The aim of this study is to investigate how older adults were affected by the COVID-19 restrictions that were put in place by the Swedish Health Authority during the first wave of the COVID-19 pandemic to protect them and the roles played by social workers during the pandemic. A qualitative study was conducted whereby two older adults aged seventy and two practising professional workers were interviewed, and their responses analyzed using thematic analysis. The results showed that one of the older adults felt isolated, while the other did not have the same experience. The social workers on the other hand felt that they were responsible for the lives of their clients as well as that of their staff.

Objetivo: Asociar el uso del servicio dental y la necesidad de tratamiento en residentes de Lima, Perú durante el aislamiento social obligatorio por la COVID-19 en el año 2020. Métodos: Estudio observacional, analítico y transversal. La muestra fue conformada por 223 residentes mayores de edad que cumplieron con los criterios de inclusión. Se tomó como base encuestas nacionales de autoreporte para seleccionar preguntas relacionadas a las variables uso del servicio dental, necesidad de tratamiento y covariables como sexo, ocupación, grado de instrucción, distrito de residencia, edad, ingreso económico y seguro de salud. Se realizó un análisis descriptivo mediante frecuencias absolutas y relativas, un análisis bivariado mediante la prueba de chi cuadrado y un análisis multivariado utilizando la regresión de Poisson con varianza robusta donde se reportaron razones de prevalencias crudas y ajustadas. Resultados: El 58.3% de los encuestados no hicieron uso del servicio dental durante el aislamiento social obligatorio a pesar de necesitar atención, siendo el principal motivo de inasistencia la pandemia por la COVID-19 (37.67%). Además, se registró que la urgencia (24,66%) fue la necesidad de tratamiento más predominante. No se halló asociación estadísticamente significativa entre el uso del servicio dental y la necesidad de tratamiento Conclusión: Las personas a pesar de tener una necesidad de tratamiento, no necesariamente utilizaron los servicios dentales durante el periodo de aislamiento social obligatorio en el Perú durante el año 2020. / Objective: To associate the use of dental services and the need for treatment in patients in Lima, Peru during social isolation mandated by COVID-19 in the year 2020. Methods: Observational, analytical and cross-sectional study. The sample consisted of 223 residents who met the inclusion criteria. National self-report surveys were used as a basis for selecting questions related to the variables use of dental services, treatment need and covariates as sex, occupation, level of education, district of residence, age, income and health insurance. A descriptive analysis was carried out using absolute and relative frequencies, a bivariate analysis using the chi-square test and a multivariate analysis using Poisson regression with robust variance where crude and adjusted prevalence ratios were reported. Results: 58.3% of the respondents didn’t make use of the dental service during the mandatory social isolation despite needing care, the main reason for non-attendance being the COVID-19 pandemic (37.67%). In addition, it was recorded that urgency (24.66%) was the most predominant need for treatment. No statistically significant association was found between the use of dental services and the need for treatment. Conclusion: Patients, despite having a need for treatment, did not necessarily use dental services during the period of compulsory social isolation in Peru in the year 2020. / Tesis

El aislamiento social es un estado en donde se pierde comunicación con el medio externo, lo cual puede generar estrés y ansiedad. Asimismo, las emociones influyen en el comportamiento alimentario de las personas, lo que genera cambios en la cantidad y calidad de alimentos. De esta manera, el presente estudio buscó explorar los efectos del estrés y ansiedad en el consumo de alimentos en adultos expuestos a un estado de aislamiento social. Se realizó una revisión sistemática cualitativa incorporando estudios cuantitativos, cualitativos y mixtos en la base de datos Scopus, Bvs Lilacs, PubMed y Web of science, así como de la literatura gris. Se incluyeron en total 8 estudios que cumplían con los criterios de elegibilidad para la extracción de la información y análisis cualitativo. La mayoría de los estudios (n=7/8), se contextualizan en el aislamiento social infligido durante la pandemia COVID-19, en donde, la mayoría de personas mantuvieron una alimentación emocional. Asimismo, una minoría de estudios mencionan que los cambios emocionales generaron un aumento del consumo de alimentos (dulces, snacks o meriendas, así como frutas y verduras). Solo un estudio se contextualiza en adultos mayores, quienes manifestaron tener menor apetito ante el sentimiento de soledad a la hora de comer. Se concluye que el estrés y ansiedad, junto a otras emociones que se detallan durante un aislamiento social, afectan el apetito de los adultos, lo cual aumenta o disminuye su consumo de alimentos e influye en la elección de alimentos. / Social isolation is a state where communication with the external environment is lost, which can generate stress and anxiety. In this way, emotions influence people's eating behavior, which is associated with changes in the quantity and quality of food. In this way, the present study seeks to explore the effects of stress and anxiety on food consumption in adults exposed to a state of social isolation. A qualitative systematic review was carried out incorporating quantitative, qualitative and mixed studies in the Scopus, Bvs Lilacs, PubMed and Web of science databases, as well as the gray literature. Most of the studies (n = 7/8) are contextualized in the social isolation inflicted during the COVID-19 pandemic, where the majority of people maintained an emotional eating. Likewise, a minority of studies mention that emotional changes generated an increase in food consumption (sweets, snacks or snacks, as well as fruits and vegetables). Only one study is contextualized in older adults, who are affected by their appetite for the feeling of loneliness when it comes to eating. It is concluded that stress and anxiety, along with other emotions that emerge during social isolation, people's appetite, which increases or decreases their food consumption, as well as influencing the choice of food. / Tesis

