Social engagement, mood, and mortality in old age

Social relationships, social activity, and experiencing fulfilment of interpersonal needs are essential aspects of well-being in older people. The purpose of this research was twofold: first, to investigate the associations of various dimensions of social activity and perceived togetherness with indicators of health decline; and second, to identify potential mediators in these associations. This dissertation is based on data from two research projects. The first, the Evergreen project, is a multidisciplinary, longitudinal follow-up study on the health and functional capacity of people aged 65–84 in 1988 (n=1 181) resident in Jyväskylä, Finland. Data on institutionalization and mortality were obtained from local and nationwide registers. The second, Promotion of mental well- being in older people (GoodMood), was a randomized controlled trial lasting for 1.5 years targeting persons aged 75–79 years (n=222–223) who reported symptoms of loneliness or melancholy at study entry. In both studies, data on social factors and health were gathered in face-to-face interviews. The results showed that those who were more active in collective social activity had reduced risk for mortality and institutionalization over the 17-year follow-up. Better mobility partially explained the association between collective and productive social activities and mortality risk. Better cognitive functioning and fewer depressive symptoms were prerequisites for participating in social activities. Of the dimensions of perceived togetherness, higher sense of attachment and opportunity for giving nurturance at baseline predicted a lower number of depressive symptoms at follow-up. In addition, the presence of depressive symptoms and loneliness at baseline predicted lower scores in the dimensions of perceived togetherness at follow-up. A social intervention of choice increased experiences of social integration, but did not affect depressive symptoms. Loneliness and melancholy were attenuated over time, also equally among controls, suggesting no additional benefit from the social intervention. Collective and productive social activity may contribute to preventing health decline in older people. A higher level of social activities and contentment in perceived togetherness, less frequent feelings of loneliness and fewer depressive symptoms often co-exist, but increased social activity may not lead to improvements in these variables.