Association Of Social Isolation Research Articles

Association of Social Isolation With Disability Burden and 1-Year Mortality Among Older Adults With Critical Illness

Disability and mortality are common among older adults with critical illness. Older adults who are socially isolated may be more vulnerable to adverse outcomes for various reasons, including fewer supports to access services needed for optimal recovery; however, whether social isolation is associated with post-intensive care unit (ICU) disability and mortality is not known. To evaluate whether social isolation is associated with disability and with 1-year mortality after critical illness. This observational cohort study included community-dwelling older adults who participated in the National Health and Aging Trends Study (NHATS) from May 2011 through November 2018. Hospitalization data were collected through 2017 and interview data through 2018. Data analysis was conducted from February 2020 through February 2021. The mortality sample included 997 ICU admissions of 1 day or longer, which represented 5 705 675 survey-weighted ICU hospitalizations. Of these, 648 ICU stays, representing 3 821 611 ICU hospitalizations, were eligible for the primary outcome of post-ICU disability. Social isolation from the NHATS survey response in the year most closely preceding ICU admission, which was assessed using a validated measure of social connectedness with partners, families, and friends as well as participation in valued life activities (range 0-6; higher scores indicate more isolation). The primary outcome was the count of disability assessed during the first interview following hospital discharge. The secondary outcome was time to death within 1 year of hospital admission. A total of 997 participants were in the mortality cohort (511 women [51%]; 45 Hispanic [5%], 682 non-Hispanic White [69%], and 228 non-Hispanic Black individuals [23%]) and 648 in the disability cohort (331 women [51%]; 29 Hispanic [5%], 457 non-Hispanic White [71%], and 134 non-Hispanic Black individuals [21%]). The median (interquartile range [IQR]) age was 81 (75.5-86.0) years (range, 66-102 years), the median (IQR) preadmission disability count was 0 (0-1), and the median (IQR) social isolation score was 3 (2-4). After adjustment for demographic characteristics and illness severity, each 1-point increase in the social isolation score (from 0-6) was associated with a 7% greater disability count (adjusted rate ratio, 1.07; 95% CI, 1.01-1.15) and a 14% increase in 1-year mortality risk (adjusted hazard ratio, 1.14; 95% CI, 1.03-1.25). In this cohort study, social isolation before an ICU hospitalization was associated with greater disability burden and higher mortality in the year following critical illness. The study findings suggest a need to develop social isolation screening and intervention frameworks for older adults with critical illness.

Social Isolation and Cognitive Functioning: A Quasi-Experimental Approach.

This study aimed to assess the relationship between social isolation and cognitive functioning. Data were retrieved from the National Survey of the Japanese Elderly, a nationally representative sample of Japanese adults, aged 60 years or older. We estimated a social isolation index to incorporate variables, such as social interactions, social engagement, and social support, with perceived social isolation, for a comprehensive measurement. The association of social isolation with cognitive functioning was assessed using a panel data fixed-effects model, controlling for age, socioeconomic status, health-related variables, and time-invariant heterogeneity. Moreover, we conducted analyses using the System Generalized Method of Moments (GMM) to address the dynamic relationship of cognitive functioning and potential endogeneity. For both men and women, the association between social isolation and cognitive functioning was significant, particularly among those aged 75 or older, as a 1% increase in social isolation was associated with decreased cognitive functioning (24% decrease for men and 20% decrease for women). However, this association was not confirmed by the System GMM, after addressing endogeneity. Our findings potentially suggest that the association between social relationship and cognitive functioning reported in previous studies was biased, due to endogeneity. Although we did not observe causal impacts, this does not necessarily mean that social isolation does not have a negative impact on health, as both positive and negative consequences of social relationships may exist. Further research is needed to reveal the causal relationship, as well as the detailed mechanisms of health effects of social relationships.

