Risk Factors For Social Isolation Research Articles

HEARING AND VISION LOSS: EPIDEMIOLOGIC AND INTERVENTION IMPLICATIONS FOR SOCIAL ISOLATION, LONELINESS, AND MOOD DISORDERS

Abstract This session will discuss hearing loss and vision impairment as modifiable risk factors for social isolation, loneliness, and mood disorders from both epidemiologic and intervention perspectives. Prevalence of hearing and vision loss is high; two-thirds of older adults have hearing loss and over one-quarter have vision impairment. Hearing loss and vision impairment have been linked to poor cognitive and physical health but remain understudied in the context of social and mental health in large, population-based studies. Research gaps remain in measurement (findings typically based on subjective assessments) and generalizability. This session will investigate associations between objectively measured hearing, vision, and dual sensory loss on social isolation and mood disorders using a sample nationally representative of older adults in the US. This session will also describe potential mechanistic and environmental factors, such as fatigue and exclusion of hearing loss and vision impairment in health care settings that may explain observed associations. Whether treatment of hearing loss and vision impairment is an effective intervention for improving social and mental health is unknown. We will conclude by presenting findings from a randomized controlled trial designed to test whether a hearing intervention consisting of provision of hearing aids and related technologies, counseling, and education could reduce cognitive decline in older adults with untreated hearing loss. We focus on the effect of hearing intervention on social isolation and loneliness, both pre-specified outcomes of this trial. This is a Loneliness and Social Isolation Interest Group Sponsored Symposium. This is a collaborative symposium between the Loneliness and Social Isolation and Sensory Health Interest Groups.

Risk factors for social isolation in older adults: A systematic review and meta-analysis.

To explore the risk factors of social isolation in older adults by meta-analysis. We examined articles that had been published on the China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service platform, VIP Periodical Chinese Journal Service platform, Medical Literature database, PubMed, Embase database, Chinese BioMedical Literature database (CBM), and the Cochrane Library. RevMan 5.3 software was used for meta-analysis. A total of 13 pieces of literature comprising 47,288 patients were included, including five in Chinese and eight in English. According to our review, the common risk factors reported were age, sex, education level, marital status, self-rated health status, depression, social support, cognitive function, and basic diseases. Gender (female), education level (lower education level), marital status (divorced), self-rated health status (poor), depression, lack of social support, inadequate cognitive function, and underlying disorders were the key risk factors for social isolation in older adults. To reduce social isolation in older adults, paying more attention to the aging population with poor marital statuses, low education levels, poor health statuses, depression, poor cognitive function, and other underlying diseases is necessary. It is essential to encourage patients and their family members to participate in social activities and build a multi-social support system to reduce social isolation in older adults.

Social isolation, depression, nutritional status and quality of life during COVID-19 among Chinese community-dwelling older adults: a cross-sectional study

ObjectiveThis survey investigated the relationship between social isolation, depression, nutritional status and quality of life among community-dwelling older adults during COVID-19.DesignThis was a cross-sectional survey study.SettingCommunities in Pudong New Area,...

Global evidence on falls and subsequent social isolation in older adults: a scoping review

BackgroundFalls are a leading cause of injury-related hospitalizations among adults aged 65 years and older and may result in social isolation.ObjectiveTo summarise evidence on falls and subsequent social isolation and/or...

Social isolation among older veterans: findings from the National Health and Aging Trends Study

Objectives Social isolation is a critical public health issue that affects multiple domains of well-being among older adults, but little is known about social isolation among older military veterans. As such, the purpose of this study was to estimate the prevalence of social isolation among older veterans and to examine risk factors for social isolation among older veterans. Method Data were derived from Round 1 of the National Health and Aging Trends Study, which is an annual, longitudinal panel survey of Medicare beneficiaries aged 65 and older. The sample included 1,683 veterans, who were primarily White and male. Weighted logistic regression models were used to predict severe social isolation (having no social participation) and social isolation (having only one source of social participation) among older veterans, while controlling for age, sex, race, marital status, education, income, and metropolitan residency. Results After accounting for other predictors, results show that veterans who are 85 and older, male, White, unmarried or unpartnered, with lower educational attainment and lower income are greatly at risk of both severe social isolation and social isolation. Conclusion The results of this study support past research showing that veterans with limited social and economic capital are at great risk of experiencing adverse outcomes in older adulthood, including social isolation. Interventions should therefore aim to improve social connectedness among this population and should address the risk-factors that contribute to social isolation among older veterans.

