Professional blog

a) Introduction

The bio-ecological framework, developed by Bronfenbrenner (1917-2005), highlights the complex interactions between individuals and their surrounding environments, showing how various environmental layers shape human development. This model identifies five key subsystems: microsystem, mesosystem, exosystem, macrosystem, and chronosystem (Krishnan & Chan, 2024).

The microsystem refers to an individual’s immediate surroundings, such as family and peers. The mesosystem looks at the connections between different microsystems, like the interaction between parents and teachers. The exosystem represents the broader social structures that indirectly impact the individual, such as parent’s workplace. The macrosystem encompasses societal and cultural influences, including law and customs. Finally, the chronosystem considers the role of time, life transitions, and historical context in shaping development (Krishnan & Chan, 2024).

Ageing and the bio-ecological framework

The ageing process can be analysed through the bio-ecological lens, recognising that biological, psychosocial, and environmental factors all influence how individuals experience ageing. These factors collectively determine the quality of life for the elderly, especially in terms of health, social relationships, and autonomy.

Microsystem

Age-related biological changes play a significant role in shaping the ageing process. These changes include decreased mobility, sensory impairments, and the onset of chronic illnesses such as cardiovascular disease, diabetes, and dementia. The microsystem which includes family, friends, healthcare services, and immediate community members directly affects how well older individuals manage these biological challenges. Support from family can improve both physical and mental health outcomes, while social isolation is associated with higher risks with depression, cognitive decline, and mortality (Tomaka et al., 2006). Additionally, those who have access to consistent medical care often report a higher quality of life due to better health outcomes and effective management of chronic diseases (Prince et. al., 2015).

According to Puts et al. (2017), frailty in older adults, which is often associated with physical decline and chronic illness, is linked to increased dependency and reduced quality of life. Early intervention and regular healthcare access can help mitigate these impacts, showing the importance of the microsystem in promoting health and well-being in older age.

Mesosystem

Psychosocial factors, including relationships with family, friends, and social networks, greatly impact the emotional and mental health of the elderly. Positive family interactions and strong social support networks can improve mental well-being and reduce feelings of loneliness and isolation, which are common in later life (Cornwell & Waite, 2009, p. 2).

In the mesosystem, the quality of interactions between the elderly’s immediate environments further influences their psychosocial well-being. For instance, supportive family relationships combined with consistent medical care can enhance the overall quality of life. This is supported by Chang et al. (2022), in their study on empty-nesters in China, based on social-ecological system theory which highlights that social and family support plays a crucial role in improving mental and emotional well-being of elderly individuals. This is particularly for those who are living alone which further emphasize the value of social networks in successful ageing. Hawkley and Cacioppo (2010) also brought up the point on how social isolation is linked to increased rates cognitive decline, depression, and mortality in the elderly. Overall emphasizing the importance of social connectedness in healthy ageing.

Exosystem

The exosystem, particularly socioeconomic conditions, profoundly influences the ageing process. Older adults who live in poverty or have limited access to resources are more vulnerable to experiencing a decline in physical and mental health. These individuals may struggle with accessing quality healthcare, proper nutrition, and housing stability, all of which contribute to poorer outcomes in ageing (Chan et al., 2010).

This is where socioeconomic disparities can impact the level of support older adults receive from government policies and community resources. Marmot and Wilkinson (2005) argue that socioeconomic inequalities significantly contribute to health disparities as well. This stresses the role of exosystem in shaping the quality of life for the elderly. Additionally, Zaninotto et al. (2020) found that lower socioeconomic status is associated with poorer physical and mental health outcomes among older adults, reinforcing the importance of economic stability in promoting healthy ageing.

Macrosystem

The macrosystem reflects the broader cultural and societal values that shape perceptions of ageing and elderly. In societies that value youth and productivity, older adults may face ageism, which can lead to marginalisation, discrimination, and a reduction in social roles. This affects not only their mental well-being but also their access to services and support systems (North & Fiske, 2013).

In contrast, cultures that revere the elderly as sources of wisdom and experience provide more social opportunities and support for their older population, enhancing their quality of life. Public policies such as the ones in Singapore prioritise the health and well-being of the elderly, such as comprehensive healthcare systems and community-based elderly care programs significantly supports ageing experience. This can be seen from transportation and senior housing initiatives (Yap & Gee, 2015).

Chronosystem

The chronosystem captures the impact of life transitions and historical contexts on the ageing process. Some key life events would be retirement, death of spouse, or moving into assisted living can be profound on the psychological and emotional aspects of an elderly. In addition, societal changes such as healthcare or economic shifts affect the way different generations experience ageing (Chan et al., 2010).

Elder (1998) underscores the importance of historical and life-course perspectives, demonstrating how individuals’ experiences of ageing are shaped by the sociohistorical context in which they live. A historical context, such as the generation in which one is born, can also influence the resources and opportunities available during adulthood. For example, older adults today might benefit from advancements in medical technology that were not available to previous generations.

(b)

Social engagement refers to the involvement of individuals in meaningful social activities and interactions within their communities and networks, which can take various forms, such as formal, informal, and civic participation (Berkman, 2001). Examples include volunteering, interactions with family and friends, or voting. As Zhang et al. (2020) noted, active engagement with life is a key aspect of the successful ageing paradigm outlined by Rowe and Kahn (1998). According to their model, social engagement has two dimensions: one focuses on maintaining social relationships and connections with others, while the other emphasizes involvement in productive activities that contribute goods or services, regardless of whether compensation is involved (Rowe & Kahn, 1997). From these definitions, social engagement can be broadly understood as active participation in cognitively stimulating or socially integrative activities.

