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Yarish NM, Posis AIB, Nguyen S, Weitlauf J, Bellettiere J, Saquib N, Richey PA, Allison M, Kroenke C, Goveas JS, Coday M, LaCroix AZ. Loneliness, social isolation, and cardiovascular disease among nonveteran and veteran women. J Women Aging 2024:1-12. [PMID: 38659158 DOI: 10.1080/08952841.2024.2336655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024]
Abstract
We examined the prospective associations of social isolation and loneliness with incident cardiovascular disease (CVD) among aging nonveteran and veteran women, and effect modification by veteran status. Participants with no history of myocardial infarction (MI), stroke, coronary heart disease (CHD), or coronary heart failure from the Women's Health Initiative Extension Study II self-reported social isolation, loneliness, health behaviors, health status, and veteran status. CVD and CVD subevents were physician adjudicated. Hazard ratios (HR) and 95% confidence intervals (CI) for the Interquartile Range (IQR) in social isolation (IQR = 1) and loneliness (IQR=.33) were calculated using Cox proportional hazard models adjusting for sociodemographic, health behavior, and health status characteristics. Veteran status was tested as an effect modifier. Among 52,442 women (Mean age = 79 ± 6.1; veterans n = 1023; 89.2% non-Hispanic White), 3579 major CVD events occurred over an average 5.8 follow-up years. Compared to nonveterans, veteran women reported higher levels of social isolation (p < .01) and loneliness (p < .01). The CVD HR was 1.07 (95% CI, 1.04-1.10) for the IQR in social isolation and 1.03 (95% CI, 1.10-1.06) for the IQR in loneliness. The HR for the IQR in both social isolation and loneliness was 1.10 (95% CI, 1.05-1.15). Social isolation was associated with CHD (HR = 1.12; 95% CI, 1.03-1.21). The CHD HR for the IQR in social isolation was 1.12 (95% CI, 1.03-1.21). Associations did not differ by veteran status (all p-interactions > 0.08). Findings suggest that the adverse associations of social isolation and loneliness with CVD are similar among veteran and nonveteran women.
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Affiliation(s)
- Natalie M Yarish
- School of Community and Environmental Health, Old Dominion University, Norfolk, Virginia, USA
| | - Alexander Ivan B Posis
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, San Diego, California, USA
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Steve Nguyen
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, San Diego, California, USA
| | - Julie Weitlauf
- Veterans Affairs Palo Alto Health Care System, Livermore, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - John Bellettiere
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, San Diego, California, USA
| | - Nazmus Saquib
- Sulaiman Al Rajhi University, Al Bukayriyah, Saudi Arabia
| | - Phyllis A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Matthew Allison
- Division of Preventive Medicine, Department of Family Medicine, UC San Diego, San Diego, California, USA
| | - Candyce Kroenke
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | | | - Mace Coday
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Andrea Z LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, San Diego, California, USA
- Women's Health Initiative, USA
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Eliacin J, Patterson SM, Mendez DM, Burgess DJ, Traylor MH, Borden MY, Slaven JE, Matthias MS. Findings from a Peer-Facilitated, Social Isolation Intervention in the Veterans Health Administration Healthcare System: A Mixed-Methods, Pilot Feasibility Study. J Gen Intern Med 2023; 38:3460-3471. [PMID: 37723366 PMCID: PMC10713941 DOI: 10.1007/s11606-023-08387-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 08/21/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Social isolation is a global public health threat. Veterans are particularly at risk for social isolation due to high rates of comorbid physical and mental health problems. Yet, effective interventions are limited. OBJECTIVES Our primary objective was to assess the feasibility and acceptability of CONNECTED, a novel, transdiagnostic intervention to reduce social isolation that includes individual and group components and is delivered by peers via telehealth. Secondary objectives were to identify appropriate outcome measures and explore preliminary intervention effects. METHODS This was a two-phase study. In Phase 1, to evaluate study feasibility, we surveyed 200 veterans to assess prevalence of social isolation and their interest in social connectedness interventions. In Phase 2, we employed a mixed-methods, pre-post study design in which we piloted CONNECTED with 19 veterans through 2 successive cohorts to further assess feasibility, to evaluate acceptability, and to explore preliminary effectiveness. Quantitative analyses involved descriptive and bivariate analyses as well as multivariate modeling. Qualitative interviews were analyzed using thematic analysis. RESULTS For Phase 1, 39% of veterans surveyed were socially isolated. Participants who were ≤ 55 years old, caregivers, and those who experienced unmet social needs were more likely to report social isolation. Over 61% expressed interest in VA programs to reduce social isolation. For Phase 2, the pilot intervention, recruitment rate was 88% and the enrollment rate was 86%. Retention rates for the two cohorts were 80% and 50%, respectively, and satisfaction rates among intervention completers were 100%. Results also showed statistically significant improvements in social isolation (+ 5.91, SD = 4.99; p = .0028), social support (+ 0.74, SD = 1.09; p = .03), anxiety (-3.92, SD = 3.73; p = .003), and depression (-3.83, SD = 3.13; p = .001). Results for the other measures were not statistically significant. CONCLUSION CONNECTED is a feasible and acceptable intervention and is likely to be an effective tool to intervene on social isolation among veterans.
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Affiliation(s)
- Johanne Eliacin
- Department of Veterans Affairs, VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.
- Regenstrief Institute, Indianapolis, IN, USA.
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Scott M Patterson
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Psychiatry, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Diana M Mendez
- Department of Psychiatry, Orlando VA Healthcare System, Orlando, FL, USA
| | - Diana J Burgess
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Morgan H Traylor
- Department of Veterans Affairs, VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Maria Y Borden
- Department of Veterans Affairs, VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - James E Slaven
- Deparmtent of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marianne S Matthias
- Department of Veterans Affairs, VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Regenstrief Institute, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Hausmann LRM, Cohen AJ, Eliacin J, Gurewich DA, Lee RE, McCoy JL, Meterko M, Michaels Z, Moy EM, Procario GT, Russell LE, Schaefer JH. Developing a brief assessment of social risks for the Veterans Health Administration Survey of Healthcare Experiences of Patients. Health Serv Res 2023; 58:1209-1223. [PMID: 37674359 PMCID: PMC10622278 DOI: 10.1111/1475-6773.14220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE To determine whether a 6- or 12-month look-back period affected rates of reported social risks in a social risk survey for use in the Veterans Health Administration and to assess associations of social risks with overall health and mental health. STUDY DESIGN Cross-sectional survey of respondents randomized to 6- or 12-month look-back period. DATA SOURCES AND STUDY SETTING Online survey with a convenience sample of Veterans in June and July 2021. DATA COLLECTION/EXTRACTION METHODS Veteran volunteers were recruited by email to complete a survey assessing social risks, including financial strain, adult caregiving, childcare, food insecurity, housing, transportation, internet access, loneliness/isolation, stress, discrimination, and legal issues. Outcomes included self-reported overall health and mental health. Chi-squared tests compared the prevalence of reported social risks between 6- and 12-month look-back periods. Spearman correlations assessed associations among social risks. Bivariate and multivariable logistic regression models estimated associations between social risks and fair/poor overall and mental health. PRINCIPAL FINDINGS Of 3418 Veterans contacted, 1063 (31.10%) responded (87.11% male; 85.61% non-Hispanic White; median age = 70, interquartile range [IQR] = 61-74). Prevalence of most reported social risks did not significantly differ by look-back period. Most social risks were weakly intercorrelated (median |r| = 0.24, IQR = 0.16-0.31). Except for legal issues, all social risks were associated with higher odds of fair/poor overall health and mental health in bivariate models. In models containing all significant social risks from bivariate models, adult caregiving and stress remained significant predictors of overall health; food insecurity, housing, loneliness/isolation, and stress remained significant for mental health. CONCLUSIONS Six- and 12-month look-back periods yielded similar rates of reported social risks. Although most individual social risks are associated with fair/poor overall and mental health, when examined together, only adult caregiving, stress, loneliness/isolation, food, and housing remain significant.
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Affiliation(s)
- Leslie R. M. Hausmann
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System (VAPHS); Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Alicia J. Cohen
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System; Department of Health Services, Policy, and Practice, Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Johanne Eliacin
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts; Department of General Internal Medicine and Geriatrics, Indiana University School of MedicineIndianapolisIndianaUSA
- Department of Health Services ResearchRegenstrief Institute, IncIndianapolisIndianaUSA
| | - Deborah A. Gurewich
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Section of General Internal Medicine, Boston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Richard E. Lee
- Veterans Rural Health Resource CenterWhite River JunctionVermontUSA
| | - Jennifer L. McCoy
- Center for Health Equity Research and Promotion and Office of Research and Development StatCore, VAPHSPittsburghPennsylvaniaUSA
| | - Mark Meterko
- Analytics and Performance Integration, Office of Quality and Patient SafetyDepartment of Veterans Affairs; Department of Health Law, Policy and Management, Boston University School of Public HealthBostonMassachusettsUSA
| | - Zachary Michaels
- Center for Health Equity Research and Promotion, VAPHSPittsburghPennsylvaniaUSA
| | - Ernest M. Moy
- Office of Health EquityVeterans Health AdministrationWashingtonDCUSA
| | - Gregory T. Procario
- Center for Health Equity Research and Promotion, VAPHSPittsburghPennsylvaniaUSA
| | - Lauren E. Russell
- Office of Health EquityVeterans Health AdministrationWashingtonDCUSA
| | - James H. Schaefer
- Analytics and Performance Integration, Office of Quality and Patient SafetyDepartment of Veterans AffairsDurhamNorth CarolinaUSA
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Russell LE, Cohen AJ, Chrzas S, Halladay CW, Kennedy MA, Mitchell K, Moy E, Lehmann LS. Implementing a Social Needs Screening and Referral Program Among Veterans: Assessing Circumstances & Offering Resources for Needs (ACORN). J Gen Intern Med 2023; 38:2906-2913. [PMID: 37165261 PMCID: PMC10171907 DOI: 10.1007/s11606-023-08181-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/17/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND The Department of Veterans Affairs (VA) healthcare system routinely screens Veterans for food insecurity, housing instability, and intimate partner violence, but does not systematically screen for other health-related social needs (HRSNs). OBJECTIVES To (1) develop a process for systematically identifying and addressing Veterans' HRSNs, (2) determine reported prevalence of HRSNs, and (3) assess the acceptability of HRSN screening among Veterans. DESIGN "Assessing Circumstances and Offering Resources for Needs" (ACORN) is a Veteran-tailored HRSN screening and referral quality improvement initiative. Veterans were screened via electronic tablet for nine HRSNs (food, housing, utilities, transportation, legal needs, social isolation, interpersonal violence, employment, and education) and provided geographically tailored resource guides for identified needs. Two-week follow-up interviews with a purposive sample of Veterans explored screening experiences. PARTICIPANTS Convenience sample of Veterans presenting for primary care at a VA urban women's health clinic and suburban community-based outpatient clinic (October 2019-May 2020). MAIN MEASURES Primary outcomes included prevalence of HRSNs, Veteran-reported acceptability of screening, and use of resources guides. Data were analyzed using descriptive statistics, chi-square tests, and rapid qualitative analysis. KEY RESULTS Of 268 Veterans screened, 50% reported one or more HRSNs. Social isolation was endorsed most frequently (29%), followed by educational needs (19%), interpersonal violence (12%), housing instability (9%), and utility concerns (7%). One in five Veterans reported at least one form of material hardship. In follow-up interviews (n = 15), Veterans found screening acceptable and felt VA should continue screening. No Veterans interviewed had contacted recommended resources at two-week follow-up, although several planned to use resource guides in the future. CONCLUSION In a VA HRSN screening and referral program, Veterans frequently reported HRSNs, felt screening was important, and thought VA should continue to screen for these needs. Screening for HRSNs is a critical step towards connecting patients with services, identifying gaps in service delivery, and informing future resource allocation.