Depressionen bei hochaltrigen Menschen sind weit verbreitet und folgenschwer, dennoch bleiben diese häufig unentdeckt und unbehandelt. Daher ist die Identifizierung von Risikofaktoren besonders wichtig, um Depressionen im Alter zu erkennen oder präventiv zu begegnen. Die Bedeutung von psychosozialen Faktoren, wie Verlusterfahrungen und das soziale Netzwerk, werden dabei häufig vernachlässigt. Dabei wird der Tod von nahestehenden Personen mit zunehmendem Alter häufiger und erfordert ein hohes Maß an psychologischer Anpassungsleistung der Hinterbliebenen. Die damit einhergehende Veränderung des sozialen Netzwerks birgt ein Risiko für soziale Isolation und damit auch für Depressionen. Das Ziel der Dissertation war es, Depressionen bei hochaltrigen Menschen in Deutschland in Abhängigkeit von sozialer Isolation und Verlusterfahrungen zu analysieren und dabei auf mögliche Geschlechtsunterschiede einzugehen. Datengrundlage der ersten Untersuchung war die „Leipziger Langzeitstudie in der Altenbevölkerung“ (LEILA 75+), eine prospektive, epidemiologische und bevölkerungs-repräsentative Kohortenstudie. Mit einer Stichprobe von 783 Personen (durchschnittliches Alter 80,78 (SD 4,52) Jahre) wurde zunächst mittels einer deskriptiven Analyse die Veränderung des sozialen Netzwerks (PANT) im Alter unter Berücksichtigung von Verlusterfahrungen analysiert. 57% der älteren Menschen lebte kontinuierlich in einem restriktiven sozialen Netzwerk. Bei 30,9% der Hochaltrigen konnte eine Änderung im sozialen Netzwerk während des Untersuchungszeitraums festgestellt werden, diese konnten allerdings in keinen Zusammenhang mit Verlusterfahrungen gebracht werden. Verlusterfahrungen (OR 7,56 (1,60–35,72)) und ein restriktives soziales Netzwerk (OR 4,08 (1,52–10,95)) stellten sich in den Hybridregressionen als signifikante Prädiktoren zur Entwicklung einer Depression (ADS-L) heraus. Protektive wirkte hingegen ein integriertes soziales Netzwerk. In der zweiten Studie wurden die AgeDifferent.de Daten, die aus drei gepoolten Alterskohortenstudien (LEILA 75+, AgeCoDe / AgeQualiDe und AgeMooDe) bestehen, ausgewertet. Das durchschnittliche Alter der 2.470 Befragten lag bei 79,2 (SD 3,64) Jahren. Bei Frauen konnte ein signifikant höherer Schweregrad der Depression festgestellt werden als bei Männern (β=0.16; 95%-CI=0.09; 0.23). Analysen zum Vergleich der Depressivität vor und nach der Verwitwung verdeutlichten, dass der Schweregrad der Depression nach der Verwitwung signifikant höher ist. In dieser Studie konnte zudem gezeigt werden, dass verwitwete Männer signifikant mehr depressive Symptome haben als nicht verwitwete Männer. Bei der Betrachtung von Frauen konnten jedoch keine Unterschiede festgestellt werden. Bei intraindividueller Betrachtung zeigte sich, dass sowohl verwitwete Männer als auch verwitwete Frauen signifikant mehr depressive Symptome haben als vor ihrer Verwitwung. In der letzten Untersuchung wurde mit Daten der AgeCoDe / AgeQualiDe Studie analysiert ob Unterschiede zwischen Verwitweten und Verheirateten in Alter, Geschlecht und Bildung auch eine mögliche Erklärung für die Unterschiede in der Depressivität zwischen diesen Gruppen sein könnten. Mit Daten von 679 Personen (456 verwitwet, 223 verheiratet), mit einem durchschnittlichem Alter von 86,5 (SD 2,9) Jahren konnte gezeigt werden, dass Verwitwete häufig älter, häufiger weiblich und eher niedriger gebildet sind. Mittels „Entropy Balancing“ wurden diese Eigenschaften von Verwitweten und Verheirateten vereinheitlicht. Das Ausmaß der depressiven Symptome bei verwitweten hochaltrigen Frauen und Männern war in dieser Untersuchung ähnlich. Bei der Berücksichtigung der sozialen Isolation stellte sich in dieser Untersuchung heraus, dass soziale Isolation vor allem in der Gruppe der Verwitweten zu mehr depressiven Symptomen führt. Verwitwete Männer und Frauen, die zudem sozial isoliert leben, weisen signifikant mehr depressive Symptome auf, als Verwitwete ohne soziale Isolation (β=0.83; 95%-CI=0.44; 1.23). Soziale Isolation hatte in der Gruppe der Verheirateten im Gegensatz zu den Verwitweten keinen Einfluss auf die Häufigkeit depressiver Symptome. Zusammenfassend zeigt sich, dass Verlusterfahrungen als ein Risikofaktor zur Entwicklung depressiver Symptome identifiziert werden konnte. Nicht eindeutig ist der Einfluss des Geschlechts. Mögliche Unterschiede zwischen Frauen und Männern im Zuge der Verwitwung könnte beispielsweise die Unterrepräsentation von verwitweten Männern sein. Wird dieser Faktor berücksichtigt, können Frauen und Männer als ähnlich vulnerabel zur Entwicklung einer Depression nach dem Verlust des Ehepartners gelten. Für Menschen die zusätzlich neben dem Verlust des Ehepartners ein sozial isoliertes soziales Netzwerk haben, ist das Risiko zur Entwicklung einer Depression noch größer. Ein gestärktes soziales Netzwerk kann hingegen bei beiden Geschlechtern als ein protektiver Faktor zum Erhalt der psychischen Gesundheit gesehen werden.:Abbildungsverzeichnis Tabellenverzeichnis Abkürzungsverzeichnis 1 Einleitung 1.1 Depressionen im Alter 1.2 Trauer- und Verlusterfahrungen im Alter 1.3 Bedeutung des sozialen Netzwerks im Alter 1.4 Geschlechtsunterschiede im Alter 2 Datengrundlage und Publikationen der vorliegenden Dissertation 2.1 Datengrundlage 2.1.1 LEILA 75+ 2.1.2 AgeCoDe / AgeQualiDe 2.1.3 AgeMooDe 2.1.4 AgeDifferent.de 2.2 Überblick über die Publikationen der vorliegenden Dissertation 3 Loss experiences in old age and their impact on the social network and depression– results of the Leipzig Longitudinal Study of the Aged (LEILA 75+) 4 Are older men more vulnerable to depression than women after losing their spouse? Evidence from three German old-age cohorts (AgeDifferent.de platform) 5 The role of social isolation and the development of depression. A comparison of the widowed and married oldest old in Germany 6 Diskussion 6.1 Allgemeine Diskussion 6.2 Implikationen für die Praxis und die Versorgungsforschung 6.3 Fazit Zusammenfassung der Arbeit Literaturverzeichnis Anhang A: Darstellung des eigenen Beitrags Anhang B: Erklärung über die eigenständige Abfassung der Arbeit Anhang C: Lebenslauf Anhang D: Wissenschaftliche Beiträge Anhang E: Danksagung