Social Isolation Among Older Adults in Long-Term Care: A Scoping Review.

Objectives: A wealth of literature has established risk factors for social isolation among older people; however, much of this research has focused on community-dwelling populations. Relatively little is known about how risk of social isolation is experienced among those living in long-term care (LTC) homes. We conducted a scoping review to identify possible risk factors for social isolation among older adults living in LTC homes. Methods: A systematic search of five online databases retrieved 1535 unique articles. Eight studies met the inclusion criteria. Results: Thematic analyses revealed that possible risk factors exist at three levels: individual (e.g., communication barriers), systems (e.g., location of LTC facility), and structural factors (e.g., discrimination). Discussion: Our review identified several risk factors for social isolation that have been previously documented in literature, in addition to several risks that may be unique to those living in LTC homes. Results highlight several scholarly and practical implications.

Discrimination and Social Isolation Among African Americans Across the Lifespan

Social isolation is associated with a wide range of health problems, including early mortality. However, little is known about the risk factors for social isolation specifically among African Americans. This study examined 1) the associations between discrimination and objective and subjective social isolation and 2) how these associations vary by age in a nationally representative sample of African American adults from the National Survey of American Life (N=3570). Multinomial logistic regression analyses indicated that discrimination was positively associated with being subjectively isolated from friends only and family only. Discrimination did not predict objective isolation. A significant interaction revealed that the association between discrimination and subjective isolation from friends only varied by age, with older adults being most vulnerable to the effects of discrimination. These findings argue for a more nuanced and systematic investigation of the detrimental effects of discrimination on older African Americans’ social relationships, especially perceptions of relationships.

Sensory Impairment and Social Isolation: Implications for the Hispanic Population

Although the likelihood of developing a disability increases with age among all demographics, older adults of hispanic origin are more likely to experience vision and hearing impairment than both their white and black non-hispanic counterparts. Both hearing impairment and vision impairment are known risk factors for social isolation, yet little research has examined this association in Hispanic populations. Using data from 472 Hispanic and 5,186 White participants of the NHATS study, we examined 8-year trajectories of social isolation, along with how sensory impairment was associated with initial levels and change over time. Findings suggest that sensory impairments are linked with steeper increases over time among White participants. Among Hispanics vision and hearing impairments were linked with higher initial levels of social isolation, yet no associations were found across time. It may be that Hispanic older adults maintain social connections across time despite potentially isolating sensory impairments.

The Epidemiology of Loneliness and Social Isolation Among Older Adults During the Last Years of Life (RP521)

•Describe the prevalence of loneliness and social isolation among older adults in the last years of life.•Identify independent risk factors for loneliness and social isolation in the last years of life. While the last years of life have an intense focus on medical care, the same emphasis has not been placed on social well-being. Consequently, the epidemiology of key indicators of social health is unknown. To determine the prevalence and correlates of loneliness and social isolation among older adults during the last four years of life. We used nationally-representative health and retirement study data to examine adults age >50 who died while enrolled (N=3,540). Subjects were interviewed once in the last four years of life and classified into one of eight 6-month cohorts based on the number of months between the interview and death. We used validated measures of loneliness (3-item UCLA Loneliness Scale) and social isolation (13-item scale describing whether an individual lived alone, was unmarried/unpartnered, had minimal interaction with children, family, or friends, and had minimal community engagement). We modeled the relationship between loneliness or social isolation and time before death adjusting for sociodemographic and key health covariates. The mean age at death was 76 (SD=11.4) and 50% were female. The prevalence of loneliness and social isolation in the last 4 years of life was 51% and 9%, respectively, and these rates were constant for four years prior to death. After adjustment, there were distinct risk factors for loneliness and social isolation (p<0.01); cognitive impairment (Normal: 44%, CIND: 52%, Dementia: 56%), vision impairment (54% vs 46%), and incontinence (54% vs 46%) were risk factors for loneliness, whereas race (White: 11% vs Non-White: 5%), low income (20% vs 8%), and inability to walk a block (12% vs 8%) were risk factors for social isolation. Loneliness occurs in half of older adults and social isolation occurs in nearly 10% of older adults, with a consistent prevalence for the four years prior to death.

