Social Isolation Of Patients Research Articles

Social isolation in chronic kidney disease and the role of mobility limitation.

BackgroundChronic kidney disease (CKD) is associated with multiple comorbidities, hospitalizations and mortality. In older adults, social isolation and poor mobility contribute to these outcomes. We tested the hypothesis that a glomerular filtration rate (GFR) <45 mL/min/1.73 m2 (CKD Stages 3b–5) is associated with social isolation and that mobility limitation is a key driver of social isolation in patients with CKD.MethodsData from 9119 participants, ages 57–107 years, from the 2016 wave of the Health and Retirement Study’s Venous Blood Study were used for this cross-sectional analysis. Kidney function measured by estimated GFR (eGFR) was the predictor and patients were classified as CKD Stages 3b–5 or non-CKD Stages 3b–5 (eGFR ≤45 or >45 mL/min/1.73 m2). The outcomes tested were mobility limitation assessed by self-report and social contact and participation measures assessed by the Psychosocial Life Questionnaire. The associations among kidney function, mobility and social isolation were examined with logistic and ordinary least squares regression, adjusted for covariates and testing for interaction with gender.ResultsParticipants with CKD Stages 3b–5 (N = 999) compared with non-CKD Stages 3b–5 were older (74.9 versus 68.2 years, P < 0.001) and fewer were female (15% versus 58%, P < 0.001). CKD Stages 3b–5 were associated with higher odds of difficulty walking several blocks [odds ratio 1.44 (95% confidence interval 1.16–1.78)]. Participants with CKD Stages 3b–5 had reduced social contact and social participation (B = −0.23, P < 0.05; B = −0.62, P < 0.05, respectively). Women with CKD Stages 3b–5 were 2.7 times more likely to report difficulty walking several blocks than men with CKD Stages 3b–5, but social isolation in CKD Stages 3b–5 did not vary by gender. In CKD Stages 3b–5 patients, mobility limitation was a risk factor for reduced social contact and participation but did not explain the poor social contact and participation.ConclusionCKD Stages 3b–5 was associated with both mobility limitation and social isolation in a population-based study of older adults. In contrast to older adults without CKD Stages 3b–5, mobility limitation did not explain the lack of social contact and poor social participation, suggesting other factors are more important.

Social isolation: Impact on treatment and survival in patients with advanced cancer.

156 Background: Social relationships are an important determinant of health, with impacts on morbidity and mortality in the general population. The influence of social isolation in patients with metastatic cancer is less clear, as are the potential mechanisms of its effect. We sought to examine patient-reported social support in a large unselected population, and explore the impact on outcome. Methods: A retrospective review was completed of all patients with metastatic cancer referred to BC Cancer from 2011-2016 who completed a psychological screen within six months of diagnosis. Social isolation was defined as a positive response to any of five questions about social support: live alone, recently lost spouse/partner, no regular contact with friends/relatives, no one to assist with IADLs, no emotional support. An isolation score was calculated as the number of positive responses. The primary outcome was overall survival (OS). Results: 7,699 patients were included in the study. Baseline characteristics: median age 68, 57% male, 60% received systemic therapy, primary tumor site 4% breast / 37% lung / 28% GI / 13% GU / 18% other. 5191 (67%) patients reported no isolation, and 2,538 (33%) were socially isolated. Patients with social isolation were more likely older (median age 70 vs. 67), female (50% vs. 40%), ECOG ≥2 (34% vs. 30%), and receive no systemic therapy (46% vs. 35%). Median OS was inferior in socially isolated patients at 10.1 m compared to those with no isolation at 13.5 m (p&lt;0.001). In a multivariate model including age, sex, ECOG, systemic therapy, and primary tumor site, the impact of social isolation on OS remained significant (HR 1.06, p=0.04). In an exploratory analysis, increasing levels of social isolation were correlated with reduced systemic therapy uptake (score 0=65% received systemic therapy, 1=56%, 2=53%, 3=47%, ≥4=43%, p&lt;0.001). Conclusions: Socially isolated patients with metastatic cancer have inferior survival, which may be influenced by the reduced use of systemic therapy. Increasing patient social support should be explored as a means to improve the uptake of systemic therapy and its benefits on survival in patients with advanced cancer.

Social isolation is associated with 90-day rehospitalization due to heart failure.