Financial Exploitation Vulnerability and Social Isolation in Older Adults: Results From a Longitudinal Survey

OBJECTIVE: This study examined the prevalence and characteristics of socially isolated older adult participants in a survey funded by National Institute of Aging (NIA), and the association of social isolation with financial exploitation (FE) vulnerability. METHODS: Baseline data were collected from 528 participants (age 60+ years) and recruited from two regions. Assessments included a detailed cognitive battery and an array of self-report measures including socio-demographic and psychosocial variables. Social isolation was measured with the Friendship Scale (Hawthorne, 2006). Participants also read six randomly ordered “scam” scenarios (investment opportunity; Medicare phishing and prescription drug fraud; health product; sweepstakes; telemarketing) and provided credibility ratings for each (1 = Not at all credible; 10 = Extremely credible). Ratings are coded “0” (credibility rating 1); “1” (ratings 2-4); “2” (ratings 5-10) and summed, with total FE “vulnerability” scores ranging from 0-12. RESULTS: Preliminary results showed the prevalence of social isolation was 12.5% overall. Social isolation was higher for males (17.4% vs. 9.8%, p<.05); single / never married (28.7% vs. 12.5%, p<.01); and those in the lowest household income (under $10,000) category (28.3% vs. 12.5%, p<.05). However, we did not find evidence that social isolation varied significantly by race or educational attainment. FE vulnerability risk was higher for socially isolated older adults (2.44 vs. 1.44, p<.001) compared to non-isolated participants. CONCLUSION: Social isolation is associated with FE vulnerability. Therefore, identifying the prevalence and characteristics of socially isolated older adults is needed to improve the targeting of interventions for those at greater risk of FE vulnerability.

Associations of Social Isolation with Anxiety and Depression During the Early COVID-19 Pandemic: A Survey of Older Adults in London, UK.

The COVID-19 pandemic is imposing a profound negative impact on the health and wellbeing of societies and individuals, worldwide. One concern is the effect of social isolation as a result of social distancing on the mental health of vulnerable populations, including older people. Within six weeks of lockdown, we initiated the CHARIOT COVID-19 Rapid Response Study, a bespoke survey of cognitively healthy older people living in London, to investigate the impact of COVID-19 and associated social isolation on mental and physical wellbeing. The sample was drawn from CHARIOT, a register of people over 50 who have consented to be contacted for aging related research. A total of 7,127 men and women (mean age=70.7 [SD=7.4]) participated in the baseline survey, May–July 2020. Participants were asked about changes to the 14 components of the Hospital Anxiety Depression scale (HADS) after lockdown was introduced in the UK, on 23rd March. A total of 12.8% of participants reported feeling worse on the depression components of HADS (7.8% men and 17.3% women) and 12.3% reported feeling worse on the anxiety components (7.8% men and 16.5% women). Fewer participants reported feeling improved (1.5% for depression and 4.9% for anxiety). Women, younger participants, those single/widowed/divorced, reporting poor sleep, feelings of loneliness and who reported living alone were more likely to indicate feeling worse on both the depression and/or anxiety components of the HADS. There was a significant negative association between subjective loneliness and worsened components of both depression (OR 17.24, 95% CI 13.20, 22.50) and anxiety (OR 10.85, 95% CI 8.39, 14.03). Results may inform targeted interventions and help guide policy recommendations in reducing the effects of social isolation related to the pandemic, and beyond, on the mental health of older people.

Health risks associated with social isolation in general and in young, middle and old age.

