Social Connection in Long-Term Care Homes: A Scoping Review of Published Research on the Mental Health Impacts and Potential Strategies During COVID-19

Stall N.M., Johnstone J., McGeer A.J., Dhuper M., Dunning J., Sinha S.K.

Abstract During the first few months of the coronavirus disease 2019 (COVID-19) pandemic, Canadian nursing homes implemented strict no-visitor policies to reduce the risk of introducing COVID-19 in these settings. There are now growing concerns that the risks associated with restricted access to family caregivers and visitors have started to outweigh the potential benefits associated with preventing COVID-19 infections. Many residents have sustained severe and potentially irreversible physical, functional, cognitive, and mental health declines. As Canada emerges from its first wave of the pandemic, nursing homes across the country have cautiously started to reopen these settings, yet there is broad criticism that emerging visitor policies are overly restrictive, inequitable, and potentially harmful. We reviewed the nursing home visitor policies for Canada's 10 provinces and 3 territories as well as international policies and reports on the topic to develop 10 provi-informed, data-driven, and expert-reviewed guidance for the re-opening of Canadian nursing homes to family caregivers and visitors.

Chu C.H., Donato‐Woodger S., Dainton C.J.

While debate over the appropriate scope and goals of COVID‐19 lockdowns has raged, all public health agencies have been clear on one matter: older adults have the highest rates of mortality (Comas‐Herrera et al., 2020) and should be isolated (Public Health Agency of Canada, 2020). Older adults and individuals with complex health conditions are most vulnerable to the virus. Yet, social isolation contributes to the onset and intensifies depression, feelings of despair and, in older adults with dementia, further cognitive decline.

Meyer C., Hickson L.

Hearing impairment (also known as hearing loss) is highly prevalent in residents of nursing facilities and its impacts are far-reaching. Hearing impairment has negative consequences for an individual's quality of life, psychosocial health, physical health, and mortality; these impacts are also exacerbated when hearing impairment cooccurs with other conditions, such as visual or cognitive impairment. These guidelines summarize the extensive evidence about the impacts of hearing impairment, the factors that are associated with increased risk of hearing impairment, assessment criteria for measuring impairment, and the management of residents' hearing impairment. Nursing interventions should focus on (a) cerumen management to reduce hearing impairment and allow for the use of hearing devices; (b) hearing device support so that residents can use hearing aids and/or other assistive listening devices; and (c) communication strategies so that conversations with residents can be facilitated. [Journal of Gerontological Nursing, 46(7), 15-25.].

McGilton K.S., Escrig-Pinol A., Gordon A., Chu C.H., Zúñiga F., Sanchez M.G., Boscart V., Meyer J., Corazzini K.N., Jacinto A.F., Spilsbury K., Backman A., Scales K., Fagertun A., Wu B., et. al.

As the COVID-19–related mortality rate of nursing home residents continues to rise, so too will the rates of mortality and morbidity of staff who care for them,1 a problem we must address now to avoid another health care crisis once this pandemic recedes. Currently, a significant proportion of deaths are attributed to persons living in nursing homes, ranging from 42% to 57% in European countries reporting data,2 to as high as 82% in several U.S. states and in Canada.2,3 However, there is a concern that many countries are not including nursing home deaths in the death toll.

Holmes E.A., O'Connor R.C., Perry V.H., Tracey I., Wessely S., Arseneault L., Ballard C., Christensen H., Cohen Silver R., Everall I., Ford T., John A., Kabir T., King K., Madan I., et. al.

Marston C., Renedo A., Miles S.

Community participation is essential in the collective response to coronavirus disease 2019 (COVID-19), from compliance with lockdown, to the steps that need to be taken as countries ease restrictions, to community support through volunteering. Communities clearly want to help: in the UK, about 1 million people volunteered to help the pandemic response1 and highly localised mutual aid groups have sprung up all over the world with citizens helping one another with simple tasks such as checking on wellbeing during lockdowns.