Social isolation has been reported to be associated with decreased quality of life and the onset of organic diseases. The objective of this study was to investigate the prevalence of social isolation in patients with heart failure and whether it is associated with rehospitalization. The study included consecutive patients aged ⩾55 years who were hospitalized due to heart failure. Social isolation was assessed using total scores less than 12 on an abbreviated version of the Lubben Social Network Scale. The endpoint was heart failure rehospitalization within 90 days after discharge. Among 148 patients with heart failure (80±8 years old, 51% male), 73 (49%) were socially isolated. The patients with social isolation had similar comorbidities compared with those without social isolation. Heart failure rehospitalization occurred within 90 days for 25 patients and the heart failure rehospitalization rate was significantly higher in the social isolation group ( p=0.036). LASSO (least absolute shrinkage and selection operator) regression confirmed that social isolation was one of the strongest predictors of heart failure rehospitalization, showing larger effects than living alone, being unemployed, and other established risk factors. Half of the patients with heart failure reported social isolation, which had a strong association with heart failure rehospitalization.

Evde bakım hizmeti alanlarda sosyal izolasyon

Evde bakım hizmeti alanlarda sosyal izolasyon

Clozapine-induced Gastrointestinal Hypomotility — New Objective Evidence for an Underestimated Side-effect

Clozapine-induced Gastrointestinal Hypomotility — New Objective Evidence for an Underestimated Side-effect

Pitfalls in the diagnosis of leprous neuropathy: Lessons learnt from a University hospital in an endemic zone

Leprosy is the oldest disease known to mankind and has piqued humans since Before Christian Era (BCE) [1]. The causative agent, Mycobacterium leprae, was thefirst bacterium to be identified as causing disease in humans. Effective treatment, viz, Promin, was introduced only in the 1940s. Multi-drug therapy came into vogue in the 1970s [2,3] and was popularised by the World Health Organisation (WHO) in the 1980s. This resulted in a rapid decline in the new case detection rates [4]. Global efforts to eliminate leprosy have met with only partial success and the disease continues to prevail in certain endemic pockets in the developing countries [5–8]. In India the prevalence of leprosy reduced from 58 per 10,000 population in 1980 to 0.69 per 10,000 in 2010 [9]. Thus, leprosy has been ‘eliminated’ as a public health problem.However, this has not ensured complete interruption of disease transmission and new cases continue to occur, sometimes after several years because of the long incubation period. This underscores the need for active and continued efforts to identify new cases [9]. The primary targets of M. leprae are the skin and peripheral nerves [6]. The diagnosis of leprosy rests on the demonstration of one or more of the three cardinal signs namely anaesthetic/hypoesthetic skin patches, thickened peripheral nerves with impaired sensation in the areas innervated by the affected nerves and acid-fast bacilli in skin smear [4,10]. Characteristically, the superficial and cooler regions of the body are affected [11,12]. The commonly affected nerves in leprosy include ulnar, radial, median, lateral popliteal, tibial, facial and trigeminal [13]. Leprous neuropathy can occur in the absence of skin lesions [14]. Even in the presence of skin lesions, a mismatch in the severity of disease in the nerves vis-a-vis skin occurs. Thus the disease may be paucibacillary in the skin, but multibacillary in the nerves [15,16]. Untreated or delayed treatment of peripheral neuropathy is the major cause of disability, deformity, morbidity and social isolation in patients with leprosy [11]. Thus it is imperative to recognise and establish an early diagnosis and institute timely therapy. Meanwhile, each one of the cardinal signs is considered to be highly sensitive and specific for leprosy [4,10]. A considerable skill and experience is required for detecting their presence failing which the diagnosis is delayed or missed [17].

The role of general practitioners in diagnosis of cutaneous melanoma: a population‐based study in France