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Affiliation(s)
- Lauren E Russell
- Office of Health Equity, Veterans Health Administration, Washington, DC, USA.
| | - Alicia J Cohen
- VA Health Services Research & Development (HSR&D) Center of Innovation in Long Term Services and Supports (LTSS-COIN), VA Providence Healthcare System, Providence, RI, USA
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Steven Chrzas
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Christopher W Halladay
- VA Health Services Research & Development (HSR&D) Center of Innovation in Long Term Services and Supports (LTSS-COIN), VA Providence Healthcare System, Providence, RI, USA
| | - Meaghan A Kennedy
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Kathleen Mitchell
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, MA, USA
| | - Ernest Moy
- Office of Health Equity, Veterans Health Administration, Washington, DC, USA
| | - Lisa Soleymani Lehmann
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
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Douglas NF, Archer B, Azios JH, Strong KA, Simmons-Mackie N, Worrall L. A scoping review of friendship intervention for older adults: lessons for designing intervention for people with aphasia. Disabil Rehabil 2023; 45:3012-3031. [PMID: 36170126 DOI: 10.1080/09638288.2022.2117866] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Map the landscape of friendship interventions/programs for older adults to guide intervention/program development inclusive of the unique needs of older people with aphasia (PWA). METHODS A search query of multiple databases was completed for articles published before 4 January 2021. Studies included all the following: (1) participants aged 55 years or older; (2) addressed an intervention/program designed to prevent social isolation and/or friendship loss; (3) used an outcome variable related to social isolation and/or friendship; and (4) published in a peer-reviewed journal. Title and abstract screening were conducted using Covidence software, which tracked disagreements across the study team. All studies included in the full-text review were identified as relevant by a minimum of two study authors, and a consensus was reached on all full-text reviews. Data were extracted according to (1) theoretical frameworks used; (2) interventionist and discipline; (3) participant characteristics; (4) intervention/program replicability; (5) format of intervention/program; (6) measures used in the intervention/programs; (7) and, reported effects of intervention/programs on individuals. RESULTS A total of 40 articles with 42 intervention/programs were included and represented 4584 intervention/program participants ranging in age from 40 to 104 years. Intervention/programs involved a wide range of theoretical frameworks (e.g., theories of loneliness, feminist theory, positive psychology). Disciplines such as psychology and exercise science informed intervention/programs. Interventionists included many types of individuals like therapists, volunteers and home health aides. Intervention/programs often lacked adequate description for replication and included individual and group formats, most commonly delievered in the participants homes. Outcomes usually included self-report measures of loneliness, social networks, or well-being, and intervention/programming was primarily educational, activity-based, or networking-based in nature. CONCLUSIONS The intervention/programs reviewed yield important lessons to support innovation in developing friendship intervention/programs for older PWA as most yielded positive results and were acceptable to participants.IMPLICATIONS FOR REHABILITATIONPeople with aphasia want their friendships addressed as part of their rehabilitation; however, the research literature has little guidance in this area.Studies reviewed of friendship intervention/programs for older adults yielded helpful lessons for consideration in developing this type of intervention/programming for people with aphasia.Interprofessional teams made up of rehabilitation professionals should address friendship for people with aphasia in both research and clinical practice.
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Affiliation(s)
- Natalie F Douglas
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant, MI, USA
| | - Brent Archer
- Department of Communication Sciences & Disorders, Bowling Green State University, Bowling Green, OH, USA
| | - Jamie H Azios
- Department of Speech & Hearing Sciences, Lamar University, Beaumont, TX, USA
| | - Katie A Strong
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant, MI, USA
| | - Nina Simmons-Mackie
- Department of Health & Human Sciences, Southeastern Louisiana University, Hammond, LA, USA
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Rudzinski K, King K, Guta A, Chan Carusone S, Strike C. "And if my goal is never to leave Casey House?": The significance of place attachment for patients at a specialty HIV hospital in Toronto, Canada. Health Place 2023; 83:103100. [PMID: 37595542 DOI: 10.1016/j.healthplace.2023.103100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/17/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023]
Abstract
The current healthcare context prioritizes shorter hospital stays and fewer readmissions. However, these measures may not fully capture care experiences for people living with HIV, especially those experiencing medical, psychosocial, and economic complexity. As part of a larger study, we conducted seven focus groups with people living with HIV (n = 52), who were current/former patients at a Toronto-based specialty hospital, examining their desires/needs for hospital programs. Using a novel place attachment lens, we conducted a thematic analysis focusing on the emotional bond between person (patient) and place (hospital). Our findings show that participants wanted an ongoing connection to hospital to fulfill their need(s) for control, security, restoration and belonging. Indeed, continual attachment to hospital may be beneficial for patients with complex care needs. Our research has implications for care engagement and retention frameworks.
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Affiliation(s)
- Katherine Rudzinski
- School of Social Work, University of Windsor, 167 Ferry Street, Windsor, ON, N9A 0C5, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada.
| | - Kenneth King
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, 167 Ferry Street, Windsor, ON, N9A 0C5, Canada.
| | | | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada.
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Monk JK, Ruhlmann L, Goff BSN, Ogan M, Miller MB. Translating Discovery Science. Fostering relationships: Service provider perspectives on community building among veteran families. FAMILY RELATIONS 2023; 72:1351-1367. [PMID: 37583766 PMCID: PMC10424772 DOI: 10.1111/fare.12724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Objective We sought to identify the social process through which communal support can be established among veteran couples and families. Background On the basis of the social organization theory of action and change, a sense of community is crucial for military veterans' well-being and may serve as a resource for intervention. Method We interviewed service providers (n = 8) and corroborated their perspectives by triangulating evaluations from veteran family participants (n = 143). Data were analyzed using grounded theory techniques. Results Providers suggested promoting a sense of community in prevention and intervention programming by (a) establishing a safe and empowering space, (b) bridging existing gaps within family and community systems, and (c) encouraging interpersonal healing by promoting connection and facilitating the sharing of common experiences. Providers also described challenges to facilitating the program, including logistics, time, and funding constraints. Conclusion According to our results, fostering community among veterans and their family members may be achieved by applying an integrative approach that goes beyond siloed individual, couple, and group therapy orchestrated by practitioners. Implications We recommend multicomponent interventions that create synergy between different levels and forms of social support. Providers recommended being intentional about the program structure to focus on community strengths and shared connection.
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Affiliation(s)
- J. Kale Monk
- Department of Human Development and Family Science, University of Missouri, Columbia, MO
| | - Lauren Ruhlmann
- Department of Human Development and Family Science, Auburn University, Auburn, AL
| | | | - Matthew Ogan
- Department of Human Development and Family Science, University of Missouri, Columbia, MO
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Griffin O, Li T, Beveridge A, Ní Chróinín D. Higher levels of multimorbidity are associated with increased risk of readmission for older people during post-acute transitional care. Eur Geriatr Med 2023:10.1007/s41999-023-00770-5. [PMID: 37010792 DOI: 10.1007/s41999-023-00770-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/08/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE Older patients are at high risk for poor outcomes after an acute hospital admission. The Transitional Aged Care Programme (TACP) was established by the Australian government to provide a short-term care service aiming to optimise functional independence following hospital discharge. We aim to investigate the association between multimorbidity and readmission amongst patients on TACP. METHODS Retrospective cohort study of all TACP patients over 12 months. Multimorbidity was defined using the Charlson Comorbidity Index (CCI), and prolonged TACP (pTACP) as TACP ≥ 8 weeks. RESULTS Amongst 227 TACP patients, the mean age was 83.3 ± 8.0 years, and 142 (62.6%) were females. The median length-of-stay on TACP was 8 weeks (IQR 5-9.67), and median CCI 7 (IQR 6-8). 21.6% were readmitted to hospital. Amongst the remainder, 26.9% remained at home independently, 49.3% remained home with supports; < 1% were transferred to a residential facility (0.9%) or died (0.9%). Hospital readmission rates increased with multimorbidity (OR 1.37 per unit increase in CCI, 95% CI 1.18-1.60, p < 0.001). On multivariable logistic regression analysis, including polypharmacy, CCI, and living alone, CCI remained independently associated with 30-day readmission (aOR 1.43, 95% CI 1.22-1.68, p < 0.001). CONCLUSIONS CCI is independently associated with a 30-day hospital readmission in TACP cohort. Identifying vulnerability to readmission, such as multimorbidity, may allow future exploration of targeted interventions.
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Affiliation(s)
- Ornagh Griffin
- Department of Geriatric Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - Tracy Li
- Department of Geriatric Medicine, Liverpool Hospital, Corner of Elizabeth and Goulburn St, Liverpool, NSW, Australia.