Risk factors for social isolation in post-hospitalized older adults

IntroductionSocial isolation in older adults is associated with high rates of adverse health outcomes. Older adults who have had a recent significant health event are likely to be at risk of social isolation following hospitalization. This study aims to identify risk factors amongst older adults at hospital discharge that are associated with social isolation at three months post-hospitalization. MethodsOlder adults were surveyed at hospital discharge and three months post-hospitalization. Baseline data including demographics, self-reported quality of life, physical activity and capacity levels, lifestyle factors, symptoms of depression and anxiety were collected at discharge. Social isolation was measured using the Friendship Scale at the three-month follow-up. Regression analyses were used to examine the relationship between baseline characteristics and social isolation at three months post-hospitalization. ResultsOlder adults (n = 311) participated in the baseline survey, of whom 241 (78 %) completed the three-month survey. Higher depressive and anxiety symptoms at hospital discharge, comorbidity of cancer, history of cigarette smoking, prior access to community and respite service, and arrangement for shopping assistance post-discharge were factors independently associated with an increased risk of social isolation at three months post-hospitalization. DiscussionThis study identified risk factors for social isolation that are unique to older post-hospitalized adults. These findings can help clinicians identify individuals at risk of social isolation and to target interventions that address these risk factors for the prevention of social isolation in older adults after hospitalization.

SOCIAL ISOLATION AMONG LGBT OLDER ADULTS: LESSONS LEARNED FROM A PILOT FRIENDLY-CALLER PROGRAM

Lesbian, gay, bisexual, and transgender (LGBT) older adults face heightened risks of social isolation, given decades of discrimination. Research on telephone buddy programs with non-LGBT participants have proved predominantly unsuccessful at addressing social isolation and have found the greatest success with same-age matches. However, evidence suggests that LGBT adults may actually benefit from telephone buddy programs and in ways uniquely different from other groups. This article shares lessons learned from 30 participants across a 12-month pilot program that matched LGBT older adults to both LGBT and non-LGBT volunteer callers of various ages. One-third of participants identified as African American or Black. This project employed community-based participatory action research to identify, execute, and evaluate the program. Data includes information from questionnaires and telephone interviews prior to and during the program. In contrast to other research, data here revealed strong support for intergenerational matches. LGBT older adults of color especially benefited from program referrals and matches with/from LGBT adults of color, regardless of age. While the project aimed to capture two groups (LGBT older adults experiencing isolation and volunteer callers), the project revealed a third group: LGBT adults at risk of social isolation. This third group usually emerged among the “volunteer” callers but also identified concerns and risk factors for social isolation. The program also revealed unexpected benefits to both LGBT and non-LGBT volunteers, including less loneliness and a stronger sense of community. This article concludes with recommendations for developing similar programs to reduce social isolation in the LGBT community.

Experiencing the diagnostic process of pancreatic cancer in the context of social isolation - A qualitative exploration with implications for further research

Social isolation in older adults is associated with high rates of adverse health outcomes. Older adults who have had a recent significant health event are likely to be at risk of social isolation following hospitalization. This study aims to identify risk factors amongst older adults at hospital discharge that are associated with social isolation at three months post-hospitalization.Older adults were surveyed at hospital discharge and three months post-hospitalization. Baseline data including demographics, self-reported quality of life, physical activity and capacity levels, lifestyle factors, symptoms of depression and anxiety were collected at discharge. Social isolation was measured using the Friendship Scale at the three-month follow-up. Regression analyses were used to examine the relationship between baseline characteristics and social isolation at three months post-hospitalization.Older adults (n = 311) participated in the baseline survey, of whom 241 (78 %) completed the three-month survey. Higher depressive and anxiety symptoms at hospital discharge, comorbidity of cancer, history of cigarette smoking, prior access to community and respite service, and arrangement for shopping assistance post-discharge were factors independently associated with an increased risk of social isolation at three months post-hospitalization.This study identified risk factors for social isolation that are unique to older post-hospitalized adults. These findings can help clinicians identify individuals at risk of social isolation and to target interventions that address these risk factors for the prevention of social isolation in older adults after hospitalization.

