Fratiglioni and others (Lancet 2000;355:1315-19) showed that an extensive social network seems to protect against dementia.  This study was done with 1473 people 75yrs and older who were not demented at baseline. Follow-up exams were done three years later. Being single and living alone increased the risk of dementia by 1.9 times. 

Hello Nicholas,

Thank you for your question and your observations.  I am currently conducting PhD research in this area. There is substantial empirical evidence supporting your observations both on the benefits of positive social engagement for people with dementia and the detrimental effects of a lack of social engagement, both generally and in aged care environments.  There are several different areas / key words that may be useful if you are interested in doing a topical search:  'social networks', 'social engagement', 'social support' (objective and perceived), 'social isolation', and 'loneliness'...together with the care level of interest 'assisted living', 'nursing home', 'continuing care', etc.  Articles on 'person-centered care' and 'relationship-based care' may also be of interest.  The journals 'Dementia' (2012) and 'The Journals of Gerontology: Series B' (2015) have published special issues on social networks.  The proceedings from the Alzheimer's Disease International Conference 2015 (Perth, AUS), contains multiple abstracts and profiles of researchers in this area.  Thank you again--I believe that your question is an important one.  All the best to you in your work.

Kind regards,

Anne-Nicole

Thanks for all the info!  I'd be very intrigued to learn of your findings in your research.  It truly is a fascinating field of research.

This free article based on research we carried out supports your ideas. While the sample were not soley those with dementia many were. Care givers clearly identified the importance to them of the socialisation aspects of respite care, and we mapped this successfully against Maslow's hierarchy of need, finding that the highest level of need for belonginess, love and esteem were seen as necessary aspects of respite care.

Good luck with this important topic

Christine

http://www.biomedcentral.com/1472-6963/14/245

Ah, you are too splendid!  thanks so much for the info! you are too great

Reading with pleasure the response by Linda Hershey, please let me quote the accompanying editorial in the same issue Lancet 2000;355 at pages 1291-2, by Lisa F Berkman, whose title is significant: "Which influences cognitive function: living alone or being alone ?" best, Mauro Colombo

Thanks a bunch! I'm looking up the article as I write this!

Hi Nicholas,

Previous comments have been very helpful, and you might like to read this short and recent review by Baumgart et al (Alzheimer's & Dementia 2015, article is open access) on "modifiable risk factors for cognitive decline and dementia". It includes citations from multiple studies on the same (+comparable) topic.

They mention social engagement as a potential protective factor, although previous studies are not numerous and/or high quality enough to consider this as a very strong scientific evidence.

In addition, the authors also listed several other modifiable risk/protective factors (cardiovascular, lifestyle, education, medical history...) you could be interested in.

Of course, this point only applies to the role of social engagement as a factor protecting from the onset of AD. The other (very relevant) question is how social engagement matters in the care of patients with Azheimer's once the disease is symptomatic, and how is can help caregivers.

Best,

Renaud

http://www.alzheimersanddementia.com/article/S1552-5260%2815%2900197-1/abstract

I look forward to the article, thank you very much.  I've long believed that factors contributing to Alzheimer/dementia are myriad and complicatedly interwoven, so this sounds right up my alley.

Social engagement such as volunteering keeps individuals socially active and a sense of purpose in life.  So, it makes sense that social engagement  protects against dementia.  Further, in a study of the Honolulu Heart Program by Ceria et al (Journal of American Geriatrics Society, 49:725-731, 2001), social networks were significantly independently associated with 6 year all-cause mortality in older Japanese American men.  Social interventions in old age may reduce early mortality.

Renaud's point on caring for people with dementia goes to the heart of Nicholas's thought. Care for people with dementia in hospitals, especially acute care,  and in residential aged care for that matter, must focus on interventions that reduce the stress of a foreign and inexplicable environment and engage the person in some meaningful or useful activity. Result, otherwise, is usually behaviours that are challenging and too often managed through seclusion, restraint and antipsychotic medications. Socialisation can be an important, if rarely used in acute hospital settings, way to manage challenging behaviours.

We provided project funding to health services to implement best care for older people practices in their hospitals. One looked at processes to engage people with dementia and/or delirium. Providing meaningful and engaging activities and actively involving people important to the person had immediate benefits in care, reducing distress of all involved and improving outcomes. Being person centred is the key.

The issue can also be considered in the context of the stigmatisation of people with dementia. ; see Alzheimer's Disease International report: http://www.alz.org/documents_custom/world_report_2012_final.pdf. This might be useful: http://www.health.vic.gov.au/dementia/

Professor John Swinton observes that the issue is not so much that the person forgets but that the person is forgotten. Family often observe that the person that they loved is no longer the person that they knew which can lead to dehumanising the person. No wonder more people fear dementia than cancer.

Such an important topic.

"the issue is not so much that the person forgets but that the person is forgotten,".  I am taking this quote to heart!  Thanks for the valuable input as well as related article.  Along similar lines on 'being forgotten', is the process of dehumanization you mention.  This seems particularly so when a patients family has difficulty in arranging visiting hours.  It can be so easy for someone (even if they care deeply), to say "Oh! I'll go visit tomorrow!", only to have tomorrow come and go.  Motivating oneself to visit a relative who has changed so dramatically can also be difficult.  Seeing someone you love dearly, slowly disappear over time, despite physically being present, is an extraordinary emotional burden.  Eventually, visiting can become an 'emotional chore', for affected family and friends.  Which of course contributes to a dehumanizing process. However, I do believe that this can create a 'vicious cycle', wherein, each postponed visitation/social engagement, only makes the next visit even more difficult.  Hence, I've come to the belief that continuity and frequency of visitations is just as essential as the content and depths of ones 'social engagement'.

The problem is that older people and people with dementia are often seen as 'non viable' persons.     I reckon it is vital to engage, with their wishes, at the outset at diagnosis to find out who they are as a person and not as a token gesture.   They need to be fully engaged with as the person they are not the dementia patient.   One of the problems is the multitude of beliefs about dementia, in the family, in the community, in hospitals and in care homes.   If they lose even being called by their name, then what have they got in life?   Yes engagement that they would wish is not just nice to have but I believe, essential.

I entirely concur.  At the core of the issue, or so I believe, is one of self esteem.  Much of human sense of self value is based on the value others place in oneself.  Becoming devalued by others is clearly detrimental to ones health.  Despite all of medical science providing physical necessities for survival, I do believe that the human 'soul' needs nourishment as well.  When you cease being a human with a name and become just a patient with a number, I cannot imagine the sense of loss one might feel.

I do agree with Daniela Fuchs; more, even when persons with dementia live in an ongoing present, they somehow keep track of [negative] experiences, though blurred - as the literature posit also for other forms of amnesia

good sunday evening, Mauro

Yes, I agree.  Social engagement is so important esp. since this can decrease negative behaviors.  There are some evidenced based practice programs to support this such as: TimeSlips (Anne Basting); Breakfast Club (Faerella Boczko), use of memory books to preserve interaction with others (Michele Bourgeois) and other interventions.  Some of these interventions along with rationales, goals, references, etc. have been posted on the N.Y. state dementia "EDGE" website @ https://www.health.ny.gov/diseases/conditions/dementia/edge/interventions/index.htm.  Hope this helps!

Ah thank you so much!  I've been quite intrigued by the usage of memory books, as I have long felt that externalizing memory in some ways aids in the internalization of it.  I very much look forward to perusing this link you provided!