an improvement in digestive symptoms. The most common intervention was an elimination diet (predominantly gluten, grains, dairy or casein), followed by supplementation. The findings suggest that IM interventions, particularly dietary changes, can effectively alleviate symptoms in FBD patients, especially for diarrhoea-dominant conditions. They also showed that less strict elimination diets may be equally effective and easier to adhere to than a low FODMAP diet. Limitations of the study included its retrospective nature, small sample size, and difficulty in comparing interventions due to their individualised nature. In addition, self-paying patients may have been more motivated to comply. A small number of patients did not experience changes and possible reasons are discussed, acknowledging that organic GI diseases were not ruled out. Future research should explore the effectiveness of dietary interventions further and consider using more IBS-specific measuring tools, as an interdisciplinary approach may be beneficial in managing FBDs effectively.
Abstract
BACKGROUND AND AIM Functional bowel disorders (FBDs), including irritable bowel syndrome (IBS) and others, are conditions without a physically identifiable etiology that, as a result, are difficult to treat. Alternatives to traditional medical interventions are needed because IBS patients require more of physician time and higher healthcare spending. The goal of this study was to determine the efficacy of alternative lifestyle interventions for patients with FBDs seen in an integrative medicine (IM) clinic at an academic medical center. METHODS We performed a retrospective chart review to determine whether patients with FBDs had improvement in symptoms following predominantly nutrition-based IM interventions that included recommendations for dietary supplements and elimination diets. We measured symptoms before and after intervention (average time between measurements 8.75 months) using a medical symptoms questionnaire (MSQ) commonly used to quantify symptom change in IM clinics. RESULTS Digestive tract symptoms, as measured by the MSQ, improved significantly in patients (n = 57) with FBDs following IM intervention. The MSQ Digestive Tract subtotal for FBD patients decreased from 10.2 (SD, 5.4) to 7.2 (SD, 5.2) (P < 0.001) after IM intervention. CONCLUSIONS Patients in an IM clinic had improved digestive tract symptoms scores following IM intervention. Because nutrition-based interventions were the primary intervention recommended by IM providers, primary care physicians and gastroenterologists may wish to consider referring FBD patients to registered dietitian-nutritionists (RDNs) skilled in implementing elimination diets.
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Effect of mindfulness-based stress reduction (MBSR) program on depression, emotion regulation, and sleep problems: A randomized controlled trial study on depressed elderly.
Javadzade, N, Esmaeili, SV, Omranifard, V, Zargar, F
BMC public health. 2024;24(1):271
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Depression and sleep issues are prevalent among elderly people due to cognitive and physical decline in old age which may affect the quality of their life. Psychological therapies such as Mindfulness-based stress reduction (MBSR) may help to reduce stress and improve emotional regulation and the quality of life in elderly people. This randomised controlled trial included sixty elderly patients with depression residing in nursing homes. After eight MBSR weekly intervention sessions, the elderly participants experienced significant improvement in depression, sleep issues and emotional regulation. Healthcare professionals can use the findings of this study to understand how MBSR can positively impact the psychological well-being of elderly individuals. Further robust studies are required to ensure the generalisability of the MBSR therapeutic strategies.
Abstract
BACKGROUND Entering old age is associated with various physical and psychological disabilities. Therefore, the aim of this study is to determine the effect of mindfulness-based stress reduction program on emotion regulation and sleep problems in depressed elderly. METHODS This study was a clinical trial conducted on 60 elderly individuals with depression using purposive sampling. These elderly were referred by geriatricians and were included in the study based on the inclusion criteria. The participants were randomly assigned to two groups: the Mindfulness-Based Stress Reduction (MBSR) group and the control group. Both groups completed the Geriatric Depression Scale (GDS), the Gratz and Roemer Emotion Regulation Questionnaire, and the Pittsburgh Sleep Quality Index before and after the intervention. The MBSR sessions were held for the experimental group in 8 sessions of 90 min each, once a week. Finally, all the data were analyzed using SPSS software version 26 through descriptive and analytical statistics such as mean and standard deviation, t-tests and mixed analysis of covariance (ANCOVA) with repeated measures. RESULTS The results showed that the MBSR intervention led to a significant reduction in depression symptoms (p < 0.001) and improvement in emotion regulation and sleep quality (p < 0.001) among the elderly participants with depression in the intervention group. DISCUSSION The results of this study showed that MBSR can be effective in reducing depression levels, improving emotion regulation, and sleep quality among depressed elderly individuals compared to the control group. Caregivers and psychotherapists of nursing homes can use care programs such as MBSR program to improve the physical and mental condition of the elderly. TRIAL REGISTRATION First Registration: 13/01/2022, Registration Number: IRCT20211118053099N1, Access: https://www.irct.ir/trial/61207 .