AGE-FRIENDLY INITIATIVES AND REDUCING SOCIAL ISOLATION: ROLES OF PHYSICAL ENVIRONMENT AND COMMUNITY ENGAGEMENT

Social isolation affects the physical and mental health of elders. Although previous literature identified risk factors for social isolation (e.g. living alone, unmarried, and social participation), few studies examined the impact of the physical environment. Informed by the theory of social determinants of health, this study examines the effects of participating in community/social events and the physical environment on an indicator of elders’ health, namely the perceived disconnectedness from their community, employing the binomial hierarchical logistic regression. The sample consists of elders aged 50 and older (n=342) living in a large metropolitan Midwest city who participated in a community needs assessment survey for the World Health Organization’s Global Network of Age-Friendly Cities and Communities initiative. Results indicate that elders without access to ramps to enter buildings are 4.76 times as likely to perceive disconnectedness as those with the access. Those answering “not sure” to access to well-maintained public buildings are 4.39 times as likely to perceive disconnectedness as those without the access, implying that unawareness of access may increase isolation. Those who identify transportation as a barrier are 6.77 times as likely to perceive isolation as those who do not. Additionally, a reduction in participation of social/community events is associated with an increased likelihood of perceived disconnectedness (Adjusted Odds Ratio 1.75). The current study underscores the importance of improving access to public buildings, ramps, and transportation to reduce the perceived disconnectedness of elders. Future studies should continue exploring effects of age-friendly initiatives on social isolation and social determinants of health.

RURAL-URBAN DIFFERENCES IN SOCIAL ISOLATION AND ITS RELATIONSHIP TO HEALTH

Research on geographic differences in social isolation and its relationship with health is limited. Using data from Wave 2 of the National Social Life, Health, and Aging Project (n=3,377, mean age=72.4), we compared differences by rurality (urban vs. rural) in measures of reported social support, social relationships, and loneliness. We also conducted stratified ordered logistic regression models to assess how the association between isolation and self-rated health (1=poor; 5=excellent) differs by rurality. Overall, rural older adults were more likely than urban older adults to say that they could rely on family and friends, and rural residents reported larger numbers of close friends and relatives. There were no differences by rurality in loneliness, with all respondents scoring an average of 3 out of 9 on the loneliness scale. In stratified models, scoring higher on the loneliness scale was associated with poorer health for both urban and rural older adults (adjusted odds ratio [AOR]: 0.88, p<0.001 and 0.92, p<0.05, respectively). In contrast, being able to rely on family members was associated with better health (AOR: 1.46, p<0.05) for urban older adults, whereas having more friends was associated with better health for rural older adults (AOR: 1.19, p<0.05). As social isolation and loneliness continue to gain recognition as urgent population health issues, there is a critical need for targeted information on the prevalence and risk factors for social isolation and associated poorer health by geography in order to design targeted, effective interventions; this study adds useful information with which to do so.

Primary care chaplaincy: an intervention for complex presentation

To determine the responsiveness of primary care chaplaincy (PCC) to the current variety of presenting symptoms seen in primary care. This was done with a focus on complex and undifferentiated illness. Current presentations to primary care are often complex, undifferentiated and display risk factors for social isolation and loneliness. These are frequently associated with loss of well-being and spiritual issues. PCC provides holistic care for such patients but its efficacy is unknown in presentations representative of such issues. There is therefore a need to assess the characteristics of those attending PCC. The effectiveness of PCC relative to the type and number of presenting symptoms should also be analysed whilst evaluating impact on GP workload. This was a retrospective observational study based on routinely collected data. In total, 164 patients attended PCC; 75 were co-prescribed antidepressants (AD) and 89 were not (No-AD). Pre- and post-PCC well-being was assessed by the Warwick-Edinburgh mental well-being score. Presenting issue(s) data were collected on a separate questionnaire. GP appointment utilisation was measured for three months pre- and post-PCC. Those displaying undifferentiated illness and risk factors for social isolation and loneliness accessed PCC. PCC (No-AD) was associated with a clinically meaningful and statistically significant improvement in well-being in all presenting issues. This effect was maintained in those with multiple presenting issues. PCC was associated with a reduction in GP appointment utilisation in those not co-prescribed AD.

MA14.05 Social Isolation Increases Psychological Distress in Patients With NSCLC

The Psychosocial Screen for Cancer (PSSCAN-R) questionnaire is a validated screening tool used to identify the psychosocial needs of patients with cancer. The questionnaire assesses patients’ perceived social supports and identifies patients at risk for developing psychological distress. The study goal was to examine patients with NSCLC who reported risk factors for social isolation and their risk for developing psychological distress. All patients with NSCLC referred to BC Cancer from 2011-2015 who completed a prospective PSSCAN-R questionnaire at the time of first visit were included in the study. Perceived social support questions include: if patients live alone, lost a life partner recently, have no help with IADLs, have no regular contact with friends and family or have no emotional support from others. Demographics were collected retrospectively. Chi-squared test and logistical regression were used to compare patient groups based on age, gender and perceived social support factors. The study cohort was comprised of 4428 patients who completed the PSSCAN-R questionnaire. Female 50%, patients ≥65 years 69%, live alone 29%, lost life partner 13%, no help with IADLs 9%, no regular contact 3% and no emotional support 5%. Female patients and patients younger than 65 are more at risk for developing moderate to severe anxiety and depression. Lack of perceived social support also contributes to the risk of developing psychological distress. In addition to developing gender and age-based resources for patients addressing their psychosocial needs, greater efforts in assessing patients’ perceived social supports and allocating community and institutional resources to isolated patients should also become an important part of the patients’ comprehensive and holistic care.