- South Western Sydney Clinical School, UNSW Sydney, Sydney, NSW, Australia.
| | - Alexander Beveridge
- Department of Geriatric Medicine, St Vincent's Hospital, Sydney, NSW, Australia
- St. Vincent's Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Danielle Ní Chróinín
- Department of Geriatric Medicine, Liverpool Hospital, Corner of Elizabeth and Goulburn St, Liverpool, NSW, Australia
- South Western Sydney Clinical School, UNSW Sydney, Sydney, NSW, Australia
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Abbas H, Aida J, Cooray U, Ikeda T, Koyama S, Kondo K, Osaka K. Does remaining teeth and dental prosthesis associate with social isolation? A six-year longitudinal study from the Japan Gerontological Evaluation Study (JAGES). Community Dent Oral Epidemiol 2023; 51:345-354. [PMID: 35352849 DOI: 10.1111/cdoe.12746] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Social isolation was associated with increased mortality and numerous adverse health outcomes. However, the longitudinal association between oral health and social isolation has not been studied. In this longitudinal prospective cohort study, the association between the number of remaining teeth and dental prosthesis use with social isolation after 6-years follow-up was examined. METHODS Functionally independent adults aged 65 years or older, who were not socially isolated in 2010, were followed up until 2016 in the Japan Gerontological Evaluation Study. Data from 26 417 participants were analysed after random forest imputation to address missing data. Logistic regression models were used to calculate the odds ratio (OR) for incident social isolation in 2016 after adjusting for age, sex, educational attainment, income, activities of daily living, living area and having depressive symptoms. RESULTS The mean age of the participants at baseline was 72.3 (SD = 5.0). A total of 1,127 (4.3%) participants were socially isolated at follow-up. Of these, 338 (3.2%) had ≥20 teeth (with or without using dental prosthesis), 171 (3.9%) had 10-19 teeth and used dental prosthesis, 112 (4.2%) had 10-19 teeth and did not use the dental prosthesis, 338 (5.1%) had 0-9 teeth and used dental prosthesis, and 168 (7.6%) had 0-9 teeth and did not use the dental prosthesis. Fully adjusted logistic regression models showed that the OR of incident social isolation was higher for those with fewer teeth; OR = 1.13 (95%CI = 0.96-1.33) for those with 10-19 teeth and OR = 1.36 (95%CI = 1.17-1.58) for those with 0-9 teeth, compared to those with ≥20 teeth. The OR of incident social isolation was lower for those who used a dental prosthesis [OR = 0.90, 95%CI = 0.80-1.02)] compared to those who did not use a dental prosthesis. The interaction between the number of teeth and dental prosthesis use demonstrated that the latter mitigated the incidence of social isolation for participants with tooth loss. Compared to those with ≥20 teeth (with or without prosthesis use), participants with 0-9 teeth that did not use a dental prosthesis were 79% [OR = 1.79, 95%CI = 1.49-2.19] more likely to be socially isolated, whereas participants with 0-9 teeth that used a dental prosthesis were only 23% [OR = 1.23, 95%CI = 1.05-1.45] more likely to be socially isolated. CONCLUSION Tooth loss was the main predictor for social isolation at follow-up, while no dental prostheses use was an additional risk factor. Dental prosthesis use may reduce the risk of social isolation especially in those with severe tooth loss.
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Affiliation(s)
- Hazem Abbas
- Department of International and Community Oral Health, Tohoku University, Graduate School of Dentistry, Sendai, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Division for Regional Community Development, Liaison Center for Innovative Dentistry, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Upul Cooray
- Department of International and Community Oral Health, Tohoku University, Graduate School of Dentistry, Sendai, Japan
| | - Takaaki Ikeda
- Department of International and Community Oral Health, Tohoku University, Graduate School of Dentistry, Sendai, Japan
- Department of Health Policy Science, Graduate School of Medical Science, Yamagata University, Yamagata, Japan
| | - Shihoko Koyama
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
- Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu City, Japan
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University, Graduate School of Dentistry, Sendai, Japan
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10
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A Faith-Based Intervention to Address Social Isolation and Loneliness in Older Adults. J Christ Nurs 2023; 40:28-35. [PMID: 36469874 DOI: 10.1097/cnj.0000000000001023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
ABSTRACT The goal of this quality improvement project was to determine if virtually offered faith-based resources for socially isolated older adults could reduce loneliness and improve quality of life. A nurse-developed program of virtual spiritual and religious interventions, including mindfulness, prayer, Scripture meditation, gratitude practices, and online church services, was offered by local ministers to older adults at risk of social isolation or loneliness. A sample of 16 adults over age 55 from local communities participated in the 12-week intervention and follow-up. The intervention resulted in a significant decrease in perception of social loneliness and improved physical health quality of life.
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11
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Lennon JC, Hantke N, Mattek N, Wu CY, Dodge H, Wall R, Beattie Z, Kaye J, Silbert L. Mood and activity changes during the COVID-19 pandemic in rural and urban Veterans and their cohabitants. Clin Gerontol 2023; 46:759-766. [PMID: 36208222 PMCID: PMC10132474 DOI: 10.1080/07317115.2022.2130123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES We aimed to examine the impact of COVID-19 pandemic-related stay-at-home orders on weekly reports of mood and activity before and during COVID-19 in a sample of older Veterans and their cohabitants. METHODS Urban and rural Veterans and their cohabitants living in the Pacific Northwest ≥62 years old were enrolled as part of the Collaborative Aging Research Using Technology initiative (n = 100, age = 71.2 ± 6.5, 41% women). Participants reported frequency of social activities (e.g., travel away), physical illness, and mood (blue mood and loneliness) via weekly online health forms. RESULTS A total of 2,441 weekly online health forms (OHFs) were collected from 100 participants. During the COVID-19 pandemic, blue mood (OR = 4.4, p < .0001) and loneliness (OR = 7.2, p < .0001) were significantly higher than before the pandemic, and travel away from home was significantly lower (OR = 0.5, p < .0001). Prevalence of blue mood and loneliness were not associated with rurality. CONCLUSIONS The current study established that blue mood and loneliness were significantly more prevalent in older Veterans following COVID-19 stay-at-home orders regardless of rurality. CLINICAL IMPLICATIONS The COVID-19 pandemic associated health precautions, while necessary to curb acute health risks, have created a unique situation that places vulnerable populations at increased risk of low mood.
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Affiliation(s)
- Jack C. Lennon
- Division of Mental Health & Clinical Neurosciences, Veterans Affairs Portland Health Care System, Portland, OR USA
| | - Nathan Hantke
- Division of Mental Health & Clinical Neurosciences, Veterans Affairs Portland Health Care System, Portland, OR USA
- Department of Neurology, Oregon Health & Science University, Portland, OR USA
- NIA-Layton Aging & Alzheimer’s Disease Research Center, Portland, OR USA
| | - Nora Mattek
- Department of Neurology, Oregon Health & Science University, Portland, OR USA
- NIA-Layton Aging & Alzheimer’s Disease Research Center, Portland, OR USA
- Oregon Center for Aging & Technology (ORCATECH), Portland, OR USA
| | - Chao-Yi Wu
- Department of Neurology, Oregon Health & Science University, Portland, OR USA
- NIA-Layton Aging & Alzheimer’s Disease Research Center, Portland, OR USA
- Oregon Center for Aging & Technology (ORCATECH), Portland, OR USA
| | - Hiroko Dodge
- Department of Neurology, Oregon Health & Science University, Portland, OR USA
- NIA-Layton Aging & Alzheimer’s Disease Research Center, Portland, OR USA
- Oregon Center for Aging & Technology (ORCATECH), Portland, OR USA
| | - Rachel Wall
- Department of Neurology, Oregon Health & Science University, Portland, OR USA
- NIA-Layton Aging & Alzheimer’s Disease Research Center, Portland, OR USA
- Oregon Center for Aging & Technology (ORCATECH), Portland, OR USA
| | - Zachary Beattie
- Department of Neurology, Oregon Health & Science University, Portland, OR USA
- NIA-Layton Aging & Alzheimer’s Disease Research Center, Portland, OR USA
- Oregon Center for Aging & Technology (ORCATECH), Portland, OR USA
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health & Science University, Portland, OR USA
- NIA-Layton Aging & Alzheimer’s Disease Research Center, Portland, OR USA
- Oregon Center for Aging & Technology (ORCATECH), Portland, OR USA
| | - Lisa Silbert
- Department of Neurology, Oregon Health & Science University, Portland, OR USA
- NIA-Layton Aging & Alzheimer’s Disease Research Center, Portland, OR USA
- Oregon Center for Aging & Technology (ORCATECH), Portland, OR USA
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12
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Sekhon H, Lavin P, Vacaflor B, Rigas C, Cinalioglu K, Su CL, Bodenstein K, Dikaios E, Goodman A, Raymond FC, Ibrahim M, Bein M, Gruber J, Se J, Sasi N, Walsh C, Nazar R, Hanganu C, Berkani S, Royal I, Schiavetto A, Looper K, Launay C, McDonald EG, Seitz D, Kumar S, Beauchet O, Khoury B, Bouchard S, Battistini B, Fallavollita P, Miresco M, Bruneau MA, Vahia I, Bukhari S, Rej S. Isolating together during COVID-19: Results from the Telehealth Intervention Program for older adults. Front Med (Lausanne) 2022; 9:948506. [PMID: 36304184 PMCID: PMC9592737 DOI: 10.3389/fmed.2022.948506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/20/2022] [Indexed: 11/27/2022] Open
Abstract
Background A pressing challenge during the COVID-19 pandemic and beyond is to provide accessible and scalable mental health support to isolated older adults in the community. The Telehealth Intervention Program for Older Adults (TIP-OA) is a large-scale, volunteer-based, friendly telephone support program designed to address this unmet need. Methods A prospective cohort study of 112 TIP-OA participants aged ≥60 years old was conducted in Quebec, Canada (October 2020–June 2021). The intervention consisted of weekly friendly phone calls from trained volunteers. The primary outcome measures included changes in scores of stress, depression, anxiety, and fear surrounding COVID-19, assessed at baseline, 4 and 8-weeks. Additional subgroup analyses were performed with participants with higher baseline scores. Results The subgroup of participants with higher baseline depression scores (PHQ9 ≥10) had significant improvements in depression scores over the 8-week period measured [mean change score = −2.27 (±4.76), 95%CI (−3.719, −0.827), p = 0.003]. Similarly, participants with higher baseline anxiety scores (GAD7 ≥10) had an improvement over the same period, which, approached significance (p = 0.06). Moreover, despite peaks in the pandemic and related stressors, our study found no significant (p ≥ 0.09) increase in stress, depression, anxiety or fear of COVID-19 scores. Discussion This scalable, volunteer-based, friendly telephone intervention program was associated with decreased scores of depression and anxiety in older adults who reported higher scores at baseline (PHQ 9 ≥10 and GAD7 ≥10).