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Exercise intervention in middle-aged and elderly individuals with insomnia improves sleep and restores connectivity in the motor network.
Chen, R, Wang, S, Hu, Q, Kang, N, Xie, H, Liu, M, Shan, H, Long, Y, Hao, Y, Qin, B, et al
Translational psychiatry. 2024;14(1):159
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Insomnia is highly prevalent in older adults. Exercise intervention has been recognized as a potential treatment to improve sleep. The most frequent exercise intervention includes aerobic and resistance exercise. The aim of this study was to identify the effects of a 12-week exercise program on sleep quality and brain functional connectivity in middle-aged and older adults with insomnia. This study was a randomised controlled trial. Ninety-two participants were randomly assigned to one of the two groups (exercise vs control group). Results showed that middle-aged and older adults with insomnia had decreases in both subjective and objective sleep quality. At the level of brain circuits, individuals with insomnia exhibited reduced connectivity within the extensive motor network. Following the exercise intervention, participants in the exercise group reported an improvement in sleep quality. Authors concluded that exercise intervention improved insomnia symptoms and motor network connectivity. Additionally, they underscore the potential to enhance sleep quality and promote brain plasticity in aging individuals through exercise intervention.
Abstract
Exercise is a potential treatment to improve sleep quality in middle-aged and elderly individuals. Understanding exercise-induced changes in functional plasticity of brain circuits that underlie improvements in sleep among middle-aged and older adults can inform treatment of sleep problems. The aim of the study is to identify the effects of a 12-week exercise program on sleep quality and brain functional connectivity in middle-aged and older adults with insomnia. The trial was registered with Chinese Clinical Trial Register (ChiCTR2000033652). We recruited 84 healthy sleepers and 85 individuals with insomnia. Participants with insomnia were assigned to receive either a 12-week exercise intervention or were placed in a 12-week waitlist control condition. Thirty-seven middle-aged and older adults in the exercise group and 30 in the waitlist group completed both baseline and week 12 assessments. We found that middle-aged and older adults with insomnia showed significantly worse sleep quality than healthy sleepers. At the brain circuit level, insomnia patients showed decreased connectivity in the widespread motor network. After exercise intervention, self-reported sleep was increased in the exercise group (P < 0.001) compared to that in the waitlist group. We also found increased functional connectivity of the motor network with the cerebellum in the exercise group (P < 0.001). Moreover, we observed significant correlations between improvement in subjective sleep indices and connectivity changes within the motor network. We highlight exercise-induced improvement in sleep quality and functional plasticity of the aging brain.
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The impact of cognitive behavioural therapy-based psychological intervention on emotional improvement in elderly patients with extensive burns.
Yu, HM, Wang, L, Pan, CZ
International wound journal. 2024;21(2):e14594
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Extensive burns in the elderly are a severe physical trauma that imposes critical physical and psychological impact on the patient. These may give rise to negative emotions such as anxiety, depression and low self-esteem. Therefore, effective psychological interventions are essential to improve the psychological wellbeing of elderly patients with extensive burns. The aim of this study was to evaluate the efficacy of cognitive behavioural therapy (CBT) as a psychological intervention for elderly patients with extensive burns, focusing on its impact on emotional well-being, self-efficacy and quality of life. This study was a prospective, randomised study. Participants were randomly assigned in a 1:1 ratio to receive either standard care (control group) or burn care based on cognitive behavioural therapy (CBT-B) (study group), with 100 patients in each group. Results showed that by helping patients change negative cognitive patterns, cope with anxiety and fear, enhance problem-solving abilities and improve self-awareness and self-care, CBT-based care can facilitate the recovery process and enhance the psychological well-being and quality of life of elderly patients. Authors concluded that psychological intervention based on CBT provides powerful tools and strategies for improving the emotional wellbeing of elderly patients with extensive burns.
Abstract
To evaluate the efficacy of cognitive behavioural therapy (CBT) as a psychological intervention for elderly patients with extensive burns, focusing on its impact on emotional well-being, self-efficacy and quality of life. A prospective, randomized study involving 200 elderly burn patients was conducted from November 2021 to January 2023. The patients were randomly assigned to receive either standard care (control group) or burn care based on cognitive behavioural therapy (CBT-B) (study group), with 100 patients in each group. Outcome measures included the Visual Analog Scale (VAS) for pain assessment, 36-item Short Form Survey (SF-36) for quality of life, General Self-Efficacy Scale (GSES) and Rosenberg Self-Esteem Scale (RSES). The study revealed that CBT-based intervention significantly reduced anxiety and depression scores compared with standard care (p < 0.05). Additionally, patients in the CBT group exhibited improved self-efficacy, self-esteem and quality of life (p < 0.05). CBT proves to be a valuable intervention for elderly burn patients, effectively addressing emotional distress and enhancing their psychological well-being. By modifying negative cognitive patterns, providing coping mechanisms and fostering problem-solving skills, CBT-based care contributes to a more positive recovery experience and improved quality of life.