IntroductionHealth effects of social isolation are well-studied at older age, in English-speaking countries, for individual health conditions, and based on unidimensional measures of isolation. Hardly any evidence exists for younger ages, for continental European and particularly German-speaking countries and based on multidimensional measures of isolation. This study therefore aimed to examine prevalence rates and associations of social isolation with various health conditions and behaviors in the entire Swiss population and across different age groups.MethodsNationally representative cross-sectional data from the Swiss Health Survey collected in 2012 were used and analyzed. The study sample covered 21,597 randomly selected adolescents and adults living in Switzerland and aged 15 and older. A multifactorial five-item social integration index was used to assess social disconnectedness and perceived isolation.ResultsSocial isolation has been found to steadily increase with age and almost consistently to be strongly associated with poor health conditions and unfavorable behaviors across all ages. Nearly a quarter of the general population could be categorized as either only partly integrated or even poorly integrated and largely isolated. The socially isolated people independent of their age showed strongly elevated relative risks of poor self-rated health (aOR = 4.0), musculoskeletal disorders (aOR = 2.8), moderate to severe depression (aOR = 11.5), and multiple health problems (aOR = 5.0). They were also found to be at comparably high risk of behaving unhealthy with regard to physical inactivity (aOR = 2.2), poor diet (aOR = 1.9) and use of psychotropic medications (aOR = 3.6). Although prevalence rates of poor health conditions and behaviors differed greatly between the studied age groups, strong associations and clear dose-response relationships have been found separately for all age groups and particularly for the youngest. A fairly weak or no association at all (depending on the age group) with the degree of social integration was observed only for daily smoking.ConclusionsSocial isolation may be less prevalent at younger ages, but is then even more strongly associated with poor health conditions and behaviors than at older ages.

The Association of Social Isolation With the Risk of Stroke Among Middle-Aged and Older Adults in China.

Given that there is limited research examining the specific role social isolation plays in stroke risk, we aimed to estimate the controlled direct effect of social isolation on stroke risk in China. A nationally representative sample (n = 12,662) of persons aged 45 years or more at baseline (2011), with corresponding follow-ups in 2013 and 2015, was taken from the China Health and Retirement Longitudinal Study. Stroke was assessed through a self- or proxy-reported physician's diagnosis. Social isolation was measured by incorporating marital status, frequency of contact with friends, family, and children, and participation in social activities. A marginal structural model with stabilized inverse probability weights was applied to examine the controlled direct effect of social isolation on stroke risk. Overall, 245 persons had a stroke within the 4-year timeline under study. The total effect model indicated that persons experiencing social isolation had a 64% increased risk of stroke (odds ratio (OR) = 1.64, 95% confidence interval (CI): 1.26, 2.13). Results from the marginal structural model also indicated that socially isolated persons had an increased risk of stroke (OR = 2.39, 95% CI: 1.49, 3.82) after adjustment for depression. Interventions to reduce social isolation may be particularly beneficial in preventing the occurrence of stroke among middle-aged and older adults in China.

Abstract MP54: Sex-Related Differences in the Association of Social Isolation With Plasma Leptin Concentration

Introduction: Studies have reported a positive associations of depression and psychosocial stress and plasma leptin concentration. Social isolation has been linked to increased leptin signaling in male rats, but this association has not been investigated in humans. Methods: We investigated the cross-sectional association of social isolation and plasma leptin concentration among 2,729 Framingham Offspring Cohort participants at the 7 th examination (1999-2001, mean age = 60.1 years, 42% men). Social isolation was measured using the Berkman-Syme Social Network Index: we assigned 1 point for being married, 1 point each for &gt;2 close friends and &gt;2 close relatives, 1 point for participation is social groups, and 1 point for participation in religious meetings ≥1-2 times per month. Social isolation was defined as a total of 0 points. Non-fasting plasma leptin levels were measured using a commercial immunoassay. The primary outcome was plasma leptin concentration. Secondary outcomes included caloric intake, measured by food frequency questionnaire, and volumes of abdominal subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT), measured by CT among 1,210 of the subjects between 2002 and 2005. Leptin concentration and adipose tissue volume were log-transformed due to skewed distributions. We estimated the associations of social isolation with all outcomes using linear regression. Models included age, body mass index, years of education, smoking status, physical activity index, hypertension, high blood glucose, and CES-D score as covariates. Because leptin levels and responses to social stress may vary among men and women, analyses were stratified by sex. Results: Socially isolated participants were younger and had higher CES-D scores than those who were not. Other characteristics were similar between the two groups. Plasma leptin concentration was 20% lower among socially isolated men (95% CI: -31, -6%) compared with men who were not isolated. Social isolation was also associated with lower caloric intake as well (β = -144.5 kcal, 95% CI: -287.1, -1.87 kcal). Among the subset of men for whom we had adipose tissue depot volume measurements (n=552), VAT volume appeared to be 10% lower among socially isolated men compared with non-isolated men (95% CI: -19, 1%), but this was not true of SAT (β = 1%, 95% C: -9, 10%). We did not observe differences in leptin concentration (β = -1%, 95% CI: -10, 15%), caloric intake (β = -39.1 kcal, 95% CI: -136.0, 57.7 kcal) or SAT β=4%, 95% CI: -3, 14%) according to social isolation among women. Socially isolated women appeared to have higher VAT (β = 10, 95% CI: -1, 10%) Conclusions: In our population of middle-aged and older adults, social isolation was associated with lower leptin levels among men, but not women. The lower leptin concentration observed among isolated men may reflect decreased caloric intake in response to social stress.