WEAVING IN WOOD  An architectural strategy in Umeå that strive to decrease loneliness and include elderly with physical and cognitive impairments A Master Thesis by Rebecka Littbrand                                                                                                   Spring 2020   Background Feelings of loneliness is common in the whole western world, especially among older people. Loneliness is of public health concerns as being a risk factor for many severe diseases and premature mortality. Scientists argues that an increase of social embeddedness is essential for improvements in well-being and quality of life. The focus group for this master thesis is elderly that lives in ordinary housing in Umeå, Sweden. Among elderly physical and cognitive impairments such as dementia are common, as well as getting help from the Home care service. Methodology This master thesis investigates different factors linked to loneliness, the current situation in Umeå regarding meeting places for elderly and architectural features to include elderly with impairments. Study visits to existing meeting places, interviews with local actors and experts within the field as well as reading literature have driven the project forward.   Findings Most districts in Umeå have no meeting place where elderly with impairments easily can participate. To include elderly with physical and cognitive impairments there are important to counteract 5 barriers: Long distance, Hidden placement, Need to plan and sign up in advance to participate, Insecurity if there will be someone there who can support you and Cost for participating.        To ease for people with dementia and to create a meeting place that feels welcoming and secure there are several architectural features that should be taken into consideration, e.g. arrange the rooms around a central common space, highlight functions by using powerful colours, being on ground floor and visual connections between certain spaces, which the “Open meeting places” provided by the municipality in Umeå have problems in fulfilling.    Conclusion  An architectural strategy in Umeå to reduce loneliness among elderly living in ordinary housing and that counteracts the barriers to include elderly with physical and cognitive impairments is needed. By placing New open meeting places next to the local food stores in the different districts of Umeå the barriers Hidden placement and Long distance are counteracted, enabling the Home care service to guide elderly to the places. The meeting places will consider important architectural features to include people with dementia and create a place that feels welcoming and secure.      The New open meeting places will collaborate with local actors, strive to highlight the importance of social interaction, take away the stigma related to loneliness as well as give the elderly population more prominent and visible places in society.

