Objectives. To examine the influence of social networks and social engagement on cognitive decline in a population-based cohort of elderly people, and to assess gender differences in the effect of social relations on cognition. Methods. A longitudinal study of community-dwelling people over 65 was carried out. Cognitive function (orientation and memory) in 1997 and cognitive decline (absent, mild, and severe) over 4 years (1993–1997) were assessed using an instrument previously validated for populations with a low level of education. The effect of social networks, social integration, and social engagement with friends, children, and relatives on cognitive function and cognitive decline was estimated by multiple linear and logistic regressions after adjusting for age, sex, education, depressive symptoms, systolic and diastolic blood pressure, and functional status. Results. Poor social connections, infrequent participation in social activities, and social disengagement predict the risk of cognitive decline in elderly individuals. The probability of cognitive decline was lower for both men and women with a high frequency of visual contact with relatives and community social integration. Engagement with friends seemed to be protective for cognitive decline in women but not in men. Discussion. This longitudinal study indicates that few social ties, poor integration, and social disengagement are risk factors for cognitive decline among community-dwelling elderly persons. The nature of the ties that influence cognition may vary in men and women.

Objectives: To assess the validity and reliability of the Short Physical Performance Battery (SPPB) in adults 65 to 74 years old, capable in all basic activities of daily living (ADL), in Quebec and Brazil. Methods: Participants were recruited in St. Bruno (Quebec) by local advertisements (n = 60) and in Santa Cruz (Brazil) by random sampling (n = 64). The SPPB includes tests of gait, balance, and lower-limb strength. Disability status was categorized as intact mobility, limited mobility, and difficulty in any of ADL. Results: There was a graded decrease in mean SPPB scores with increasing limitation of lower limbs, disability, and poor health. Using the test–retest reliability the authors evaluated the intraclass correlation coefficient, which was high in both samples: .89 (95% CI: 0.83, 0.93) in St. Bruno and .83 in Santa Cruz (95% CI: 0.73, 0.89). Discussion: This study provides evidence for the validity and reliability of SPPB in diverse populations.

Background. Gender, social conditions, and health throughout the life course affect functional health in later life. This article addresses two specific hypotheses: i) life-course social and health conditions are associated with frailty; and ii) differential exposure and/or vulnerability of women and men to life-course conditions may account for gender differences in frailty. Methods. Data originated from a cross-national survey of older adults living in five large Latin American cities. Frailty was defined as the presence of three or more of five criteria: unintentional weight loss (10 pounds during the past year), self-reported exhaustion/poor endurance, weakness (grip strength), limitations in lower extremities, and low physical activity; a prefrail state was defined as the presence of one or two of the above criteria. Associations between frailty and social and health indicators were examined using a proportional odds ordinal logistic regression. Results. Prevalence of frailty varied from 0.30 to 0.48 in women and from 0.21 to 0.35 in men. Childhood (hunger, poor health, and poor socioeconomic conditions), adulthood (little education and non-white-collar occupation), and current social conditions (insufficient income) were associated with higher odds of frailty in both men and women. Comorbidity and body mass index were related to frailty, but their effects differed in women and men. Male/female age-adjusted odds of frailty varied from 1.55 (Bridgetown) to 2.77 (Havana). Differential exposure and vulnerability partially explained differences between women and men. Conclusion. Theoretical models to explain gender and social differences in frailty should use a life-course perspective.

Objective To assess the association between emotional and instrumental support from children and living arrangements with the physical and mental health of older people in Spain. Methods A face-to-face home interview was carried out with 1284 community-dwelling people over 65 (response rate = 83%) randomly sampled according to an age- and sex-stratified sampling scheme in 1993 at Leganés (Spain). Close to 93% of the participants had children and 45% of them coresided with them. Depressive symptoms were assessed by the CES-D (Center for Epidemiologic study depression scale) and self-rated health (SRH) by a single-item question. Emotional support was measured with a six-item scale on affection and reciprocity. Instrumental support was assessed by help received from children in 17 activities of daily living. Four living arrangements were considered: Living with spouse only, living with a spouse and children, widower living alone, and widower living with children. Results Multivariate analysis controlling for age, gender, education and functional status showed that low emotional support and reception of instrumental aid were significantly associated with poor SRH. Being a widower and sharing living arrangements with children was associated with good SRH. Living arrangements modify some of the associations of support of children with SRH. Depressive symptoms were associated with low emotional support, reception of instrumental help and being a widower who did not share living arrangements with children. For widowers who do not cohabit with children, reception of instrumental aid is associated with low depressive symptomatology. Discussion Emotional support from children seems to play an important role in maintaining the physical and mental health of elderly people in Spain. Instrumental support is widely available. Coresidence with children is very common and it is associated with good self-perceived health and low prevalence of depressive symptoms in a culture where family interdependence is highly valued. Families should be protected and encouraged to continue care-giving through a variety of community services and respite care, adapted to their needs and preferences. Research should be undertaken to find more efficient ways to help family caregivers in the Mediterranean context.

We assessed conjoint trajectories of cognitive decline and social relations over 7 years on a representative sample of community-dwelling elderly persons. We analyzed data using repeated measurement models. Social integration, family ties, and engagement with family were associated with cognitive function at advanced ages, controlling for education and introducing depressive symptoms, functional limitations, and chronic conditions as intervening variables. Association of social integration, through participation in community activities, with change in cognitive decline was more significant at advanced ages. Having friends was significantly associated with change in cognitive function in women only. Our findings have important implications for clinical medicine and public health because associations of social relations with cognitive function suggests that they may help to maintain cognitive function in old age.

To assess the socioeconomic, geographical and demographic inequities in the use of postnatal health-care services in low- and middle-income countries. We searched Medline, Embase and Cochrane Central databases and grey literature for experimental, quasi-experimental and observational studies that had been conducted in low- and middle-income countries. We summarized the relevant studies qualitatively and performed meta-analyses of the use of postnatal care services according to selected indicators of socioeconomic status and residence in an urban or rural setting. A total of 36 studies were included in the narrative synthesis and 10 of them were used for the meta-analyses. Compared with women in the lowest quintile of socioeconomic status, the pooled odds ratios for use of postnatal care by women in the second, third, fourth and fifth quintiles were: 1.14 (95% confidence interval, CI : 0.96-1.34), 1.32 (95% CI: 1.12-1.55), 1.60 (95% CI: 1.30-1.98) and 2.27 (95% CI: 1.75-2.93) respectively. Compared to women living in rural settings, the pooled odds ratio for the use of postnatal care by women living in urban settings was 1.36 (95% CI: 1.01-1.81). A qualitative assessment of the relevant published data also indicated that use of postnatal care services increased with increasing level of education. In low- and middle-income countries, use of postnatal care services remains highly inequitable and varies markedly with socioeconomic status and between urban and rural residents.