Little data are available concerning the role of general practitioners (GPs) in the diagnosis of melanoma. To evaluate the actual role of GPs in a population-based study covering five regions of France and 8·2 million inhabitants. A survey of cancer registries and pathology laboratories, and questionnaires to practitioners were used to identify incident melanomas in 2008, and evaluate characteristics of patients (age, sex, area of residence, social isolation), tumours (Breslow, ulceration, location, histological type), and GPs (training, conditions of practice), and their influence on patterns of diagnosis and Breslow thickness. Among 898 melanomas, 376 (42%) were first diagnosed in a general practice setting (GP group). Breslow thickness was much higher in the GP group than in other melanomas (median: 0·95 vs. 0·61 mm, P < 0·0001). Multivariate analysis identified an older age, lower limb location, nodular subtype and Breslow thickness as factors associated with the GP group. Within this group, 52·5% of melanomas were detected by patients (median Breslow thickness: 1·30 mm) and 47·5% by GPs (median Breslow thickness: 0·80 mm, P = 0·0009), including 8% during a systematic full-body skin examination. Previous GP training on melanoma was associated with active detection by GPs. Male sex and social isolation of patients were associated with thicker melanomas, whereas active detection by GPs was associated with thinner CMs. GPs play a key role in melanoma diagnosis in France, but still frequently detect thick tumours. Increasing awareness and training of GPs and focusing attention on male and/or socially isolated patients should help to improve early detection of melanoma.

The experience of being a neutropenic cancer patient in an acute care isolation room: a systematic review of qualitative evidence.

Protective isolation is one of the precautionary measures put in place for neutropenic cancer patients, where patients will be placed in an isolation room during their medical treatment in the hospital. The purpose of this practice is to minimise neutropenic patients from contracting nosocomial infection and the length of stay in the isolation room varies depending on their medical condition. It has been reported in some literature that this group of patients experience social isolation, a wide range of emotions and psychological burdens such as depression and anxiety as a result of staying in the isolation room. Therefore, a systematic review on neutropenic cancer patients' experience in isolation room will add knowledge to the nursing science of providing high quality care for this particular group of patients. The objectives of this review are to understand neutropenic cancer patients' experiences in the isolation room and their coping mechanisms. The participants of interest were adults neutropenic cancer patients aged 18 years old and above.The phenomenon of interest i was the experience of neutropenic cancer patients who were nursed in an isolation room due to chemotherapy induced neutropenia or during the period of haematopoietic stem cell transplant.The studies of interests were are qualitative studies which focus on adult neutropenic cancer patients' experiences in an isolation room.The outcome of interest wai s patients' self reported experiences. An initial search to identify keywords was undertaken in MEDLINE and CINAHL. A second search using all identified keywords and index terms across the databases was performed subsequently. The final search included reference lists from included papers for additional studies. Six qualitative papers were included in this review. The papers were qualitative descriptive, phenomenological, qualitative exploratory and grounded theory. All the papers used interview as primary method to collect data except one study which had an additional art making directive method. Data were extracted using standardised data extraction tools from JBI-QARI. Categories were formed based on aggregation from the similar findings with like meaning. The categories were then read and reread to develop two synthesised findings that were presented as declamatory and generalisable statements to guide and inform clinical practice. Two syntheses were generated based on the meta-aggregation. The first synthesis was that health care workers need to be aware physical isolation could result in social isolation in patients that made them feel powerless. The second synthesis was that health care workers should encourage patients to use cognitive mechanisms to cope with isolation experiences. Family, friends and nurses should step in to provide help in any form whenever patients need it. Isolation room has a negative impact on the neutropenic cancer patients while they are hospitalised. However, they are coping effectively using cognitive mechanisms and receive adequate support externally.Offering patients more options especially having flexibility in their daily routine such as meal times could be a useful intervention to allow them to take some control. Notifying the patient in advance of their time of treatment and involving patients in their treatment care will promote their autonomy. Tracking the patients' coping mechanisms and offering support when necessary will ease the patients' isolation experience.The psychological effects of being cared for in isolation room may undermine the clinical benefits of infection control. Therefore, future research is needed to evaluate the effectiveness of isolation room in preventing neutropenic cancer patients from infection.

The Use of Innovative Methods Designed to Relieve Social Isolation in Patients with Chronic Heart Failure; Volunteer Befriending, Forums and a Newsletter

Social isolation in patients with chronic heart failure (CHF) is an adverse prognostic factor. This paper reports the creation of a supportive patient/carer network (Heart Failure Support Service), led by a voluntary sector/National Health Service (NHS) partnership which involved volunteer befriending, regular patient and carer forum and a newsletter. Over 3 years, 37 volunteers were 'befrienders' to over 50 individuals with CHF. A thorough training and matching process ensured that the first befriending visit was a positive experience. 100% of patients found the visits from the volunteer worthwhile and said they would recommend the service to other patients. Prior to the first patient-carer forum, 200 questionnaires were sent out with a 56% response rate, 44% of respondents believed that a forum and a newsletter would be valued. Over a period of 3 years, 12 quarterly meetings were held with an average attendance of 30-40 per meeting. The newsletter (current circulation >800 per quarter) contributed to self-management and encouraged communication between professionals and patients-carers. The Heart Failure Support Service (volunteers, forum and newsletter) created a supportive patient-carer network and represents a successful voluntary sector/NHS partnership.

