A Social Model of Loneliness: The Roles of Disability, Social Resources, and Cognitive Impairment

Purpose of the study: We consider the points at which cognitive impairment may impact on the pathway to loneliness for older people, through impeding social interaction with family and friends, or by interfering with judgments concerning satisfaction with relationships.Design and methods: We conceptualize a mediation model anticipating that social resources (LSNS-6) will mediate the pathway between disability (Townsend Disability Scale) and loneliness (De Jong Gierveld 6 item scale) and a moderated-mediation model in which we hypothesize that cognitive impairment (MMSE) will moderate the association between disability and social resources and between social resources and loneliness. To validate the hypothesized pathways, we draw on the CFAS Wales data set (N=3,593) which is a nationally representative study of community-dwelling people aged 65 and over in Wales Results: Disability had a significant indirect effect on loneliness through the mediating variable social resources. Cognitive impairment was significantly associated with social resources, but did not moderate the relationship between disability and social resources. Cognitive impairment had a significant impact on loneliness, and moderated the effect of social resources on loneliness. Implications: Social structures can (dis)empower people with cognitive impairment and lead to exclusion from social resources or impact on the social construction of ageing, cognitive impairment and dementia. The sense of self for an older person with cognitive impairment may be influenced by social norms and stereotypes, or through a temporal social comparison with an ‘earlier’ sense of self. We conclude that loneliness interventions should be theoretically-informed to identify key areas for modification

Seeking assistance in later life:How do older people evaluate their need for assistance?

Background: legislation places an onus on local authorities to be aware of care needs in their locality and to prevent and reduce care and support needs. The existing literature overlooks ostensibly ‘healthy’ and/or non-users of specific services, non-health services and informal assistance and therefore inadequately explains what happens before or instead of individuals seeking services. We sought to address these gaps by exploring older adults’ accounts of seeking assistance in later life. / Methods: we conducted semi-structured qualitative interviews with 40 adults aged 68–95. We invited participants to discuss any type of support, intervention, or service provision, whether medical, social, family-provided, paid or unpaid. / Findings: this paper reports older people’s accounts of how they evaluated their need for assistance. We found that the people in our sample engaged in a recursive process, evaluating their needs on an issue-by-issue basis. Participants’ progression through this process hinged on four factors: their acknowledgement of decline; the perceived impact of decline on their usual activities and independence; their preparedness to be a recipient of assistance; and, the opportunity to assert their need. In lieu of seeking assistance, participants engaged in self-management, but also received unsolicited or emergency assistance. / Conclusions: older people’s adaptations to change and attempts to meet their needs without assistance mean that they do not present to services, limiting the local authority’s knowledge of their needs and ability to plan appropriate services. Our findings offer four stages for policymakers, service providers and carers to target to address the uptake of assistance

Conceptualising and Understanding Artistic Creativity in the Dementias: Interdisciplinary Approaches to Research and Practise

Creativity research has a substantial history in psychology and related disciplines; one component of this research tradition has specifically examined artistic creativity. Creativity theories have tended to concentrate, however, on creativity as an individual phenomenon that results in a novel production, and on cognitive aspects of creativity, often limiting its applicability to people with cognitive impairments, including those with a dementia. Despite growing indications that creativity is important for the wellbeing of people living with dementias, it is less well understood how creativity might be conceptualised, measured and recognised in this population, and how this understanding could influence research and practise. This paper begins by exploring prevailing concepts of creativity and assesses their relevance to dementia, followed by a critique of creativity and dementia research related to the arts. Perspectives from researchers, artists, formal and informal caregivers and those with a dementia are addressed. We then introduce several novel psychological and physiological approaches to better understand artistic-related creativity in this population and conclude with a conceptualisation of artistic creativity in the dementias to help guide future research and practise

The importance of not only individual, but also community and society factors in resilience in later life

Little work has focused on resilience amongst older adults, and few factors have been identified that promote their resilience. Kalisch et al. suggest that socioenvironmental factors are distant influences. We argue, however, that community and societal influences are as important as individual ones. Further, an ecological framework explains why some older adults are resilient whilst others are no

Reasons for Polytobacco Use among Young Adults: Scale Development and Validation

Introduction Limited research has examined reasons for polytobacco use, an increasing public health problem, particularly among young adults. We examined reasons for polytobacco use among users of more than one tobacco product in the past 4 months enrolled in an ongoing six-wave longitudinal study of 3,418 students aged 18-25 from seven US colleges and universities. Methods An expert panel generated items related to reasons for polytobacco use, included in Wave 3 (administered in Summer 2015). Participants reporting use of more than one tobacco product in the past four months (n=540) were asked to complete the Reasons for Polytobacco Use scale and measures related to tobacco/nicotine use/dependence, use motives, perceptions of tobacco, parental/friend use, other substance use, and mental health. We conducted a factor analysis and then examined convergent and discriminant validity for the derived factors. Results Our sample was an average age of 20.40 (SD=1.84), 48.0% male, and 21.9% Black. Four factors were identified: Instrumentality, Social Context, Displacement, and Experimentation. Instrumentality was the only factor associated with little cigar/cigarillo and marijuana use. Displacement and Social Context showed similar associations; however, Social Context was associated with having friends who used tobacco while Displacement was not. Experimentation was associated with greater perceived addictiveness and harm of using tobacco products as well as greater perceived social acceptability of tobacco use. Conclusions Each of the four factors identified demonstrated unique convergent and discriminant validity. The use of this scale to characterize polytobacco using young adults may help inform and target cessation or prevention interventions

Exposure to Violence, Substance Use, and Neighborhood Context

Adolescent exposure to violence and substance use are both public health problems, but how neighborhood context contributes to these outcomes is unclear. This study uses prospective data from 1416 adolescents to examine the direct and interacting influences of victimization and neighborhood factors on adolescent substance use. Based on hierarchical Bernoulli regression models that controlled for prior substance use and multiple individual-level factors, exposure to violence significantly increased the likelihood of marijuana use but not alcohol use or binge drinking. There was little evidence that community norms regarding adolescent substance use influenced rates of substance use or moderated the impact of victimization. Community disadvantage did not directly impact substance use, but the relationship between victimization and marijuana use was stronger for those in neighborhoods with greater disadvantage. The results suggest that victimization is particularly likely to affect adolescents’ marijuana use, and that this relationship may be contingent upon neighborhood economic conditions