Social engagement is vital for the mental health of older adults, promoting their emotional, cognitive, and social well-being. Firstly, it helps to alleviate feelings of loneliness and isolation, which are major contributors to depression and anxiety in later life.  Research by Hawley and Cacioppo (2010) shows that elderly individuals who engage in regular social interactions tend to experience lower levels of loneliness and fewer depressive symptoms. The quality of these social connections is just as important as the quantity, with meaningful connections significantly improving emotional well-being.

Secondly, social engagement can also enhance cognitive function in elderly individuals. As people age, they often experience a decline in cognitive abilities, including memory, attention, and problem-solving skills, which can lead to conditions such as dementia or Alzheimer’s disease (Barnes & Pinel, 2021). Research by Fratiglioni et al. (2004) suggests that elderly persons who regularly involve in social activities, whether through community engagement, volunteering, or social clubs, exhibit a lower risk of cognitive decline.

Regular interactions with others require mental engagement such as conversations and emotional processing, all of which help keep the brain active and stimulated. This cognitive stimulation acts as a protective factor against age-related cognitive decline by keeping neural connections intact, effectively “exercising” the brain (Barnes & Pinel, 2021). This could be group activities such as games which maintain intellectual vitality.

In addition to cognitive benefits, it also fosters emotional reliance among elderlies. Social engagement can help them better manage stress, loss, and emotional upheaval. Emotional resilience refers to the ability to adapt to challenging circumstances, recover from setbacks, and maintain a positive outlook (Windle, 2010). Being socially engaged means having access to a network of people who can provide emotional support, advice, companionship during difficult times (Berkman, 2001). For instance, Berkman et al. (2000) found that elderly individuals with strong social ties were more emotionally stable and had a reduced risk of mental health problems such as depression and anxiety. This is because social interactions create a buffer against stress and provide a sense of purpose and identity, both of which are critical for emotional well-being. Additionally, supportive relationships can help older adult feel valued and needed, countering feelings of worthlessness that sometimes accompany ageing.

Furthermore, emotional well-being is closely linked to the sense of belonging that social engagement fosters. As people age, they often lose the roles that once defined their identity such as being a employee, a parent to dependent children, or a spouse. Participating in social activities helps older adults rediscover a sense of their purpose, whether through volunteer work or maintaining close personal relationships. This sense of purpose is vital for psychological health, as it provides a reason to remain active and engaged with life. It can also foster a positive self-image, reducing feelings of dependency and helplessness that are sometimes associated with ageing (Thoits, 2011).

In summary, social engagement supports the mental health of the elderly by reducing loneliness, enhancing cognitive function, and fostering emotional resilience. Its positive effects on mental health are well-documented and highlight the importance encouraging social opportunities for elderly persons.

(c) Monoamine Theory of Depression

As stated by Barnes and Pinel (2021), the monoamine theory of depression posits that depression is linked to a deficiency in the levels of monoamine neurotransmitters. This includes serotonin, norepinephrine, and dopamine in the brain. This theory is grounded in several key observations. First, various antidepressant medications, such as monoamine oxidase inhibitors, tricyclic antidepressants, and selective serotonin reuptake inhibitors, aim to increase the availability of these neurotransmitters at synapses, which supports the notion that low levels contribute to depressive symptoms (Malhi et el., 2016).

Studies have shown that individuals with untreated depression often exhibit an up-regulation of norepinephrine and serotonin receptors, indicating a compensatory response to low neurotransmitter level (Barnes & Pinel, 2021). Despite its strengths, the monoamine theory has limitations. Many patients find monoamine agonists ineffective, raising questions about the theory’s comprehensiveness (Linde et al., 2015). Moreover, while the effects of these medications on neurotransmitter levels can be rapid, the antidepressant effects often take days or weeks to manifest (Harmer et al., 2017). This delay suggests that additional factors like social engagement could significantly influence mental health outcomes.

Social Engagement as a Protective Factor

Social engagement significantly reduces the incidence of depression among the elderly. Active participation in social activities can enhance emotions through various mechanisms. Firstly, social interactions stimulate the release of neurotransmitters like serotonin and dopamine, alleviating depressive symptoms (Miller & Raison, 2021).

Secondly, engaging with others provides crucial emotional support, which helps elderly persons cope with stress, thereby reducing feelings of loneliness and isolation. Research indicates that elderly individuals with strong social networks exhibit lower rates of depression. Furthermore, social engagement fosters a sense of purpose and belonging, essential for psychological well-being. Participation in social activities can help redefine older adults’ sense of purpose, maintaining self-esteem and mitigating feelings of helplessness (Thoits, 2011).

Program Example in Singapore

The Silver Generation Office (SGO) in Singapore exemplifies a program addressing the mental health needs of the elderly through social engagement. SGO empowers seniors to lead active, healthy lives by connecting them with community resources and social networks. Their initiatives, including health talks and social events, create opportunities for social interaction (Agency for Integrated Care, 2024). This helps to alleviate feelings of loneliness and reducing risk of depression among elderly persons. Through these social environments it helps to promote the release of key neurotransmitters, including serotonin and dopamine. Therefore, this is crucial for enhancing mood and reducing the incidence of depression among the elderly.

References

Agency for Integrated Care. (2024, October 4). About SGO – Agency for Integrated Care. https://www.aic.sg/community/about-sgo/

Barnes, S., & Pinel, J. P. J. (2021). Biopsychology, Global Edition (11th ed.). Pearson International Content. https://suss.vitalsource.com/books/9781292367668

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Zhang, W., Liu, L., Tang, F., & Dong, X. (2018). Social engagement and sense of loneliness and hopelessness: findings from the PINE study. Gerontology and Geriatric Medicine, 4, 233372141877818. https://doi.org/10.1177/2333721418778189

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