Santini Z.I., Jose P.E., York Cornwell E., Koyanagi A., Nielsen L., Hinrichsen C., Meilstrup C., Madsen K.R., Koushede V.

Summary Background Research indicates that social isolation and loneliness increase the risk of mental disorders, but less is known about the distinct contributions of different aspects of isolation. We aimed to distinguish the pathways through which social disconnectedness (eg, small social network, infrequent social interaction) and perceptions of social isolation (eg, loneliness, perceived lack of support) contribute to anxiety and depression symptom severity in community-residing older adults aged 57–85 years at baseline. Methods We did a longitudinal mediation analysis with data from the National Social Life, Health, and Aging Project (NSHAP). The study included individuals from the USA born between 1920 and 1947. Validated measures on social disconnectedness, perceived isolation, and depression and anxiety symptoms were used. Structural equation modelling was used to construct complete longitudinal path models. Findings Using data from 3005 adults aged 57–85 years, we identified two significant longitudinal mediation patterns with symptoms of depression, and two with anxiety symptoms. Overall, social disconnectedness predicted higher subsequent perceived isolation (β=0·09; p Interpretation Social network structure and function are strongly intertwined with anxiety and depression symptoms in the general population of older adults. Public health initiatives could reduce perceived isolation by facilitating social network integration and participation in community activities, thereby protecting against the development of affective disorders. Funding Nordea-fonden.

Estabrooks C.A., Straus S.E., Flood C.M., Keefe J., Armstrong P., Donner G.J., Boscart V., Ducharme F., Silvius J.L., Wolfson M.C.

The Royal Society of Canada Task Force on COVID-19 was formed in April 2020 to provide evidence-informed perspectives on major societal challenges in response to and recovery from COVID-19. The Task Force established a series of working groups to rapidly develop policy briefings, with the objective of supporting policy makers with evidence to inform their decisions. This paper reports the findings of the COVID-19 Long-Term Care (LTC) working group addressing a preferred future for LTC in Canada, with a specific focus on COVID-19 and the LTC workforce. First, the report addresses the research context and policy environment in Canada’s LTC sector before COVID-19 and then summarizes the existing knowledge base for integrated solutions to challenges that exist in the LTC sector. Second, the report outlines vulnerabilities exposed because of COVID-19, including deficiencies in the LTC sector that contributed to the magnitude of the COVID-19 crisis. This section focuses especially on the characteristics of older adults living in nursing homes, their caregivers, and the physical environment of nursing homes as important contributors to the COVID-19 crisis. Finally, the report articulates principles for action and nine recommendations for action to help solve the workforce crisis in nursing homes.

Bethell J., Babineau J., Iaboni A., Green R., Cuaresma-Canlas R., Karunananthan R., Schon B., Schon D., McGilton K.S.

IntroductionSocial well-being is associated with better physical and mental health. It is also important for quality of life, including from the perspectives of those living in long-term care (LTC) homes. However, given the characteristics of the LTC home environment and the people who live there, the nature and influence of social integration and loneliness, and strategies to address them, may differ in this population compared with those living in the community. The objective of this scoping review is to provide an overview of the nature and extent of research on social integration and loneliness among LTC home residents, including a summary of how these concepts have been operationalised and any evidence from specific groups.Methods and analysisThis study protocol describes the methods of a scoping review of peer-reviewed literature related to social integration and loneliness among LTC home residents. A literature search was developed by an Information Specialist and will be conducted in MEDLINE(R) ALL (in Ovid, including Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily) and then translated into CINAHL (EBSCO), PsycINFO (Ovid), Scopus, Sociological Abstracts (Proquest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid) and AgeLine (EBSCO). Two reviewers will independently screen titles and abstracts of articles identified in the search. Two reviewers will then independently review full text articles for inclusion. Data extraction will also be carried out in duplicate. We will engage LTC home community members, including residents, family and staff, to refine the review questions, assist in interpreting the results and participate in knowledge translation.Ethics and disseminationEthics approval is not required. We will present findings at conferences and publish in a peer-reviewed journal. Ultimately, we hope to inform future observational and interventional research aimed at improving the health and quality of life of LTC home residents.