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Social connection and end-of-life outcomes among older people in 19 countries: a population-based longitudinal study.
Pivodic, L, Van den Block, L, Pivodic, F
The lancet. Healthy longevity. 2024;5(4):e264-e275
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Social connection plays a crucial role in health, but its impact on end-of-life outcomes remains poorly understood. This study aimed to explore changes in social connection components during older people’s last years of life and assess how social connection predicts end-of-life outcomes. The aims of this study were to determine changes in structure, function, and quality components of social connection over time in older people's last years of life, and to examine the extent to which social connection in the last years of life predicts end-of-life outcomes This study used longitudinal data from the Survey of Health, Ageing, and Retirement in Europe (SHARE), covering 18 European countries and Israel. Deceased participants from waves 4 and 6 were included, with proxy interviews conducted for their last year of life. Results showed that: - Changes in social connection components between waves 4 and 6 included shifts in marital status, personal care or practical help, loneliness, satisfaction with social networks, and emotional closeness. - Loneliness at wave 6 predicted a higher likelihood of experiencing symptoms (pain, breathlessness, anxiety, or sadness) in the last month of life. Authors concluded that social connection significantly influences end-of-life well-being, emphasising the importance of fostering strong social ties for older adults during their final chapter.
Abstract
BACKGROUND Social connection is a key determinant of health, but its role in shaping end-of-life outcomes is poorly understood. We examined changes in structure, function, and quality components of social connection in older people's last years of life, and the extent to which social connection predicts end-of-life outcomes (ie, symptoms, health-care utilisation, and place of death). METHODS This study used longitudinal data of representative samples from across 18 European countries and Israel in the Survey of Health, Ageing, and Retirement in Europe (SHARE), the largest European cohort study of people aged 50 years or older. We included deceased participants of waves 4 and 6 (which contained social network modules) for whom a proxy provided an end-of-life interview. We did paired sample t-tests (for continuous variables), Wilcoxon signed-rank tests (for ordinal variables), and McNemar's tests (for non-ordinal categorical variables) to assess changes in structure, function, and quality components of social connection between waves 4 and 6. To examine social connection as a predictor of end-of-life outcomes, we used social connection data from wave 6 core interviews and end-of-life interviews from wave 7, conducted with a proxy respondent covering the deceased participant's last year of life. End-of-life outcomes included symptoms (pain, breathlessness, and anxiety or sadness) in the last month of life, health-care utilisation in the last year of life, and place of death. We conducted a mixed-effects logistic regression analysis per social connection measure, for each end-of-life outcome. FINDINGS Data were collected in 2011-12 for wave 4, 2015-16 for wave 6, and 2017-18 for wave 7. We studied 3356 individuals (mean age at death was 79·7 years [SD 10·2]), with interviews conducted, on average, 4·6 (1·2) years (wave 4) and 1·1 (0·7) years (wave 6) before death. From wave 4 to wave 6, the following changes in social connection were observed: proportion of married or partnered participants (from 1406 [60·9%] of 2310 to 1438 [57·1%] of 2518; p<0·0001), receiving personal care or practical help (from 781 [37·2%] of 2099 to 1334 [53·1%] of 2512; p<0·0001), loneliness (from mean 1·4 [SD 0·5] to 1·5 [0·6]; p<0·0001; scale 1-3), satisfaction with social network (from 8·8 [1·67] to 8·7 [1·7]; p=0·037; scale 0-10), and emotional closeness to social network (eg, from 1883 [88·8%] of 2121 to 1710 [91·3%] of 1872 participants who indicated being either very close or extremely close to social network members; p<0·0001). Higher levels of loneliness at wave 6 predicted a greater likelihood of experiencing symptoms in the last month of life (odds ratio range across symptoms: 1·29 [95% CI 1·08-1·55] to 1·58 [1·32-1·89]). Being married (1·32 [1·03-1·68]) or receiving personal care or practical help (1·25 [1·04-1·49]) predicted death in hospital. INTERPRETATION Social connection undergoes multifaceted changes towards older people's end of life, countering prevalent ideas of generally declining social trajectories. Loneliness in the final months of life might be a risk factor for end-of-life symptoms. Further research is needed to substantiate a causal relationship and to identify underpinning mechanisms, which could inform screening and prevention measures. FUNDING Research Foundation-Flanders and European Union.