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Affiliation(s)
- Harmehr Sekhon
- Department of Psychiatry, McGill University, Montreal, QC, Canada,Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada,GeriPARTy Research Lab, Montreal, QC, Canada,McLean Hospital, Harvard Medical School, Boston, MA, United States,*Correspondence: Harmehr Sekhon
| | - Paola Lavin
- Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada,GeriPARTy Research Lab, Montreal, QC, Canada
| | - Blanca Vacaflor
- GeriPARTy Research Lab, Montreal, QC, Canada,Pierre-Boucher Hospital, Longueuil, QC, Canada
| | - Christina Rigas
- Department of Psychiatry, McGill University, Montreal, QC, Canada,Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada,GeriPARTy Research Lab, Montreal, QC, Canada
| | - Karin Cinalioglu
- Department of Psychiatry, McGill University, Montreal, QC, Canada,Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada,GeriPARTy Research Lab, Montreal, QC, Canada
| | | | - Katie Bodenstein
- Department of Psychiatry, McGill University, Montreal, QC, Canada,Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada,GeriPARTy Research Lab, Montreal, QC, Canada
| | | | - Allana Goodman
- Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada
| | | | | | - Magnus Bein
- GeriPARTy Research Lab, Montreal, QC, Canada
| | | | - Jade Se
- GeriPARTy Research Lab, Montreal, QC, Canada
| | - Neeti Sasi
- GeriPARTy Research Lab, Montreal, QC, Canada
| | - Chesley Walsh
- Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada,GeriPARTy Research Lab, Montreal, QC, Canada
| | - Rim Nazar
- GeriPARTy Research Lab, Montreal, QC, Canada
| | - Cezara Hanganu
- Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada,GeriPARTy Research Lab, Montreal, QC, Canada
| | - Sonia Berkani
- Department of Psychiatry, McGill University, Montreal, QC, Canada,Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada
| | - Isabelle Royal
- Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada
| | | | - Karl Looper
- Department of Psychiatry, McGill University, Montreal, QC, Canada,Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada
| | - Cyrille Launay
- Department of Psychiatry, McGill University, Montreal, QC, Canada,Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada
| | | | - Dallas Seitz
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Sanjeev Kumar
- Geriatric Clinical Research, The Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Olivier Beauchet
- Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada
| | - Bassam Khoury
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Stephane Bouchard
- Department of Psychoeducation and Psychology, Université du Quebec en Outaouais, Gatineau, QC, Canada
| | - Bruno Battistini
- Quebec Heart and Lung Institute, Department of Medicine, Laval University, Quebec City, QC, Canada
| | - Pascal Fallavollita
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Marc Miresco
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | | | - Ipsit Vahia
- McLean Hospital, Harvard Medical School, Boston, MA, United States
| | - Syeda Bukhari
- Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada,GeriPARTy Research Lab, Montreal, QC, Canada
| | - Soham Rej
- Department of Psychiatry, McGill University, Montreal, QC, Canada,Jewish General Hospital/Lady Davis Institute, Montreal, QC, Canada,GeriPARTy Research Lab, Montreal, QC, Canada
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13
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Clifton K, Gao F, Jabbari J, Van Aman M, Dulle P, Hanson J, Wildes TM. Loneliness, social isolation, and social support in older adults with active cancer during the COVID-19 pandemic. J Geriatr Oncol 2022; 13:1122-1131. [PMID: 36041993 PMCID: PMC9385725 DOI: 10.1016/j.jgo.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/09/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
Abstract
Introduction The COVID-19 pandemic has had a considerable impact on mental health. The social distancing and stay-at-home orders have likely also impacted loneliness, social isolation, and social support. Older adults, particularly those with comorbidities such as cancer, have a greater potential to be impacted. Here we assessed loneliness, social isolation, and social support in older adults undergoing active cancer treatment during the pandemic. Materials and methods A mixed methods study in which quantitative data and qualitative response items were collected in parallel was conducted in 100 older adults with cancer. Participants completed a survey by telephone with a series of validated questionnaires to assess the domains of loneliness, social isolation, and social support as well as several open-ended questions. Baseline demographics and geriatric assessments were summarized using descriptive statistics. Bivariate associations between social isolation and loneliness and social support and loneliness were described using Spearman correlation coefficients. Conventional content analysis was performed on the open-ended questions. Results In a population of older adults with cancer, 3% were noted to be severely lonely, although 27% percent screened positive as having at least one indicator of loneliness by the University of California, Los Angeles (UCLA) Three Item Loneliness Scale. There was a significant positive correlation between loneliness and social isolation (r = +0.52, p < 0.05) as well as significant negative correlation between loneliness and social support (r = −0.49, p < 0.05). There was also a significant negative correlation between loneliness and emotional support (r = −0.43, p < 0.05). There was no significant association between loneliness and markers of geriatric impairments, including comorbidities, G8 score or cognition. Discussion Reassuringly, in this cohort we found relatively low rates of loneliness and social isolation and high rates of social support. Consistent with prior studies, loneliness, social isolation, and social support were found to be interrelated domains; however, they were not significantly associated with markers of geriatric impairments. Future studies are needed to study if cancer diagnosis and treatment may mediate changes in loneliness, social isolation, and social support in the context of the pandemic as well as beyond.
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Affiliation(s)
- Katherine Clifton
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America.
| | - Feng Gao
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America
| | - JoAnn Jabbari
- Goldfarb School of Nursing at Barnes-Jewish College, Saint Louis, MO, United States of America
| | - Mary Van Aman
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America
| | - Patricia Dulle
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America
| | - Janice Hanson
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America
| | - Tanya M Wildes
- Division of Hematology/Oncology, University of Nebraska Medical Center/Nebraska Medicine, Omaha NE, United States of America
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14
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K B, M L, Anatharaman V. Social network and its effect on selected dimension of health and quality of life among community dwelling urban and rural geriatric population in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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15
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Validating the Persian Version of the Lubben Social Network Scale-18. AGEING INTERNATIONAL 2022. [DOI: 10.1007/s12126-021-09477-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Grenawalt TA, Lu J, Hamner K, Gill C, Umucu E. Social isolation and well-being in veterans with mental illness. J Ment Health 2022; 32:407-411. [PMID: 35001791 DOI: 10.1080/09638237.2021.2022625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Veterans with mental illness are a growing population in the United States (US). For some veterans, their military service has a negative effect on well-being. Social isolation is problematic for veterans' mental health by increasing incidence of depression, suicidal ideation or attempts, and readmittance to psychiatric hospitals. Social support is a protective factor for individuals with mental illness and is key to a successful military-to-civilian transition. AIM Thus, we examine the relationship of social isolation on well-being among veterans with any mental illness. METHODS This cross-sectional correlational study consisted of a sample of 146 US veterans with any mental illness. A three-step hierarchical regression analysis was used to determine if social isolation is a predictor of well-being after controlling for demographics, functional limitations and depression. RESULTS Findings revealed social isolation was positively correlated with functional limitations (r = 0.48, p < 0.001), depression (r = 0.66, p < 0.001) and negatively correlated with well-being (r = -.64, p < 0.001). Hierarchical regression analysis revealed social isolation was negatively correlated (β = -.44, p < 0.001) with well-being. Overall, our three-step model accounted a total of 50% of variance in well-being, a large effect size. CONCLUSION The findings underscore the importance of assessing the relationship of social isolation on well-being in veterans with mental illness. The findings also highlight promising targets to improve prevention and psychosocial interventions to improve well-being among veterans with mental illness.
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Affiliation(s)
| | - Junfei Lu
- The University of Alabama, Tuscaloosa, AL, USA
| | - Karl Hamner
- The University of Alabama, Tuscaloosa, AL, USA
| | | | - Emre Umucu
- Department of Counseling, Educational Psychology & Special Education, Michigan State University, East Lansing, MI, USA
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17
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Galiatsatos P, Ajayi A, Maygers J, Archer Smith S, Theilheimer L, Golden SH, Bennett RG, Hale WD. Together in Care: An Enhanced Meals on Wheels Intervention Designed to Reduce Rehospitalizations among Older Adults with Cardiopulmonary Disease-Preliminary Findings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010458. [PMID: 35010718 PMCID: PMC8744970 DOI: 10.3390/ijerph19010458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
Abstract
Rehospitalizations in the Medicare population may be influenced by many diverse social factors, such as, but not limited to, access to food, social isolation, and housing safety. Rehospitalizations result in significant cost in this population, with an expected increase as Medicare enrollment grows. We designed a pilot study based upon a partnership between a hospital and a local Meals on Wheels agency to support patients following an incident hospitalization to assess impact on hospital utilization. Patients from an urban medical center who were 60 years or older, had a prior hospitalization in the past 12 months, and had a diagnosis of diabetes, hypertension, heart failure, and/or chronic obstructive pulmonary disease were recruited. Meals on Wheels provided interventions over 3 months of the patient’s transition to home: food delivery, home safety inspection, social engagement, and medical supply allocation. Primary outcome was reduction of hospital expenditure. In regard to the results, 84 participants were included in the pilot cohort, with the majority (54) having COPD. Mean age was 74.9 ± 10.5 years; 33 (39.3%) were female; 62 (73.8%) resided in extreme socioeconomically disadvantaged neighborhoods. Total hospital expenditures while the cohort was enrolled in the transition program were $435,258 ± 113,423, a decrease as compared to $1,445,637 ± 325,433 (p < 0.01) of the cohort’s cost during the three months prior to enrollment. In conclusion, the initiative for patients with advanced chronic diseases resulted in a significant reduction of hospitalization expenditures. Further investigations are necessary to define the impact of this intervention on a larger cohort of patients as well as its generalizability across diverse geographic regions.