Large portions of the US population live in poor inner-city communities. Health needs assessment data have shown that these communities have disproportionately high rates of chronic illnesses. The patient-centered medical home (PCMH) model was developed to address the gaps that exist in the primary care system, and emphasizes a redesign of primary care that is patient centered, utilizes multiple levels of healthcare professionals, information technology, and care coordination. However, little evidence exists on the value of this model which may explain why it has not gained wide acceptance by primary care providers. Therefore, this study was designed to examine the efficacy of the PCMH model through emergency department and inpatient utilization reductions, and with a specific focus on the role of social connectedness. This research used existing data on 706 participants from Columbia University and a local New York inner-city hospital. An in-depth analysis of hospital utilization data, using an unpaired two-sample t-test and linear regression, found that the PCMH framework strengthens continuity of care and care coordination, and helps reduce avoidable hospitalization utilization. Additionally, these reductions were greater for study participants with strong social support networks. This research highlights the relationships between primary care, social support networks, and good health outcomes. Over time, further enhancement of the PCMH and systemic changes to the delivery of care may contribute to the development of a stronger primary care system that place patients at the center of care, focuses on the importance of social connectedness, and contributes to a lasting impact on society through the development of overall healthier communities.

As a social species, human beings are driven by an innate desire to belong and are thus motivated to develop and maintain meaningful social relationships. As such, perceiving a lack of belongingness strongly impacts psychological and physiological health and well-being. A common form of perceived relationship deficits is loneliness, a negative-affective experience detrimental to health and well-being over time. Through a series of three manuscripts, this dissertation applies the full-cycle model of social psychological research to explore various affective, behavioral, and cognitive consequences of loneliness. Whereas existing models of loneliness focus on long-lasting or chronic forms of loneliness, these studies investigate chronic and transient loneliness, as well as processes through which transient loneliness may develop into more chronic levels. The first paper demonstrates that solitary consumption is a unique behavioral response to transient loneliness, which may exacerbate the experience of loneliness and negatively impact health over time. The second paper provides support for a positivity-deficit perspective, demonstrating that chronic loneliness is related to less disclosure of recent positive experiences, a deficit which may be consequential for the development of close relationships. The third paper demonstrates the role of transient loneliness in inhibiting individuals and their interaction partners from reaping the social rewards of positive-event disclosure, particularly among those who typically feel socially connected. Taken together, these studies expand the current understanding transient loneliness, revealing various social-cognitive and behavioral consequences which could impede the social-reaffiliation process, and thus contribute to the maintenance of loneliness over time.

This study examines how older people in Sweden experience life during the restrictions following the Covid-19 pandemic. Six elderly people were interviewed and the transcriptions were analyzed using a qualitative research method. The study showed that the restrictions have not yet led to any deterioration in well-being, but the majority of the group felt that the restrictions had affected their life situation in a negative way. The group had to limit social contacts and minimize visits from loved ones during the pandemic. Active life was also set aside due to the restrictions, which was perceived negatively by the respondents. The results are in line with previous research which shows that elderly people experience dissatisfaction with social isolation that resulted from the Covid-19 restrictions, but it turned out that the respondents seemed to have a strong safety net and strong resilience as they adapted well to the social restrictions.

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Everyone deserves a home that promotes well-being and reduces stress. Mental illness among students has tripled in the 21st century and statistics show higher numbers than ever. The problems can often be linked to socioeconomic factors and for many young people, it applies to education. The design of our cities has a great impact on how we feel and how we choose to live our lives and through awareness and knowledge of health-promoting factors, the architect can design more stress-reducing and functional environments. We need to create a pleasant environment for students to live in using architectural strategies that counteract stress. Building enjoyable apartments incorporating architectural means to reduce stress can help students in their everyday life. Having both private spaces and different scales of public areas creates opportunities to choose where they want to spend their time depending on how much interaction with other people they want. The way we design and manage spaces around apartments, outdoor as well as indoor, can support both the development of interaction between humans and solitary activities. According to studies, offering both active and passive social participation creates security and belonging. Each person takes control over their own presence in social interactions which decreases the risk of social isolation.