Lockwood C., dos Santos K.B., Pap R.

Scoping reviews are a useful approach to synthesizing research evidence although the objectives and methods are different to that of systematic reviews, yet some confusion persists around how to plan and prepare so that a completed scoping review complies with best practice in methods and meets international standards for reporting criteria. This paper describes how to use available guidance to ensure a scoping review project meets global standards, has transparency of methods and promotes readability though the use of innovative approaches to data analysis and presentation. We address some of the common issues such as which projects are more suited to systematic reviews, how to avoid an inadequate search and/or poorly reported search strategy, poorly described methods and lack of transparency, and the issue of how to plan and present results that are clear, visually compelling and accessible to readers. Effective pre-planning, adhering to protocol and detailed consideration of how the results data will be communicated to the readership are critical. The aim of this article is to provide clarity about what is meant by conceptual clarity and how pre-planning enables review authors to produce scoping reviews which are of high quality, reliability and readily publishable.

Campos J.L., Höbler F., Bitton E., Labreche T., McGilton K.S., Wittich W.

Vision impairments are prevalent, but underdiagnosed in individuals with dementia living in long-term care (LTC). Effective screening tools could identify remediable vision problems. This scoping review was conducted to identify vision screening tests used with individuals with dementia and assesses their suitability for administration by nurses in LTC. A literature search using the Arksey and O'Malley (2005) method included research articles, conference proceedings, and dissertations. Data were included from participants over 65 years of age with a diagnosis of probable dementia. A panel of vision experts evaluated the suitability of the candidate vision tests. The search yielded 179 publications that met the inclusion criteria. Of 134 vision tests that were identified, 19 were deemed suitable for screening by nurses in LTC. Tests screened for acuity (12), visual field (1), anatomy (2), color vision (2), and general visual abilities (2). Tests were excluded because of complexity of interpretation (90), need for specialized training (83), use in research only (57), need for specialized equipment (54), not assessing visual function (44), long test duration (21), uncommonness (13), and needing an act reserved for specialists (7). Psychometric properties were not often reported for tests. Few of the tests identified had been validated for use with individuals with dementia. Based on our review, few tests were deemed suitable for use by nurses to assess this population in LTC. Identifying appropriate tools to screen vision in individuals with dementia is a necessary first step to interventions that could potentially improve functioning and quality of life.

Husebø B.S., Ballard C., Aarsland D., Selbaek G., Slettebo D.D., Gulla C., Aasmul I., Habiger T., Elvegaard T., Testad I., Flo E.

To investigate if the multicomponent intervention of the COSMOS trial, combining communication, systematic pain management, medication review, and activities, improved quality of life (QoL) in nursing home patients with complex needs.Multicenter, cluster-randomized, single-blinded, controlled trial.Thirty-three nursing homes with 67 units (clusters) from 8 Norwegian municipalities.Seven hundred twenty-three patients with and without dementia (≥65 years) were cluster randomized to usual care or intervention in which health care staff received standardized education and on-site training for 4 months with follow-up at month 9.Primary outcome was change in QoL as measured by QUALIDEM (QoL dementia scale); QUALID (QoL late-stage dementia scale), and EQ-VAS (European QoL-visual analog scale) from baseline to month 4. Secondary outcomes were activities of daily living (ADL), total medication, staff distress, and clinical global impressions of change (CGIC).During the active intervention, all 3 QoL measures worsened, 2 significantly (QUALID P = .04; QUALIDEM P = .002). However, follow-up analysis from month 4 to 9 showed an intervention effect for EQ-VAS (P = .003) and QUALIDEM total score (P = .01; care relationship P = .02; positive affect P = .04, social relations P = .01). The secondary outcomes of ADL function, reduction of medication (including psychotropics) and staff distress, improved significantly from baseline to month 4. Intervention effects were also demonstrated for CGIC at month 4 (P = .023) and 9 (P = .009), mainly because of deterioration in the control group.Temporarily, the QoL decreased in the intervention group, leading to our hypothesis that health care staff may be overwhelmed by the work-intensive COSMOS intervention period. However, the decrease reversed significantly during follow-up, indicating a potential learning effect. Further, the intervention group improved in ADL function and received less medication, and staff reported less distress and judged COSMOS as able to bring about clinically relevant change. This suggests that nonpharmacologic multicomponent interventions require long follow-up to ensure uptake and beneficial effects.