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Affiliation(s)
- Panagis Galiatsatos
- Office of Diversity and Inclusion, Johns Hopkins Health System, Baltimore, MD 21205, USA;
- Department of Medicine, Medicine for the Greater Good, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA; (A.A.); (W.D.H.)
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
- Correspondence: ; Tel.: +1-(410)-550-0522; Fax: +1-(410)-550-1094
| | - Adejoke Ajayi
- Department of Medicine, Medicine for the Greater Good, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA; (A.A.); (W.D.H.)
- Meals on Wheels, Baltimore, MD 21224, USA; (S.A.S.); (L.T.)
| | - Joyce Maygers
- Office of Population Health, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA;
| | | | | | - Sherita H. Golden
- Office of Diversity and Inclusion, Johns Hopkins Health System, Baltimore, MD 21205, USA;
- Departments of Medicine and Epidemiology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Richard G. Bennett
- Division of Geriatrics, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA;
- Office of the President, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA
| | - William Daniel Hale
- Department of Medicine, Medicine for the Greater Good, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA; (A.A.); (W.D.H.)
- Office of the President, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA
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18
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Grenier A, Burke E, Currie G, Watson S, Ward J. Social Isolation in Later Life: The Importance of Place, Disadvantage and Diversity. J Aging Soc Policy 2021; 34:471-495. [PMID: 33656413 DOI: 10.1080/08959420.2021.1886637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Social isolation among older people is a complex social problem and growing policy concern. This study investigated social isolation under the auspices of the Hamilton Senior Isolation Impact Plan, a government funded program in Canada. It situates the study of social isolation in a unique region of Ontario and involved 7 focus groups and 32 interviews with older people and stakeholders. Results outline how place and spatial relations can create and/or reinforce isolation; how addressing social isolation requires attention to the relationship between poverty, inequality and disadvantage; and how regional experiences of isolation may differ substantially from what is assumed, where diversity and the needs of particular sub-populations of older people are concerned. Findings highlight the need to broaden policy and practice efforts on social isolation to better include diverse groups of older people who may be poorly served by the agenda of connection alone.
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Affiliation(s)
- Amanda Grenier
- Professor, Norman and Honey Schipper Chair in Gerontological Social Work,Factor-Inwentash Faculty of Social Work, University of Toronto, Canada.,Senior Research Scientist, Baycrest's Rotman Research Institute, Toronto, Canada
| | - Equity Burke
- Researcher, Gilbrea Centre, McMaster University, Hamilton, Ontario, Canada
| | - Glenys Currie
- Researcher, Gilbrea Centre, McMaster University, Hamilton, Ontario, Canada
| | - Susannah Watson
- Researcher, Gilbrea Centre, McMaster University, Hamilton, Ontario, Canada
| | - Jonelle Ward
- Researcher, Gilbrea Centre, McMaster University, Hamilton, Ontario, Canada
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19
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Koo JH, Son N, Yoo KB. Relationship between the living-alone period and depressive symptoms among the elderly. Arch Gerontol Geriatr 2021; 94:104341. [PMID: 33497913 DOI: 10.1016/j.archger.2021.104341] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The study aims to understand the relationship between the living-alone period and depressive symptoms among the elderly in South Korea. METHODS The study obtained data on the elderly over 65 years old from the 2006 to 2019 Korea Welfare Panel Study. Generalized estimating equation (GEE) analysis was performed to understand changes in depressive symptoms over periods of living alone. Additional subgroup analysis of age and gender was conducted to observe differences. RESULTS A total 568 (19% of the study samples) elderly transitioned from living with others into a living-alone state. Males and females showed a significant increase in depressive symptoms as they started to live alone, which gradually decreased with prolonged periods of living alone. The result of the GEE analysis demonstrated high odds of depressive symptoms during the first (OR = 1.857; 95% CI: 1.492-2.310), second (OR = 1.414; 95% CI: 1.127-1.774), and third (OR = 1.413; 95% CI: 1.105-1.808) years of living alone compared with living with others. Regarding additional subgroup analysis, the female and old-old groups showed high odds of depressive symptoms in the first 3 years of living alone, whereas the male and young-old groups showed high odds for the first year only. CONCLUSIONS The study provides valuable insights into the relationship between the living-alone period and depressive symptoms among the elderly. Future research using the living-alone period on various social factors are recommended.
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Affiliation(s)
- Jun Hyuk Koo
- Yonsei Institute of Health and Welfare, Yonsei University, Wonju, South Korea; Department of Health Administration, Yonsei University Graduate School, Wonju, South Korea.
| | - Noorhee Son
- Department of Health Administration, Yonsei University Graduate School, Wonju, South Korea.
| | - Ki-Bong Yoo
- Department of Health Administration, Yonsei University Graduate School, Wonju, South Korea; Department of Information & Statistics, Yonsei University College of Science & Technology, Yonsei University, Wonju, South Korea.
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20
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Koren Y, Leveille S, You T. Tai Chi Interventions Promoting Social Support and Interaction Among Older Adults: A Systematic Review. Res Gerontol Nurs 2021; 14:126-137. [PMID: 34039148 PMCID: PMC9836824 DOI: 10.3928/19404921-20210325-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Tai chi is known to improve balance and reduce falls in older adults. Yet, little is known about the impact of group tai chi on perceived social support and its relationship with participant self-efficacy and adherence. The current systematic review, guided by Social Cognitive Theory and Successful Aging, includes an overview of tai chi interventions with and without enhancements (e.g., music, mentorship, group practice) that evaluated social support among their outcomes (N = 10). PubMed, CINAHL, and PsycINFO databases were searched for studies eligible under the inclusion criteria: sample population aged ≥60 years and published between 1999 and 2019. Four articles reported on tai chi interventions with specific enhancements to promote social interaction and reported increased perceived social support (p < 0.05). Six studies evaluated social support outcomes of tai chi programs without specific modifications to promote social engagement. Four of the six traditional tai chi intervention studies reported improved social support (p < 0.05). Group tai chi interventions for older adults may increase social support and therefore further increase health benefits of tai chi exercise among this population. [Research in Gerontological Nursing, 14(3), 126-137.].
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Affiliation(s)
- Yael Koren
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Suzanne Leveille
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Tongjian You
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
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21
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Roy-Desruisseaux J. Le suivi en première ligne sur une base volontaire : effets sur la patientèle en gérontopsychiatrie. CANADIAN JOURNAL OF BIOETHICS 2020. [DOI: 10.7202/1073545ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Au cours des dernières décennies, l’autonomie est devenue une valeur phare dans nos sociétés, consacrant la volonté des patients comme prémisse à l’accès aux soins et services en première ligne. Ainsi, dans le cas de patients refusant l’aide à domicile, la volonté de participer à une évaluation a souvent préséance aux besoins identifiés par les intervenants, aussi prégnants soient-ils. Pour la patientèle gérontopsychiatrique, cette position organisationnelle peut mener à plusieurs écueils, voire même à des situations risquées ou dangereuses. En effet, le refus de soins et services chez les ainés, fréquemment associé à des comportements d’autonégligence, peut évoluer jusqu’à une détérioration clinique, à l’hospitalisation ou même à la mort. Il est donc essentiel de s’intéresser aux motivations de ces choix faits par les ainés et d’adapter l’approche des intervenants face à ces situations. Le consentement aux soins est une démarche dialogique qui doit inclure l’explication des risques en cas de refus; aussi l’accès aux soins ne doit pas être limité à la moindre opposition sans engager une réflexion supplémentaire. Cet article décrit pourquoi des solutions concrètes doivent être activement recherchées pour nuancer la compréhension et l’application des valeurs d’autonomie et de protection auprès des ainés dans une prestation saine de soins et services, encore plus auprès de la patientèle vulnérable des patients vieillissants et souffrant de symptômes psychiques.
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Affiliation(s)
- Jessika Roy-Desruisseaux
- Département de psychiatrie, CIUSSS de l’Estrie – CHUS, Sherbrooke, Québec, Canada
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Kist N, van den Berg JF, Kok RM. Predicting rehospitalisation in older inpatients with a psychotic disorder. Int J Geriatr Psychiatry 2020; 35:1151-1155. [PMID: 32419240 DOI: 10.1002/gps.5337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/28/2020] [Accepted: 05/10/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The objective of this study was to predict rehospitalisation in a psychiatric clinic in older inpatients with a psychotic disorder. METHODS/DESIGN In this prospective, observational study, all eligible inpatients aged 55 years and over with a primary psychotic disorder, admitted to a specialised ward for older psychotic patients in a large psychiatric inpatient clinic in the Netherlands, were asked to participate. Whether or not patients were rehospitalised and time to rehospitalisation were assessed 1 year after discharge from the ward. We recorded age, gender, living arrangement, psychiatric diagnosis, severity of psychotic symptoms, duration of index episode, age of onset of psychotic disorder, number of previous admissions, involuntary admission and use of depot medication at discharge. All patients underwent a neuropsychological assessment. RESULTS Of the 90 patients that were included, 32 (35.6%) had been readmitted within 1 year after discharge. None of the demographic or clinical variables predicted rehospitalisation or the time to rehospitalisation. CONCLUSION Factors that predict rehospitalisationin younger adult patients with schizophrenia may not predict rehospitalisationin older patients with a psychotic disorder, of which the majority suffered from schizophrenia. We expect that other factors than those investigated may be of greater importance to predict rehospitalisation, as for example social support and coping mechanisms.
