The effects of loneliness and social isolation on cognitive functioning in older adults: a need for nuanced assessments.
The effects of loneliness and social isolation on cognitive functioning in older adults: a need for nuanced assessments.
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孤独和社会孤立对老年人认知功能的影响：需要进行细致入微的评估。
DOI：
10.1017/s1041610218001849
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发表时间：
2019
影响因子：
7
通讯作者：
Palmer,BartonW
中科院分区：
文献类型：
--
作者：
Palmer,BartonW
近年来，公众和研究人员越来越关注老年人以及更广泛的一般人口中的国际“孤独流行病”。总体患病率因评估方法和抽样国家或地区而有所不同，但大部分研究表明，总体患病率约为20%-25%。老龄化与孤独的风险和性质之间的关系是复杂的，不同研究的结果并不一致，并且可能受到许多特定因素的影响，例如与年龄相关的配偶/伴侣的丧失，一个人更广泛的社会网络的变化，其他环境变化，以及一系列积极和消极的心理因素。在老年人和年轻人中，孤独不仅是一种令人厌恶的经历，它对认知和身体健康有有害影响，并与全因死亡率的大幅增加有关（Cacioppo等人，2015）。在孤独对健康和福祉的多重不利影响中，与老年人维持独立功能最相关的影响之一是认知功能障碍和痴呆的风险增加（Cacioppo等人，2015）。需要阐明这些关联背后的机制，以制定更好的预防和干预策略。这项工作的一个相关组成部分是澄清客观社会孤立与孤独的性质、演变和影响。先前的研究表明，社会孤立和孤独都会影响认知功能、健康和死亡率，但这两个概念并不是同义词。“社会孤立”是指一个人在客观社会网络和支持方面的缺陷。相比之下，孤独代表了一种主观的内在状态，这种状态是由一个人实际的社会关系与他期望的社会关系之间的自我感知差异造成的。社会孤立会导致孤独感，而持续的孤独感会加剧客观的社会孤立，但这两种结构只有适度相关（r ~ 0.25-0.28）。这种区别本身似乎是不言自明的，因为一个真正内向的人可能非常孤立，但并不感到孤独，而一个外向的人可能仍然感到“孤独在人群中”。尽管Fung等人（2018）的报告本质上是探索性的，但它很好地说明了一种阐明孤独和社会隔离对认知功能潜在互动影响的方法。他们采用了横断面设计，对居住在香港的497名“认知健康”老年人（年龄≥60岁）进行了面对面访谈。他们研究的一个关键方面是，社会网络的规模是根据两个维度来衡量的：(1)“信任”与“不信任”的网络，(2)“亲密关系”（即家庭人数）与“非亲密”关系（即朋友人数）。信任与不信任的网络规模被定义为受访者认为他们可以分享与不能分享他们内心感受的人数。分析的重点是整体孤独感（中文版de Jong Gierveld孤独感量表总分）与上述社会网络规模维度的相互作用，作为认知功能并发水平的统计预测因子（从单词列表中延迟回忆，类别流畅性和中文版迷你精神状态检查总分的综合）。在控制了各种潜在的混杂因素后，他们发现孤独感和非信任网络规模在并发认知综合得分的统计预测中具有显著的相互作用。相比之下，孤独感和信任网络之间没有显著的相互作用。
In recent years, there has been increased public and research attention directed towards the international “epidemic of loneliness” among older adults, as well as in the broader general population. Overall prevalence varies somewhat by method of assessment and country or region of sampling, but the bulk of studies suggest a general prevalence of approximately 20%–25%. The relationship of aging to the risk and nature of loneliness is complex, with inconsistent findings across studies, and may be affected by a number of specific factors, such as age-related loss of spouse/partners, changes in one’s broader social network, other environmental changes, as well as a range of positive and negative psychological factors. In older and younger adults, loneliness is not only an aversive experience, it has a deleterious impact on cognitive and physical health, and is associated with a substantial increase in all-cause mortality (Cacioppo et al., 2015). Of the multiple adverse effects of loneliness on health and well-being, one of those most relevant to the maintenance of independent functioning among older adults is the increased risk of cognitive dysfunction and dementia (Cacioppo et al., 2015). Elucidation of the mechanisms underlying these associations is needed to develop better prevention and intervention strategies. One relevant component in that effort is clarifying the nature, evolution, and effects of objective social isolation in combination with loneliness. Prior research has shown that social isolation and loneliness each affect cognitive functioning, health, and mortality, but the two constructs are not synonymous.“Social isolation” refers to deficits in a person’s objective social network and support. In contrast, loneliness represents a subjective internal state resulting from a selfperceived discrepancy between one’s actual social relationships versus one’s desired social relationships. Social isolation can lead to loneliness, and persistent loneliness can exacerbate objective social isolation, but the two constructs are only modestly correlated (r∼ 0.25–0.28). The distinction is in itself seemly self-evident as a true introvert may be very isolated but feel no loneliness, while an extrovert may still feel “alone in the crowd.” Although exploratory in nature, the report from Fung et al.(2018) nicely illustrates an approach toward elucidating the potential interactive effects of loneliness and social isolation on cognitive functioning. They employed a cross-sectional design, using in-person interviews with 497 “cognitively healthy” older adults (ages≥ 60 years) residing in Hong Kong. A key aspect of their study was that social network size was measured in reference to two dimensions:(1)“confiding” versus “non-confiding” network, and (2)“close-ties”(ie, number of family) versus “non-close” ties (ie, number of friends). Confiding versus non-confiding network sizes were defined as the numbers of persons whom the respondents felt they could share versus could not share their inner feelings. The focus of analyses was on the interaction of overall loneliness (total score on the Chinese version of the de Jong Gierveld Loneliness Scale) with the above dimensions of social network size, as statistical predictors of the concurrent level of cognitive functioning (a composite of delayed recall from a word list, category fluency, and total score on the Chinese version of the Mini-Mental State Examination). After controlling for various potential confounding factors, they found a significant interaction of loneliness and non-confiding network size in the statistical prediction of concurrent cognitive composite scores. In contrast, there were no significant interactions of loneliness and confiding network …