Predictors of depressive symptoms in patients with stroke – a three-month follow-up

Background and purposeDepression is one of the most common post-stroke complications, which could impair rehabilitation outcome and quality of life, and could also increase mortality after stroke. The aim of the present study was to assess the association between demographic, socioeconomic and clinical (stroke risk factors, type of stroke, location of vascular lesion, cognitive functions) factors on the presence and severity of post-stroke depressive symptoms in patients after first ever stroke as well as on their social functioning. Material and methodsA prospective, cohort study with a three-month observation period was performed in seven centres. Severity of depressive symptoms was assessed with the help of a short, 15-item version of the Geriatric Depression Scale (GDS), 3 months after stroke onset. ResultsOn the basis of GDS (GDS ≤ 5 points or > 5 points) patients were allocated to a group without (n = 160) or with symptoms suggestive of depression (n = 82). The study groups did not differ with respect to age, sex or place of residence. Univariate logistic regression analysis showed that independent predictors for the presence of symptoms suggestive of depression at 3 months after stroke were: low level of education, low income, greater severity of stroke, worse functional status, self-reported problems with daily-living activities and need of help in daily living activities. More than 60% of patients with depressive symptoms limited their social contacts. Patients with depressive symptoms were unsatisfied with their relations with life partners and friends. ConclusionsOur study showed a complex aetiology of post-stroke depressive symptoms with an important role of socioeconomic factors. Depressive symptoms after stroke worsen existing health, social and economic problems, and cause social isolation of patients.

Depression, Hostility, and Social Isolation in Patients with Coronary Artery Disease.

Psychosocial risk factors such as depression, hostility, and social isolation are substantially more prevalent in patients with coronary artery disease (CAD) than is widely recognized. It has been demonstrated that patients with CAD who have these risk factors, individually or together, may have a substantially increased risk for recurrent ischemic events, as well as cardiac death, when compared with unaffected CAD patients. Numerous adverse physiologic changes that appear to occur as a consequence of these psychosocial risk factors have been identified, including increased platelet aggregation, hyperadrenergic states, elevated cortisol levels, abnormal endothelial function, and an increased propensity towards malignant ventricular arrhythmias. Each of these may explain the increased risk of recurrent coronary events (including death) among afflicted patients. Under-recognition, and hence under-treatment, remains a principal obstacle for improvements in the care of patients with CAD who have psychosocial risk factors. The diagnosis of psychosocial risk factors depends on systematic patient evaluation by experienced clinicians trained in the recognition of these disorders. All clinicians must be aware of the potential importance of these factors, their sometimes subtle presenting characteristics, and the available treatment options. The universal use of comprehensive cardiovascular rehabilitation offers the ideal conduit for such evaluation and management. Nonpharmacologic therapies for psychosocial risk factors include psychotherapy, stress-reduction techniques, and exercise therapy. Studies suggest that the reduction of social isolation among depressed patients with CAD may result in a reduced mortality rate in comparison with those without improvements in isolation. Pharmacologic therapies are mainly for the management of depression, and largely center on the use of selective serotonin reuptake inhibitors (SSRIs). Several SSRIs (paroxetine and sertraline) recently have been shown to be safe and effective for the treatment of depression in patients with ischemic heart disease. Whether use of antidepressants attenuate the increased cardiac risk from depression in the setting CAD remains to be proven; however, their use improves the quality of life in properly selected patients.

Psychosocial Factors in the Occurrence of Environmental Intolerances

The phenomenon referred to as environmental illness, especially multiple chemical sensitivity, is an extremely controversial and puzzling issue. Despite the seeming gestalt of the disease there is no objective measure for diagnosis and pathophysiology. Psychological and psychosocial factors have a significant role in the presentation and prospects of the disease. Medical neglect of the suffering of the patients as well as iatrogenic attribution towards a chemical intoxication might both increase the risk of chronification and social isolation of patients up to a point of no return. Several observations and results from studies with environmental patients and in related fields are presented and discussed with the aim to encourage continuous research and a critical approach towards a phenomenon where the political necessity to decide is more advanced than the ability to understand.