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Affiliation(s)
- Nicolien Kist
- Department of Old Age Psychiatry, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Julia F van den Berg
- Department of Old Age Psychiatry, Parnassia Psychiatric Institute, The Hague, The Netherlands.,Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Rob M Kok
- Department of Old Age Psychiatry, Parnassia Psychiatric Institute, The Hague, The Netherlands
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Kellezi B, Wakefield JRH, Stevenson C, McNamara N, Mair E, Bowe M, Wilson I, Halder MM. The social cure of social prescribing: a mixed-methods study on the benefits of social connectedness on quality and effectiveness of care provision. BMJ Open 2019; 9:e033137. [PMID: 31727668 PMCID: PMC6887058 DOI: 10.1136/bmjopen-2019-033137] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/20/2019] [Accepted: 10/18/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study aimed to assess the degree to which the 'social cure' model of psychosocial health captures the understandings and experiences of healthcare staff and patients in a social prescribing (SP) pathway and the degree to which these psychosocial processes predict the effect of the pathway on healthcare usage. DESIGN Mixed-methods: Study 1: semistructured interviews; study 2: longitudinal survey. SETTING An English SP pathway delivered between 2017 and 2019. PARTICIPANTS Study 1: general practitioners (GPs) (n=7), healthcare providers (n=9) and service users (n=19). Study 2: 630 patients engaging with SP pathway at a 4-month follow-up after initial referral assessment. INTERVENTION Chronically ill patients experiencing loneliness referred onto SP pathway and meeting with a health coach and/or link worker, with possible further referral to existing or newly created relevant third-sector groups. MAIN OUTCOME MEASURE Study 1: health providers and users' qualitative perspectives on the experience of the pathway and social determinants of health. Study 2: patients' primary care usage. RESULTS Healthcare providers recognised the importance of social factors in determining patient well-being, and reason for presentation at primary care. They viewed SP as a potentially effective solution to such problems. Patients valued the different social relationships they created through the SP pathway, including those with link workers, groups and community. Group memberships quantitatively predicted primary care usage, and this was mediated by increases in community belonging and reduced loneliness. CONCLUSIONS Methodological triangulation offers robust conclusions that 'social cure' processes explain the efficacy of SP, which can reduce primary care usage through increasing social connectedness (group membership and community belonging) and reducing loneliness. Recommendations for integrating social cure processes into SP initiatives are discussed.
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Affiliation(s)
| | | | | | | | | | - Mhairi Bowe
- Psychology, Nottingham Trent University, Nottingham, UK
| | - Iain Wilson
- Psychology, Nottingham Trent University, Nottingham, UK
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24
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Dietrich E, Davis K, Chacko L, Rahmanian KP, Bielick L, Quillen D, Feller D, Porter M, Malaty J, Carek PJ. Comparison of Factors Identified by Patients and Physicians Associated with Hospital Readmission (COMPARE2). South Med J 2019; 112:244-250. [PMID: 30943545 DOI: 10.14423/smj.0000000000000959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Factors contributing to hospital readmission have rarely been sought from the patient perspective. Furthermore, it is unclear how patients and physicians compare in identifying factors contributing to readmission. The objective of the study was to identify and compare factors contributing to hospital readmission identified by patients and physicians by surveying participants upon hospital readmission to a teaching medicine service. METHODS Patients 18 years and older who were discharged and readmitted to the same service within 30 days and the physicians caring for these patients were surveyed to identify factors contributing to readmission. Secondary outcomes included comparing responses between groups and determining level of agreement. Patients could be surveyed multiple times on subsequent readmissions; physicians could be surveyed for multiple patients. RESULTS A total of 131 patients and 37 physicians were consented. The mean patient age was 60.1 years (standard deviation 16.8 years) and 55.6% were female; 56.4% were white, and 42.1% were black/African American. In total, 179 patient surveys identified "multiple medical problems" (48.6%), "trouble completing daily activities" (45.8%), and "discharged too soon" (43.6%) most frequently as contributing factors; 231 physician surveys identified "multiple medical problems" (45.0%) and "medical condition too difficult to care for at home" (35.6%) most frequently as contributing factors. Paired survey results were available for 135 readmissions and showed fair agreement for only 1 factor but no agreement for 5 factors. CONCLUSIONS Patients identified previously unknown factors contributing to readmission. Little agreement existed between patients and physicians. Additional research is needed to determine how best to address patient-identified factors contributing to readmission.
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Affiliation(s)
- Eric Dietrich
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
| | - Kyle Davis
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
| | - Lisa Chacko
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
| | - Kiarash P Rahmanian
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
| | - Lauren Bielick
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
| | - David Quillen
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
| | - David Feller
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
| | - Maribeth Porter
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
| | - John Malaty
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
| | - Peter J Carek
- From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville
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Meshi D, Cotten SR, Bender AR. Problematic Social Media Use and Perceived Social Isolation in Older Adults: A Cross-Sectional Study. Gerontology 2019; 66:160-168. [PMID: 31522178 DOI: 10.1159/000502577] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/08/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Social isolation in older adults is associated with numerous adverse health outcomes. In today's digital society, if individuals perceive themselves to be socially isolated, they can take steps to interact with others on social media platforms. Research with younger adults indicates that social media use is positively linked to social isolation. However, less is known about social media use and social isolation in older adults. OBJECTIVE The objective of this study was to investigate the possible association between social isolation and degree of social media use in older adults. METHODS Using Internet sources, we recruited 213 participants (79.8% female; mean age 62.6 years, SD 8.3) who responded to an online survey focusing on living situation, depression, social isolation, and 2 measures of social media use: estimated daily time on social media and problematic social media use. Next, using binary logistic regression, we assessed associations between social isolation and social media use. RESULTS Our analyses failed to identify a relationship between perceived social isolation and estimated daily time on social media; however, higher problematic social media use was associated with higher perceived social isolation (OR 1.17). DISCUSSION AND CONCLUSION Although no causal attribution can be made, our findings demonstrate an association between problematic social media use and perceived social isolation in older adults. Researchers conducting social media interventions in older adults should note this potential and monitor maladaptive use of these platforms. Overall, our results provide an important starting point for future studies on social media use and social isolation in older adults.
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Affiliation(s)
- Dar Meshi
- Department of Advertising and Public Relations, Michigan State University, East Lansing, Michigan, USA,
| | - Shelia R Cotten
- Department of Media and Information, Michigan State University, East Lansing, Michigan, USA
| | - Andrew R Bender
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA.,Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan, USA
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Aoki T, Urushibara‐Miyachi Y. A qualitative study of socially isolated patients' perceptions of primary care. J Gen Fam Med 2019; 20:185-189. [PMID: 31516804 PMCID: PMC6732495 DOI: 10.1002/jgf2.262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/21/2019] [Accepted: 05/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although the previous quantitative study revealed that social isolation was negatively associated with patient experience of primary care, the underlying reasons for this phenomenon remain unclear. In the present study, we aimed to explore the reasons underlying the influence of social isolation on patient experience in the primary care setting. METHODS This study was a qualitative study and part of a mixed methods research. Semistructured telephone interviews were performed. We recruited participants among eligible participants in the previous quantitative survey who were classified as being socially isolated. Data were transcribed verbatim and analyzed thematically by two independent researchers until saturation was reached. RESULTS Eight socially isolated patients in the research were interviewed. In the thematic analysis, three major themes emerged as reasons underlying the influence of social isolation on patient experience of primary care: restriction of information about local primary care physicians, finding a usual primary care physician haphazardly, and superficial relationship with a usual primary care physician. CONCLUSIONS This study identified three major themes, which are beneficial to expand our understanding of socially isolated patients' perceptions of primary care. These findings can be used to improve patient experience of primary care in socially isolated patients.
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Affiliation(s)
- Takuya Aoki
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of MedicineKyoto UniversityKyotoJapan
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Choi HG, Yeom HA. [Experiences of Ego Integrity Recovery in Elderly Cancer Patients: Grounded Theory Approach]. J Korean Acad Nurs 2019; 49:349-360. [PMID: 31266931 DOI: 10.4040/jkan.2019.49.3.349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/20/2019] [Accepted: 05/13/2019] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was conducted to derive a substantive theory on lived experiences of elderly cancer patients. METHODS The data were collected from February to March 2018 through in-depth personal interviews with 14 elderly cancer patients. The collected data were analyzed based on Corbin and Strauss's grounded theory. RESULTS The core category was "the journey to find balance in daily lives as a cancer patient by recovering disturbed ego integrity." The core phenomenon was "shattered by suffering from cancer," and the causal conditions were "physical change" and "limitations in daily life." The contextual conditions were "decreased self-esteem," "feelings of guilt toward the family," and the sense of "economic burden." The participants' action and interaction strategies were "maintaining or avoiding social relations," "seeking meaning of the illness," "falling into despair," and "strengthening the willingness to battle the cancer." The intervening conditions were "support from health care providers and family," "dissatisfaction with health care providers," "spiritual help from religion," and "the improvement or worsening of health conditions." The consequences were "having a new insight for life," "living positively along with cancer illness," and "the loss of willingness to live." A summary of the series of processes includes the "crisis stage," "reorganizing stage," and the "ego integration stage." CONCLUSION This study explored the holistic process of ego integrity impairment and the recovery experience of elderly cancer patients. This study is expected to be used as a basis for the development of nursing interventions that can support patients when coping with all stages of their cancer illness trajectory.
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Affiliation(s)
- Han Gyo Choi
- College of Nursing, The Catholic University of Korea, Seoul, Korea
| | - Hye Ah Yeom
- College of Nursing, The Catholic University of Korea, Seoul, Korea.
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Cené CW, Frerichs L, Evans JK, Kroenke CH, Dilworth-Anderson P, Corbie-Smith G, Snively B, Naughton MJ, Shumaker S. A descriptive pilot study of structural and functional social network ties among women in the women's health initiative (WHI) study. J Women Aging 2019; 33:1-29. [PMID: 31177928 DOI: 10.1080/08952841.2019.1608138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Few studies examine the network structure and function of older women's health discussion networks. We sought to assess the feasibility and acceptability of collecting social network data via telephone from 72 women from the Women's Health Initiative study and to describe structural and functional characteristics. Women were socially connected and had dense networks. Women were emotionally close to network members, but their networks were not used to facilitate communication with health-care providers. One-third of network members was not influential on health-related decision-making. Collecting social network data via telephone is feasible and an acceptable, though un-preferred, mode of data collection.