Budgett J., Brown A., Daley S., Page T.E., Banerjee S., Livingston G., Sommerlad A.

Choi H., Jung Y., Kim H.

Aggressive behavior is one of the most challenging behavioral psychological symptoms for older adults and their caregivers in nursing homes.The purpose of this study was to examine and identify contributing factors of aggressive behaviors among older adults in nursing homes in South Korea.This is a secondary analysis of a national survey on health and functional status among older nursing home residents.Participants were recruited from 91 nursing homes.A total of 1447 older adults were included for final analysis and they were randomly selected from a nationally representative sample of people 65 years and older at the sampled nursing homes.Presence of aggressive behaviors was identified when participants showed at least one of the five symptoms in the Korean interRAI Long-Term Care Facility Assessment Tool such as physical abuse, verbal abuse, socially inappropriate or destructive behaviors, and resistance to care. Theory-based contributing factors were selected and examined. Multivariate logistic regression analyses were performed.About 19% of older nursing homes residents had aggressive behaviors, and several health and social factors including social engagement are associated with aggressive behaviors.Aggressive behavior is prevalent in older nursing home residents with and without dementia in South Korea and individual and institutional level interventions are necessary.

Pramesona B.A., Taneepanichskul S.

Background The burden of depressive elderly is high globally. However, nursing home-based studies on prevalence and risk factors of depression are scarce due to feasibility and difficulties in data collection. Methods This cross sectional study was conducted at three nursing homes (NHs) in three districts in Yogyakarta province, Indonesia. A total of 181 elderly NH residents aged ≥60 were recruited purposively. Information regarding socio-demographics, health-related characteristics and social support among respondents were collected by a modified questionnaire through face-to-face interviews. A short form Geriatric Depression Scale (GDS) Indonesian version was employed to assess levels of depression. Multivariate logistic regression was used to analyze the data. Results Overall, the prevalence of geriatric depression was assessed to be at 42.5% (31.5% in women and 11% in men). Risk factors that were found to be significantly associated with depression in the univariate analysis were female, none or lack of social support, had ≥3 chronic diseases, and perceived inadequacy of care. In the multivariate analysis, perceived inadequacy of care remained significant risk factor for depression amongst the elderly NH residents. Limitations Besides a number of important variables were determined by self-report, the used sampling technique was purposive. In addition, the elderly who had severe cognitive impairment or dementia and were not able to communicate meaningfully were excluded from this study. Conclusions The prevalence rates of depression were relatively high among elderly NH residents in our study area. Adequate health services are needed in order to reduce the risk of depression among elderly NH residents.

Akhtar S.A.

Abstract Next of kin play a vital role in the informal care of older relatives in long-term-care facilities (LTCFs). However, finding a sustainable balance between everyday commitments and caring for their loved ones can be demanding, and there is a need to explore new ways to support their caregiving efforts while prioritising their wellbeing. Digital communication technologies have shown promise in enabling meaningful social interactions between older adults and their families, yet their potential to foster connections in LTCFs remains understudied. This study explores the efficacy of a communication technology called Komp in facilitating meaningful connections between next of kin and older relatives in LTCFs. It utilises Norwegian data from all public nursing homes in Oslo municipality to assess whether Komp can facilitate social contact between nursing home residents and their next of kin, and if the use of Komp impacts the next of kin’s experience of satisfaction with this contact. Based on 238 next of kin, this study uses two data sources: (1) survey data collected from all next of kin, in three waves, and (2) a highly detailed weekly data stream from each Komp device. These sources are combined and analysed using multiple regression analysis. The results generally show a positive and significant relationship between use of Komp and increased social satisfaction, indicating that Komp can serve as a valuable tool to help next of kin maintain social bonds with older relatives in LTCFs.