Social Isolation and Mortality in US Black and White Men and Women

Social isolation is associated with higher mortality in studies comprising mostly white adults, yet associations among black adults are unclear. In this prospective cohort study, we evaluated whether associations of social isolation with all-cause, cardiovascular disease, and cancer mortality differed by race and sex. Adults enrolled in Cancer Prevention Study II in 1982/1983 were followed for mortality through 2012 (n = 580,182). Sex- and race-specific multivariable-adjusted hazard ratios and 95% confidence intervals were estimated for associations of a 5-point social isolation score with risk of death. Social isolation was associated with all-cause mortality in all subgroups (P for trend ≤ 0.005); for the most isolated versus the least isolated, the hazard ratios were 2.34 (95% confidence interval (CI): 1.58, 3.46) and 1.60 (95% CI: 1.41, 1.82) among black men and white men, respectively (P for interaction = 0.40) and 2.13 (95% CI: 1.44, 3.15) and 1.84 (95% CI: 1.68, 2.01) among black women and white women, respectively (P for interaction = 0.89). The association did not differ between black men and black women (P for interaction = 0.33) but was slightly stronger in white women than in white men (P for interaction = 0.01). Social isolation was associated with cardiovascular disease mortality in each subgroup (P for trend < 0.03) but with cancer mortality only among whites (P for trend < 0.0001). Subgroup differences in the influence of specific social isolation components were identified. Identifying and intervening with socially isolated adults could improve health outcomes.

Sex differences in the association of social network satisfaction and the risk for type 2 diabetes

BackgroundThe role of an individual’s social network satisfaction (SNS) in the association of social isolation or living alone and incident type 2 diabetes (T2D) is unclear. We assessed the association of SNS with incident T2D and analysed potential modifications of the SNS-T2D association by social isolation or living alone.MethodsThe study population (N = 6839 aged 25–74 years without diabetes at baseline) derived from the prospective population-based MONICA/KORA study (1989–2009). Social network satisfaction was assessed by a single item. Cox regression was used to estimate hazard ratios (HR) for SNS separately in men and women.ResultsIn men with low SNS, risk for incident T2D increased significantly (HR: 2.15, 95% CI: 1.33–3.48, p value 0.002). After additional adjustments for social isolation or living alone, the risk for incident T2D was still significant, albeit less pronounced (HRs 1.85 or 2.05, p values 0.001 or 0.004). The interaction analysis showed an increased T2D risk effect for low SNS compared to high SNS in women living in a partnership (HR: 2.11, 95% CI: 1.00–4.44, p value for interaction: 0.047) and for moderate SNS compared to high SNS in socially connected women (1.56, 1.01–2.39, 0.010).ConclusionsFurther research is needed to address the complexities of the perception of social relationships and social interactions, or interdependence, especially when another major public health issue such as T2D is concerned.