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Affiliation(s)
- Crystal W Cené
- Department of Medicine, UNC School of Medicine , Chapel Hill, NC, USA
| | - Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health , Chapel Hill, NC, USA
| | - Joshua K Evans
- Wake Forest University School of Medicine , Winston-Salem, NC, USA
| | | | - Peggye Dilworth-Anderson
- Department of Health Policy and Management, Gillings School of Global Public Health , Chapel Hill, NC, USA
| | - Giselle Corbie-Smith
- Department of Medicine, UNC School of Medicine , Chapel Hill, NC, USA.,Department of Social Medicine, UNC School of Medicine , Chapel Hill, NC, USA
| | - Beverly Snively
- Department of Biostatistical Sciences, Wake Forest University School of Medicine , Winston-Salem, NC, USA
| | - Michelle J Naughton
- Department of Internal Medicine, Ohio State University College of Medicine , Columbus, OH, USA
| | - Sally Shumaker
- Social Sciences and Health Policy, Wake Forest University School of Medicine , Winston-Salem, NC, USA
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Lhussier M, Dalkin S, Hetherington R. Community care for severely frail older people: Developing explanations of how, why and for whom it works. Int J Older People Nurs 2019; 14:e12217. [PMID: 30592173 DOI: 10.1111/opn.12217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/15/2018] [Accepted: 11/19/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND A Community Wellness Team was implemented in North East England in 2014, in line with national policy directives to support frail older people in the community. The service provides a comprehensive and integrated care package, which aims to reduce avoidable admissions, inappropriate service use and enable patients to stay at home. DESIGN A realist design combining a review of the literature and primary data collection from service providers and patients was used to develop programme theories explaining the links between the Team interventions and expected outcomes. RESULTS Five programme theories were developed, detailing: trust development and relationship building; risk minimisation in the home environment; advice on self-management; referral to preventative services; and coordination of services. DISCUSSION The programme theories explain the role and impact of the Community Wellness Team. These programme theories are interrelated and impact one another; a hypothesised progression of programme theories indicating how the Community Wellness Team "works" is discussed. Of particular importance was the comprehensive initial assessment, which leads to the alteration of the social and physical environment within which older people live. CONCLUSION Severely frail older people present cases that are complex socially, medically, financially and environmentally. In order to meet these needs, the Team coordinators are adopting a complex and flexible person-centred approach. IMPLICATIONS FOR PRACTICE This study paves the way for further research into the care networks surrounding severely frail older people living in the community, and how they can most effectively be implemented.
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Affiliation(s)
- Monique Lhussier
- Faculty of Health and Life Sciences, Public Health and Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Sonia Dalkin
- Faculty of Health and Life Sciences, Public Health and Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Ross Hetherington
- Station View Medical Centre, Durham Dales Health Federation, Bishop Auckland, Co. Durham, UK
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Jones E, Bhui K, Engelbrecht A. The return of the traumatized army veteran: a qualitative study of UK ex-servicemen in the aftermath of war, 1945 to 2000. Int Rev Psychiatry 2019; 31:14-24. [PMID: 30997854 DOI: 10.1080/09540261.2019.1585767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The challenge of transition from service to civilian life is explored through the experiences of a sample of 225 UK army veterans between 1945 and 2000. All subjects had a war pension for a psychological disorder, and most had served overseas in combat roles. Statements about issues of adjustment and health were analyzed by the constant comparison method. Although 20 themes were identified, three ('anxiety, nerves and depression', 'enduring illness attributed to combat exposure', and 'illness interferes with the ability to find or keep employment') accounted for 46% of the total and were reported by between 53% and 86% of subjects. Consistency was observed in the ranking of themes over time. In content, they replicate those reported by veterans of recent conflicts, suggesting that the core issues of transition have an enduring quality. Most statements (66%) date from the 1940s, a time when the application process for a pension required the veteran to provide an explanation for his illness. A rise in the number of statements during the 1980s and 1990s reflected wider cultural acceptance of post-traumatic illness and veteran population entering retirement with time to reflect on defining experiences.
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Affiliation(s)
- Edgar Jones
- a Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience , King's College London , London , UK
| | - Kamaldeep Bhui
- b Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London , Queen Mary University of London , London , UK
| | - Alberta Engelbrecht
- a Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience , King's College London , London , UK
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Menec VH, Newall NE, Mackenzie CS, Shooshtari S, Nowicki S. Examining individual and geographic factors associated with social isolation and loneliness using Canadian Longitudinal Study on Aging (CLSA) data. PLoS One 2019; 14:e0211143. [PMID: 30707719 PMCID: PMC6358157 DOI: 10.1371/journal.pone.0211143] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/08/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND A large body of research shows that social isolation and loneliness have detrimental health consequences. Identifying individuals at risk of social isolation or loneliness is, therefore, important. The objective of this study was to examine personal (e.g., sex, income) and geographic (rural/urban and sociodemographic) factors and their association with social isolation and loneliness in a national sample of Canadians aged 45 to 85 years. METHODS The study involved cross-sectional analyses of baseline data from the Canadian Longitudinal Study on Aging that were linked to 2016 census data at the Forward Sortation Area (FSA) level. Multilevel logistic regression analyses were conducted to examine the association between personal factors and geographic factors and social isolation and loneliness for the total sample, and women and men, respectively. RESULTS The prevalence of social isolation and loneliness was 5.1% and 10.2%, respectively, but varied substantially across personal characteristics. Personal characteristics (age, sex, education, income, functional impairment, chronic diseases) were significantly related to both social isolation and loneliness, although some differences emerged in the direction of the relationships for the two measures. Associations also differed somewhat for women versus men. Associations between some geographic factors emerged for social isolation, but not loneliness. Living in an urban core was related to increased odds of social isolation, an effect that was no longer significant when FSA-level factors were controlled for. FSAs with a higher percentage of 65+ year old residents with low income were consistently associated with higher odds of social isolation. CONCLUSION The findings indicate that socially isolated individuals are, to some extent, clustered into areas with a high proportion of low-income older adults, suggesting that support and resources could be targeted at these areas. For loneliness, the focus may be less on where people live, but rather on personal characteristics that place individuals at risk.
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Affiliation(s)
- Verena H. Menec
- Department of Community Health Sciences, University of Manitoba, Manitoba, Canada
| | - Nancy E. Newall
- Department of Psychology, Brandon University, Manitoba, Canada
| | | | - Shahin Shooshtari
- Department of Community Health Sciences, University of Manitoba, Manitoba, Canada
| | - Scott Nowicki
- Department of Community Health Sciences, University of Manitoba, Manitoba, Canada
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Ha JH, Hougham GW, Meltzer DO. Risk of Social Isolation among Older Patients: What Factors Affect the Availability of Family, Friends, and Neighbors upon Hospitalization? Clin Gerontol 2019. [PMID: 29533159 DOI: 10.1080/07317115.2018.1447524] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To examine the prevalence of social isolation among older patients admitted to a hospital, and the effects of sociodemographic and health-related factors on the availability of their family, friends, and neighbor networks. METHODS Analyses are based on interviews with a sample of 2,449 older patients admitted to an urban academic medical center in the United States. A nine-item version of Lubben's Social Network Scale was developed and used to assess the availability of different social networks. RESULTS About 47% of the sample was at risk of social isolation. The oldest old and non-White older adults showed greater risk. The availability of family networks was associated with age, sex, marital status, and prior hospitalization; friend networks with age, race, education, prior hospitalization, and functional limitations; neighbor networks with race, education, marital status, and functional limitations. CONCLUSIONS The risk of social isolation and the availability of social support for hospitalized older adults varies by both patient and network characteristics. Health professionals should attend to this risk and the factors associated with such risk. CLINICAL IMPLICATIONS By assessing the availability of various types and frequency of support among older patients, health professionals can better identify those who may need additional support after discharge. Such information should be used in discharge planning to help prevent unnecessary complications and potential readmission.
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Affiliation(s)
- Jung-Hwa Ha
- a Department of Social Welfare and Center for Social Sciences , Seoul National University , Seoul , South Korea
| | - Gavin W Hougham
- b Advanced Analytics and Health Research , Battelle Memorial Institute , Columbus , Ohio , USA
| | - David O Meltzer
- c Department of Medicine , University of Chicago , Chicago , Illinois , USA
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Wilson G, Hill M, Kiernan MD. Loneliness and social isolation of military veterans: systematic narrative review. Occup Med (Lond) 2018; 68:600-609. [DOI: 10.1093/occmed/kqy160] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G Wilson
- Faculty of Health and Life Sciences, Department of Nursing, Midwifery and Health, Northern Hub for Veterans and Military Families’ Research, Northumbria University, Newcastle-upon-Tyne, UK
| | - M Hill
- Faculty of Health and Life Sciences, Department of Nursing, Midwifery and Health, Northern Hub for Veterans and Military Families’ Research, Northumbria University, Newcastle-upon-Tyne, UK
| | - M D Kiernan
- Faculty of Health and Life Sciences, Department of Nursing, Midwifery and Health, Northern Hub for Veterans and Military Families’ Research, Northumbria University, Newcastle-upon-Tyne, UK
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Aoki T, Yamamoto Y, Ikenoue T, Urushibara-Miyachi Y, Kise M, Fujinuma Y, Fukuhara S. Social Isolation and Patient Experience in Older Adults. Ann Fam Med 2018; 16:393-398. [PMID: 30201635 PMCID: PMC6130989 DOI: 10.1370/afm.2257] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/27/2018] [Accepted: 03/22/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Social isolation has been identified as a major health problem, particularly in the elderly. In the present study, we examine the association between social isolation and patient experience in elderly primary care patients. METHODS This cross-sectional study was conducted in a primary care practice-based research network (28 clinics) in Japan. We assessed social isolation using an abbreviated Lubben Social Network Scale and patient experience of primary care using a Japanese version of the Primary Care Assessment Tool (JPCAT), which comprises 6 domains: first contact, longitudinality, coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. We used a linear mixed effects model to adjust clustering within clinics and individual covariates. RESULTS Data were analyzed for 465 elderly primary care patients aged ≥65 years. After adjustment for possible confounders and clustering within clinics, social isolation was negatively associated with the JPCAT total score, (mean difference = -3.67; 95% CI, -7.00 to -0.38). Among the JPCAT domain scores, social isolation was significantly associated with longitudinality, comprehensiveness (service provided), and community orientation scores. CONCLUSIONS Social isolation was associated with negative patient experience in elderly primary care patients. Raising awareness regarding patient social networks among primary care providers and targeted interventions for socially isolated elderly patients aimed at improving the experience of primary care, especially regarding longitudinality, comprehensiveness, and community orientation, may be warranted.