Armoon B., Fleury M.

Li X., Yin C., Abude-Aribo J.O., Conklin R., Mpofu E.

Background and Aims: Resident satisfaction is a critical indicator of the quality of care in long-term care facilities (LTCFs). Yet, the relative importance quality of care factors in predicting resident satisfaction remains unclear for guiding resident support initiatives. This study aims to identify the relative contribution of personal and facility care service factors as predictors of satisfaction LTCF residents. Methods: This cross-sectional study enrolled a convenience sample of 399 older adult residents from LTCFs in Shanghai, Nanjing, and Changsha, China, from June to December 2023. The inclusion criteria were age 65 or older, fluency in speaking and reading simplified Chinese Mandarin, having resided in long-term care facilities for at least one month, and cognitive competence to comprehend the questionnaires. Hierarchical multiple regressions were utilized to examine self-report survey data on ten resident personal variables, and seven care facility service domains were examined for their relative contribution to resident care satisfaction. Moreover, the analysis included the interaction between personal factors and care service attributes. Results: The combined personal and care service factors explained 26.1% of the variance in overall resident satisfaction. Personal factors that predicted resident satisfaction included age, level of independence, and length of stay (ΔR2 = 0.11). Of the care facility factors, the significant predictors of higher resident satisfaction were spending time (β = 0.60, p < 0.01, ΔR2 = 0.09) and environment domains (β = 0.62, p < 0.01, ΔR2 = 0.03). Age moderated the relationship between the spending time domain and overall satisfaction, with a positive effect for residents aged 70–79 compared to those aged 60–69 (β = −1.26, p < 0.05). Conclusions: This study provides evidence to suggest the importance of personal and care facility characteristics to LTFC resident satisfaction. Based on these findings, improved resident satisfaction is likely with LTCF care services that provide tailored care plans using resident characteristics.

Yao Y., She K., Wang Y.

With the growing popularity of short video media, concerns about the addictive of short videos have sparked discussion. In particular, after the outbreak of the pandemic, the isolation compressed and challenged young people’s offline social spaces, shifting social interactions towards online forms, thus promoting the use of short videos. Therefore, in order to explore the interrelationship between short-video addiction and social contact, this paper innovatively decomposes the traditional concept of social contact into two parts: online social contact and offline social activities. Using an innovative sampling method, this study takes students from the University of Macau (N = 333) as the study population to better measure the social contact of those who rely on online forms of socialization in the post-epidemic era. On the basis of more comprehensive sampling, a questionnaire analysis using the structural equation model (SEM) analysis and in-depth interviews exploring the relationship between short video addiction and the intensity of social contact were conducted. The analysis results show that participation in social activities has a significant inhibitory effect on college students’ use of short videos (β= -1.428, P < 0.001). Notably, there is a positive correlation between social connections and university students’ use of short videos through further social activities participation, reflecting a mutually reinforcing relationship between short video use and social contact. Further interviews and exploration of this influence mechanism revealed that the popularity of short videos may increase people’s social anxiety, making it difficult for them to realize there is a problem when addicted, and leading to potential mental health issues. In the post-epidemic era, people’s socialization and social contacts are gradually moving towards a combined virtual-reality approach as the impact of short-form video is further strengthened. This shift promotes social community while also creating concerns about related psychosocial issues.

Bradley R., Ryan A., Penney S.

Quigley D.D., Chastain A.M., Ma H.S., Pogorzelska-Maziarz M., Stone P.W.

