Abstract
IntroductionSocial disconnection is a public health problem in older adults, as it can lead to decreased quality of life for this population. This study describes the prevalence of social disconnection and patient interest in social resources to address social disconnection among older adults receiving emergency department (ED) care.MethodsWe conducted a cross-sectional survey of community-dwelling older adults (≥65 years) receiving care at two U.S. EDs. We described participant characteristics (demographic, social, and health variables), social disconnection prevalence, and desire for social resources using percentages and 95% confidence intervals. Then, we performed Chi Square tests and logistic regression to determine factors associated with positive screens for social disconnection.ResultsOf 289 participants, 51% were female and the median age was 72 (interquartile range: 69–78). Most (76%) engaged with the community regularly, and 68% reported driving. Regarding social disconnection, a substantial minority of participants reported feeling as if they were burdensome to others (37%); as if they didn’t belong (27%); or that people would be better off if they were gone (15%); 52% reported at least one of these. In separate regression analyses, the perceptions of being a burden or better off if gone were each significantly associated with needing help with routine tasks (odds ratio [OR] [5.87, 5.90]); perceived burden was associated with hospitalization in the prior month (OR [2.09]); and low belonging was associated with not engaging in the community regularly (OR [2.50]), not seeing family regularly (OR [3.82]), and difficulty affording food (OR [2.50]). Regarding potential ED referrals, most participants were interested in transportation options (68%), food assistance (58%), and mental health resources (55%). Participants experiencing difficulties affording food were interested in food and housing assistance (p=.03; p=.01).ConclusionOver half of this sample of older ED patients reported feeling socially disconnected. Social and functional health problems are often related and both must be addressed to optimize older ED patient quality of life. Future research should consider the impact of social disconnection on older adults discharged from the ED and work to develop ED services that could refer this population to programs that may decrease social disconnection.
Highlights
Social disconnection is a public health problem in older adults, as it can lead to decreased quality of life for this population
The perceptions of being a burden or better off if gone were each significantly associated with needing help with routine tasks; perceived burden was associated with hospitalization in the prior month (OR [2.09]); and low belonging was associated with not engaging in the community regularly (OR [2.50]), not seeing family regularly (OR [3.82]), and difficulty affording food (OR [2.50])
Future research should consider the impact of social disconnection on older adults discharged from the emergency department (ED) and work to develop ED services that could refer this population to programs that may decrease social disconnection. [West J Emerg Med. 2018;19(6)919–925.]
Summary
Social disconnection is a public health problem in older adults, as it can lead to decreased quality of life for this population. This study describes the prevalence of social disconnection and patient interest in social resources to address social disconnection among older adults receiving emergency department (ED) care. In 2009, adults aged ≥65 years accounted for 18% of visits to emergency departments (ED) in the United States (U.S.).[1,2] Because hospitalization may negatively impact older patients, providers seek safe discharge plans.[3] Recent Geriatric ED Guidelines[4] address older ED patients’ physical needs, but important social health determinants (e.g., social support, food, and housing access) receive less focus.[5,6]. Two subjective forms of social disconnection are perceptions of burdensomeness, and not “belonging.”[7] According to the Interpersonal Theory of Suicide (ITS), those feeling burdensome and as if they do not belong (to the point that they feel others would be better off if they were gone) may experience increased suicidality.[14,15,16] Older adults with access to resources such as peer companionship, transportation, or food assistance may feel more connected.[17]
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