Social Isolation and the Built Environment: A Call for Research and Advocacy

Social isolation can be defined as a state in which an individual experiences less social engagement with others than they would prefer, and that interferes with their quality of life. Social isolation can happen at any point during the life span; however, social isolation among older adults often presents gradually due to specific life transitions and life events. Although older age is often cited as a main characteristic of social isolation, research has demonstrated that older age does not have a universal negative influence on social connectedness (Cornwell, Schumm, Laumann, Kim, & Kim, 2014). Factors associated with social isolation vary, and can include retirement, poor health, change in socioeconomic status, or the loss of a friend or family member (Bekhet & Zauszniewski, 2012). Research also identifies living alone, having a small social network, and infrequent participation in social activities as risk factors for social isolation among older adults (Cornwell & Waite, 2009).

Risk Factors for Social Isolation in Older Korean Americans.

Given the importance of social ties and connectedness in the lives of older ethnic immigrants, the present study examined the prevalence of social isolation and its risk factors in older Korean Americans. Using survey data from 1,301 participants (Mage = 70.5, SD = 7.24), risk groups for marginal social ties with family and friends were identified and predictors of each type of social isolation explored. Male gender and poorer rating of health were identified as common risk factors for marginal ties to both family and friends. Findings also present specific risk factors for each type of social isolation. For example, an increased risk of having marginal ties with friends was observed among individuals with perceived financial strain, greater functional impairment, and a shorter stay in the United States. The common and specific risk factors should be incorporated in programs to reduce social isolation in older immigrant populations.

Social isolation risk factors in older hospitalized individuals

BackgroundElderly people are particularly vulnerable to the effects of social reduction, so there is an urgent need to identify the risks associated with social isolation. The aim of this paper was to analyze associations between psychological, socio-demographic, functional aspects on the risk of social isolation, mortality and re-hospitalization in older persons. MethodsThis is a longitudinal study on 580 hospitalized elderly sample aged ≥70yrs recruited from 2005 to 2007 in the Geriatrics Operative Unit of INRCA in Fermo, Italy. The comprehensive geriatric assessment (CGA) was used. Outcome measures included 36-month mortality and re-hospitalization. ResultsIn all patients, approximately 20% (n=112) of the subjects were socially isolated. Women perceived their social support significantly worse than men (77.7 vs. 22.3%; p<0.001). A multiple logistic regression analysis (goodness of fit χ2=102.86, p<0.001) with risk of social isolation as the dependent variable, showed that women were at a greater risk than men for social isolation (OR=1.99, 95% CI=1.13–3.50). Furthermore, patients with a higher number of family components (OR=0.72, 95% CI=0.59–0.88) and good parameters of quality of life (PCS-12: OR=0.94, 95% CI=0.91–0.98; MCS-12: OR=0.94, 95% CI=0.92–0.97) were less likely to be socially isolated. Cox regression models adjusted for gender, quality of life and number of family components, showed that the social isolation did not predict mortality (HR=1.44, 95% CI=0.84–2.46, p=0.19), but was associated with higher re-hospitalization rates (HR=1.28, 95% CI=1.02–1.59, p=0.03). ConclusionsOur findings highlight several aspects related to the risk of social isolation and re-hospitalization in a specific group of older persons.

Mortality from selected cancers in NSW and Sydney, Australia.

This study utilizes unit list mortality data for New South Wales, Australia in differential mortality analysis, at state and local levels, and examines geographic patterns of stomach, colo-rectum, respiratory system, female breast cancer and total cancer mortality in Sydney. Associations between manual occupations, low socioeconomic status and male stomach and respiratory cancer mortality were found, as were higher mortality from stomach and respiratory cancer among European-born immigrants in manual occupations. However, unexpected associations were also found between high mortality from stomach and respiratory cancers and managerial occupations. There were also more acute associations between colo-rectum and female breast cancer and higher status areas. Further, mortality variations between specific occupational groups occurred when martial status was controlled for, and the strongest variations were between married and never married males where the social isolation risk factors were presumed to be operative. The highest mortality at the local level in Sydney occurred where more than one at risk population resided and where other influences may have been operative.