Abstract Background and Objectives Coronavirus disease 2019 (COVID-19) negatively influenced resident well-being in nursing homes (NHs). We examine perceptions and experiences of U.S. NH staff during the COVID-19 pandemic regarding resident well-being. Research Design and Methods We sampled 68 NHs (out of 13,423) in strata defined by quality ratings, urban/rural location, and whether they served a resident population of &lt;70% White. We enrolled 10 NHs and interviewed 11 nursing staff (8 certified nursing assistants/aides, 3 registered or licensed practical/vocational nurses), 12 managerial staff (4 administrators, 8 directors of nursing), and 5 infection preventionists. Thematic analysis identified themes related to challenges of quarantine/isolation, attempted solutions, and lessons learned concerning resident well-being. Results Nursing home managerial, infection prevention, and nursing staff described how COVID-19 policies contributed to increased resident loneliness and declines in physical and cognitive well-being. Solutions/strategies employed across the United States and in low- and high-quality NHs included proactive mental health support, resident-centered family visitation, increased communication and care planning with families and efforts to maintain resident normalcy. Discussion and Implications Strategies to mitigate and alleviate concerns with resident well-being were both structural and made via staff choices. NH leadership needs to proactively plan how to adapt processes and structures that prioritize resident well-being along with resident care in times of crisis. Research is needed to outline the planning, implementation, and recommendations required to operationalize these strategies into practice. Determining the most effective ways to implement these structural changes within NH practices and workflows is critical to ensure that staff have sufficient time to spend with residents.

Sharkiya S.H., Malak M.Z., Shehadeh A.

Chapman H., Bethell J., Dewan N., Liougas M.P., Livingston G., McGilton K.S., Sommerlad A.

Abstract Background Social connection is a basic human need and is essential to quality of life. It is associated with better mental and physical health outcomes for long-term care (LTC) home residents and is a key aspect of quality of care and person-centred care. There are considerations for LTC homes that may present obstacles to and opportunities for social connection. It is therefore important to understand what restricts or enables good social connection in LTC homes, to guide better quality care and future interventions in this population. This qualitative study aims to identify barriers and facilitators to social connection for LTC residents. Methods We used thematic analysis to describe themes derived from individual and group qualitative interviews from 67 participants (18 residents, 17 staff members and clinicians, 32 family members and friends) recruited from LTC homes in the United Kingdom and Canada. Results Themes were grouped into four categories: (1) becoming familiar with life in the LTC home to support social connection; (2) physical and virtual access beyond the LTC home as strategies to maintain contact; (3) getting to know residents to deepen relationships; (4) person-centred approaches to build social connection. ‘Becoming familiar with life in the LTC home to support social connection’ described the benefits of counteracting the institutionalized feel of LTC homes, enabling LTC residents to spend time in meaningful ways, and increasing freedom of mobility around the home. ‘Physical and virtual access beyond the LTC home as strategies to maintain contact’ related to the benefits of outings, providing support with technology, and involving family and friends in LTC home life. ‘Getting to know residents to deepen relationships’ related to the benefits of using routine care and interactions as opportunities for social contact, using family and friend knowledge as a resource, and fostering resident relationships. ‘Person-centred approaches to build social connection’ included considering physical, mental, cognitive, and sensory impairments, accounting for adjustment and sociability, using communal spaces well, and prioritizing psychosocial needs. Conclusions This study identifies barriers and facilitators to social connection for LTC residents which can be addressed in care policies, staff selection and training, and can inform policies and interventions to build and maintain social connection in LTC homes. Clinical trial number clinicaltrials.gov ID NCT05315960.

Abedi A., Khan S.S., Iaboni A., Bronskill S.E., Bethell J.

The objective of this study was to use population-based clinical assessment data to build and evaluate machine-learning models for predicting social engagement among female and male residents of long-term care (LTC) homes. Routine clinical assessments from 203,970 unique residents in 647 LTC homes in Ontario, Canada, collected between April 1, 2010, and March 31, 2020, were used to build predictive models for the Index of Social Engagement (ISE) using a data-driven machine-learning approach. General and sex-specific models were built to predict the ISE. The models showed a moderate prediction ability, with random forest emerging as the optimal model. Mean absolute errors were 0.71 and 0.73 in females and males, respectively, using general models and 0.69 and 0.73 using sex-specific models. Variables most highly correlated with the ISE, including activity pursuits, cognition, and physical health and functioning, differed little by sex. Factors associated with social engagement were similar in female and male residents.