Early life adversities or high fat diet intake reduce cognitive function and alter BDNF signaling in adult rats: Interplay of these factors changes these effects

Environmental factors, like early exposure to stressors or high caloric diets, can alter the early programming of central nervous system, leading to long-term effects on cognitive function, increased vulnerability to cognitive decline and development of psychopathologies later in life. The interaction between these factors and their combined effects on brain structure and function are still not completely understood. In this study, we evaluated long-term effects of social isolation in the prepubertal period, with or without chronic high fat diet access, on memory and on neurochemical markers in the prefrontal cortex of rats. We observed that early social isolation led to impairment in short-term and working memory in adulthood, and to reductions of Na+,K+-ATPase activity and the immunocontent of phospho-AKT, in prefrontal cortex. Chronic exposure to a high fat diet impaired short-term memory (object recognition), and decreased BDNF levels in that same brain area. Remarkably, the association of social isolation with chronic high fat diet rescued the memory impairment on the object recognition test, as well as the changes in BDNF levels, Na+,K+-ATPase activity, MAPK, AKT and phospho-AKT to levels similar to the control-chow group. In summary, these findings showed that a brief social isolation period and access to a high fat diet during a sensitive developmental period might cause memory deficits in adulthood. On the other hand, the interplay between isolation and high fat diet access caused a different brain programming, preventing some of the effects observed when these factors are separately applied.

Abstract P092: Association of Social Isolation with Functional Status and Mental Health in Patients with Heart Failure

Background: Social isolation has been shown to have a negative impact on psychosocial and physical health, particularly among older adults. However, these relationships have not been fully examined among patients with heart failure (HF). Methods: Residents from 11 southeast MN counties with a first-ever ICD-9 code 428 for HF between 1/1/2013 and 3/31/2014 (N=1649) were mailed a survey to measure social isolation (PROMIS Social Isolation Short Form) and functional status and mental health (PROMIS 29 Health Profile). A total of 778 patients returned the survey (response rate 47%), and among these, 645 completed all questions and were retained for analysis. Patients who returned a completed survey were similar on age (p=0.15), sex (p=0.80), and Charlson comorbidity index (p=0.28) to those who did not return or returned an incomplete survey. The relationship between social isolation and functional status and mental health was analyzed using linear regression, adjusted for age, sex, and Charlson comorbidity index. Results: Among 645 patients with HF, 53% were men, the mean age was 73 years, and the mean Charlson index was 2.2. The mean scores for each functional and mental health subscale and the total score increased with increasing severity of social isolation (Table). For example, the mean physical function scores were 8.6, 11.3, and 12.8 and the mean depression scores were 5.0, 7.3, and 9.8 for those with low, moderate, and high social isolation, respectively. In addition, the total score increased from 51.1 among those with low social isolation to 80.2 for those with high social isolation. Observed differences persisted after adjustment for age, sex, and comorbidity. Conclusion: In patients with HF, greater social isolation is associated with worse functional and mental health, independent of comorbidity. As functional status and mental health impact disease management, addressing social isolation may help with managing HF.

Social isolation, loneliness, and all-cause mortality in older men and women

Both social isolation and loneliness are associated with increased mortality, but it is uncertain whether their effects are independent or whether loneliness represents the emotional pathway through which social isolation impairs health. We therefore assessed the extent to which the association between social isolation and mortality is mediated by loneliness. We assessed social isolation in terms of contact with family and friends and participation in civic organizations in 6,500 men and women aged 52 and older who took part in the English Longitudinal Study of Ageing in 2004-2005. A standard questionnaire measure of loneliness was administered also. We monitored all-cause mortality up to March 2012 (mean follow-up 7.25 y) and analyzed results using Cox proportional hazards regression. We found that mortality was higher among more socially isolated and more lonely participants. However, after adjusting statistically for demographic factors and baseline health, social isolation remained significantly associated with mortality (hazard ratio 1.26, 95% confidence interval, 1.08-1.48 for the top quintile of isolation), but loneliness did not (hazard ratio 0.92, 95% confidence interval, 0.78-1.09). The association of social isolation with mortality was unchanged when loneliness was included in the model. Both social isolation and loneliness were associated with increased mortality. However, the effect of loneliness was not independent of demographic characteristics or health problems and did not contribute to the risk associated with social isolation. Although both isolation and loneliness impair quality of life and well-being, efforts to reduce isolation are likely to be more relevant to mortality.