Chen X., Hu Y., Deng Y., Wang X., Yang X., Wang Y., Lian Y., Wang S., Xiang X., Liu C., Wu F., Chen S., Li H.

IntroductionThe mental health of populations is usually affected after a disaster event. However, it is not known what the level of mental health of Chinese population 1 year after COVID-19, nor what factors influence it.AimThis study aimed to examine the mental health status of general population in Chengdu 1 year after COVID-19, and then analyse influencing factors.MethodThis study is a cross-sectional survey based on the SCL-90 questionnaire. Continuous data were described as M and SD, and counting data were described as frequencies(n) and percentages (%). Chi-square test or Fisher’s exact test were used for statistical inference, and significance variables were included in the binary logistic regression equation for multivariate analysis.ResultsThere were 172 participants with positive screening results. Age, marital status, number of kids, self-perceived health and the presence of chronic disease had an effect on screening results. Logistic regression analysis showed that age and self-perceived health were the main influencing factors.DiscussionYoung people aged 18–19 and those who consider themselves not very healthy were at higher risk of poor mental health 1 year after the COVID-19 outbreak.Impact statementCommunity institutions and community workers should focus on the mental health status of people 1 year after COVID-19, with a focus on people with poor self-perceived health and younger age groups, and take early preventive measures.

Nesbitt H., Hamilton M., Ulibarri N., Williamson M.A.

Abstract Background&#xD;Social capital is frequently invoked as a reason for engaging in collaborative environmental governance. Yet we have a limited understanding of how collaborative environmental governance mobilizes different types of social capital and how the advantages and costs of social capital accrue for different groups of people. Explicit measures of social capital, such as through social network methods, will help build an understanding of how social capital facilitates collective processes and for whom.&#xD;Methods&#xD;We reviewed highly cited articles in Web of Science and Scopus using “social capital” as the search term to identify foundational and emergent social capital concepts. In the context of collaborative environmental governance, we operationalized these social capital concepts with network measures drawn from our expertise and highlighted existing empirical relationships between such network measures and collaborative outcomes.&#xD;Review results&#xD;We identified two different camps of social capital concepts - one based on social relations that could be readily operationalized with social network measures and the other based on actor characteristics that can further contextualize network data. Relational social capital concepts included social relations among actors; the collective social setting in which relations are embedded; and the advantages and costs that social capital confers to individuals and the collective. Social capital concepts based on actor characteristics included socio-cognitions (e.g., trust, norms, identification with a group, shared meanings) and community engagement (e.g., group membership, civic participation, volunteerism). Empirical evidence using social network approaches to measure social capital reveals patterns in relationship building that influence collaborative and other sustainability outcomes.&#xD;Discussion&#xD;Social network approaches described here may help define and quantify the social capital mobilized by collaborative governance. Additional research is necessary to track the social capital of collaboratives over time, link it to outcomes, and better understand the social justice implications of collaborative governance.

Hoang P.M., Conn D.

Social isolation and loneliness are major public health concerns and are associated with morbidity and mortality. As this is an increasing issue in older adults, guidance for healthcare providers is a priority. The Canadian Coalition for Senior’s Mental Health (CCSMH) has developed the first Canadian social isolation and loneliness guidelines to help providers recognize, assess, and manage social isolation and loneliness among older adults. We review and summarize these guidelines to support healthcare and social service providers to apply best practices and evidence-based care for older adults experiencing social isolation and loneliness.

Fang Y., Ma L., Chen H., Cai S., Jiang W., Luo F., Wang J., Zheng E., Zhou C., Zhu L., Guo Q., Yin Z.

BackgroundBoth pre-or post-COVID-19, older adults residing in nursing homes are at significant risk for social isolation, which is negatively associated with cognitive ability. Currently, the elderly aged 80 years and older are the fastest-growing age group globally. The extent of social isolation within this group post-COVID-19 and its impact on cognitive abilities remain inadequately explored.ObjectiveThis research aimed to evaluate the prevalence of social isolation among the oldest old in Chinese nursing homes post-COVID-19 and to investigate the mediating and moderating roles of basic activities of daily living (BADL), depression, and subjective socioeconomic status in the relationship between social isolation and cognitive ability.MethodsThis cross-sectional study included 453 participants aged 80 years and older from 11 nursing homes in Ningbo, Zhejiang Province, China. Social isolation was assessed using the Lubben Social Network Scale-6 (LSNS-6), cognitive ability using the Mini-Mental State Examination (MMSE), BADL using the Barthel Index (BI), and depression using the Patient Health Questionnaire-9 items (PHQ-9). Mediation and moderation effects were statistically analyzed using SPSS 23.0 and PROCESS 3.5.ResultsThe mean age of the study sample was 87.1 ± 3.8 years, among whom 60.3% (n = 273) were female, and 56.1% experienced social isolation, with 41.1% and 63.1% being isolated from family and friends, respectively. Social isolation indirectly affected cognitive ability through BADL and depression, respectively, and through the chain mediation effect of BADL and depression. Subjective socioeconomic status moderated the relationships between social isolation and BADL and between social isolation and depression. However, no moderating effect of subjective socioeconomic status was found between social isolation and cognitive ability.ConclusionThis study deepens our understanding of the current state of social isolation and its mechanisms of action in the oldest old post-COVID-19 and provides a new basis for future public health policy development and related research.

Collins J.T., Irvine L., Logan P., Robinson K., Sims E., Gordon A.L.

Abstract Background People living in care homes often have problems with pain, anxiety and depression. Whether being on analgesia, anxiolytics or antidepressants has any bearing on pain severity and quality of life (QoL) in this population, requires further investigation. Objectives (i) to examine the relationship between pain, anxiety and depression and medication use in care home residents and (ii) to compare those on medications to treat pain, anxiety and depression, and those who were not, and associations with pain severity and overall QoL. Methods This was a secondary analysis of a randomised controlled trial testing a falls prevention intervention in care homes. We recorded pain, anxiety and depression, QoL measurements and prescribed medication use. Results In 1589 participants, the mean age was 84.7 years (±9.3 SD), 32.2% were male and 67.3% had a diagnosis of dementia. 54.3% and 53.2% of participants had some level of pain and anxiety or depression respectively, regardless of prescribed medication use. There was a direct association between pain severity and being on any analgesia, opioid analgesia, and antidepressants, but no associations between pain severity and use of paracetamol and anxiolytics. QoL was best for residents with no pain and not on any analgesia, anxiolytics or antidepressants and worst for those with moderate-extreme pain and taking at least two of these classes of medications. Conclusion Many care home residents live with pain, anxiety and depression. Addressing residents’ pain may also increase their quality of life, but using medication alone to reach this goal may be inadequate.

Longacre M.L., Redington S., Miller M.F.

A Continuing Care Retirement Community (CCRC) initiated a voluntary cohort or "social cluster" (SC) program during the pre-vaccination phase of COVID. SCs are self-selected small groups of persons who decide about types of social interactions. The program began in April 2020, and a cross-sectional survey of residents was conducted in November 2020 to assess perceptions of COVID (e.g., worry and prevention) and of program participation. A secondary goal was to explore if program involvement was associated with perceptions of social isolation. Participants (n = 85) were "somewhat" (49 %) or "very" (11 %) worried about COVID, and 34 % participated in a SC. 89 % of the SC participants indicated that "Dining within 6ft" was most preferred. Improvement in boredom, social isolation, activity level, mental health, hope, and fear was noted among some SC participants (55 %, 52 %, 41 %, 38 %, and 14 %, respectively). Findings contribute to understanding social engagement needs amidst COVID.