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Affiliation(s)
- Takuya Aoki
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuyoshi Ikenoue
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Morito Kise
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
| | - Yasuki Fujinuma
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan .,Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan
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Lowthian JA, Lennox A, Curtis A, Wilson G, Rosewarne C, Smit DV, O'Brien D, Browning CJ, Boyd L, Smith C, Cameron P, Dale J. HOspitals and patients WoRking in Unity ( HOW R U?): telephone peer support to improve older patients' quality of life after emergency department discharge in Melbourne, Australia-a multicentre prospective feasibility study. BMJ Open 2018; 8:e020321. [PMID: 29903788 PMCID: PMC6009511 DOI: 10.1136/bmjopen-2017-020321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 05/04/2018] [Accepted: 05/14/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To ascertain the feasibility and acceptability of the HOW R U? programme, a novel volunteer-peer postdischarge support programme for older patients after discharge from the emergency department (ED). DESIGN A multicentre prospective mixed-methods feasibility study. SETTING Two tertiary hospital EDs in metropolitan Melbourne, Australia. PARTICIPANTS A convenience sample of 39 discharged ED patients aged 70 years or over, with symptoms of social isolation, loneliness and/or depression. INTERVENTION The HOW R U? intervention comprised weekly social support telephone calls delivered by volunteer peers for 3 months following ED discharge. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were feasibility of study processes, intervention acceptability to participants and retention in the programme. Secondary outcomes were changes in loneliness level (UCLA-3-3-item Loneliness Scale), mood (5-item Geriatric Depression Scale) and health-related quality of life (EQ-5D-5L and EQ-VAS) postintervention. RESULTS Recruitment was feasible, with 30% of eligible patients successfully recruited. Seventeen volunteer peers provided telephone support to patient participants, in addition to their usual hospital volunteer role. HOW R U? was well received, with 87% retention in the patient group, and no attrition in the volunteer group.The median age of patients was 84 years, 64% were female, and 82% lived alone. Sixty-eight per cent of patients experienced reductions in depressive symptoms, and 53% experiencing reduced feelings of loneliness, and these differences were statistically significant Patient feedback was positive and volunteers reported great satisfaction with their new role. CONCLUSION HOW R U? was feasible in terms of recruitment and retention and was acceptable to both patients and volunteers. The overall results support the potential for further research in this area and provide data to support the design of a definitive trial to confirm the observed effects. TRIAL REGISTRATION NUMBER ANZCTRN12615000715572; Results.
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Affiliation(s)
- Judy A Lowthian
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Bolton Clarke Research Institute, Melbourne, Victoria, Australia
| | - Alyse Lennox
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrea Curtis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gillian Wilson
- Volunteer Services, Alfred Health, Melbourne, Victoria, Australia
| | - Cate Rosewarne
- Volunteer Services, Cabrini Health, Malvern, Victoria, Australia
| | - De Villiers Smit
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
| | | | - Colette Joy Browning
- Shenzhen International Institute for Primary Health Care Research, Shenzhen, China
- Australian National University, Canberra, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Lee Boyd
- Nursing Services and Cabrini Institute, Cabrini Health, Malvern, Australia
| | | | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
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Pool MS, Agyemang CO, Smalbrugge M. Interventions to improve social determinants of health among elderly ethnic minority groups: a review. Eur J Public Health 2018; 27:1048-1054. [PMID: 29095995 DOI: 10.1093/eurpub/ckx178] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Like the European general population, ethnic minorities are aging. In this group, important social determinants of health (social participation, social isolation and loneliness) that lead to negative health outcomes frequently occur. Interventions targeting these determinants may decrease negative health outcomes. The goal of this article was to identify effective interventions that improve social participation, and minimise social isolation and loneliness in community dwelling elderly ethnic minorities. Methods An electronic database (PubMed) was systematically searched using an extensive search strategy, for intervention studies in English, French, Dutch of German, without time limit. Additional articles were found using references. Articles were included if they studied an intervention aimed to improve social participation or minimise social isolation or loneliness and were focusing on community dwelling elderly ethnic minorities. Data regarding studies characteristics and results were extracted. Results Six studies (three randomized controlled trials, three non-controlled intervention studies) were included in the review. All studies were group-based interventions and had a theoretical basis. Five out of six studies showed improvement on a social participation, -isolation or loneliness outcome. Type of intervention included volunteering-, educational- and physical activities. In three studies active participation of the participant was required, these interventions were not more effective than other interventions. Conclusion Some interventions improved the included social determinants of health in community dwelling elderly ethnic minorities. Investment in further development and implementation of these interventions may help to improve social determinants of health in these populations. It is necessary to evaluate these interventions in the European setting.
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Affiliation(s)
- Michelle S Pool
- Zorgbalans, elderly care organisation, Haarlem, the Netherlands.,Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - Charles O Agyemang
- Department of Public Health, Amsterdam Medical Centre, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
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Lowthian JA, Arendts G, Strivens E. Australian recommendations for the integration of emergency care for older people: Consensus Statement. Australas J Ageing 2018; 37:224-226. [PMID: 29732736 DOI: 10.1111/ajag.12535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Management of older patients during acute illness or injury does not occur in isolation in emergency departments. We aimed to develop a collaborative Consensus Statement to enunciate principles of integrated emergency care. METHODS Briefing notes, informed by research and evidence reviews, were developed and evaluated by a Consensus Working Party comprising cross-specialty representation from clinical experts, service providers, consumers and policymakers. The Consensus Working Party then convened to discuss and develop the statement's content. A subcommittee produced a draft, which was reviewed and edited by the Consensus Working Party. RESULTS Consensus was reached after three rounds of discussion, with 12 principles and six recommendations for how to follow these principles, including an integrated care framework for action. CONCLUSION Dissemination will encourage stakeholders and associated policy bodies to embrace the principles and priorities for action, potentially leading to collaborative work practices and improvement of care during and after acute illness or injury.
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Affiliation(s)
- Judy A Lowthian
- Bolton Clarke Research Institute, Bolton Clarke, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Glenn Arendts
- Department of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Edward Strivens
- Older Persons and Subacute Services, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
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Social Isolation, Physical Capacity, and Physical Activity in Older Community-Dwelling Adults Post-Hospitalization. J Aging Phys Act 2018; 26:204-213. [PMID: 28657813 DOI: 10.1123/japa.2016-0257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper investigated the potential relationships between physical capacity and physical activity (recreational and household) with social isolation amongst older adults. Data for hospitalized Victorians (n = 311) were analyzed in univariable, multivariable and latent growth curve analyses over six months. Measures included items from the Friendship Scale, Lubben Social Network Scale (LSNS-6), Australian Survey of Disability, Ageing and Carers Household (SDAC), and Phone-FITT. Over six months, improvements in physical capacity were related to reduced social isolation (-0.65, CI = -1.21, -0.09). Increased total (0.02, CI = 0.004, 0.04) and household-based physical activity (0.03, CI = 0.001, 0.06) were related to contact with more relatives. Higher baseline household-based physical activity was related to contact with fewer relatives (-0.01, CI = -0.02, -0.001). Along with physical capacity and activity, household-based physical activity appears to be strongly related to social isolation. Further research is required to determine the direction of relationships, to provide evidence for effective interventions.
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Valtorta NK, Moore DC, Barron L, Stow D, Hanratty B. Older Adults' Social Relationships and Health Care Utilization: A Systematic Review. Am J Public Health 2018; 108:e1-e10. [PMID: 29470115 DOI: 10.2105/ajph.2017.304256] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Deficiencies in older people's social relationships (including loneliness, social isolation, and low social support) have been implicated as a cause of premature mortality and increased morbidity. Whether they affect service use is unclear. OBJECTIVES To determine whether social relationships are associated with older adults' use of health services, independently of health-related needs. SEARCH METHODS We searched 8 electronic databases (MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, Scopus, the Cochrane Library, and the Centre for Reviews and Dissemination) for data published between 1983 and 2016. We also identified relevant sources from scanning the reference lists of included studies and review articles, contacting authors to identify additional studies, and searching the tables of contents of key journals. SELECTION CRITERIA Studies met inclusion criteria if more than 50% of participants were older than 60 years or mean age was older than 60 years; they included a measure of social networks, received social support, or perceived support; and they reported quantitative data on the association between social relationships and older adults' health service utilization. DATA COLLECTION AND ANALYSIS Two researchers independently screened studies for inclusion. They extracted data and appraised study quality by using standardized forms. In a narrative synthesis, we grouped the studies according to the outcome of interest (physician visits, hospital admissions, hospital readmissions, emergency department use, hospital length of stay, utilization of home- and community-based services, contact with general health services, and mental health service use) and the domain of social relationships covered (social networks, received social support, or perceived support). For each service type and social relationship domain, we assessed the strength of the evidence across studies according to the quantity and quality of studies and consistency of findings. MAIN RESULTS The literature search retrieved 26 077 citations, 126 of which met inclusion criteria. Data were reported across 226 678 participants from 19 countries. We identified strong evidence of an association between weaker social relationships and increased rates of readmission to hospital (75% of high-quality studies reported evidence of an association in the same direction). In evidence of moderate strength, according to 2 high-quality and 3 medium-quality studies, smaller social networks were associated with longer hospital stays. When we considered received and perceived social support separately, they were not linked to health care use. Overall, the evidence did not indicate that older patients with weaker social relationships place greater demands on ambulatory care (including physician visits and community- or home-based services) than warranted by their needs. AUTHORS' CONCLUSIONS Current evidence does not support the view that, independently of health status, older patients with lower levels of social support place greater demands on ambulatory care. Future research on social relationships would benefit from a consensus on clinically relevant concepts to measure. Public Health Implications. Our findings are important for public health because they challenge the notion that lonely older adults are a burden on all health and social care services. In high-income countries, interventions aimed at reducing social isolation and loneliness are promoted as a means of preventing inappropriate service use. Our review cautions against assuming that reductions in care utilization can be achieved by intervening to strengthen social relationships.
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Affiliation(s)
- Nicole K Valtorta
- Nicole K. Valtorta, Lynn Barron, Daniel Stow, and Barbara Hanratty are with the Institute of Health and Society/Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom. Danielle Collingridge Moore is with the International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
| | - Danielle Collingridge Moore
- Nicole K. Valtorta, Lynn Barron, Daniel Stow, and Barbara Hanratty are with the Institute of Health and Society/Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom. Danielle Collingridge Moore is with the International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
| | - Lynn Barron
- Nicole K. Valtorta, Lynn Barron, Daniel Stow, and Barbara Hanratty are with the Institute of Health and Society/Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom. Danielle Collingridge Moore is with the International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
| | - Daniel Stow
- Nicole K. Valtorta, Lynn Barron, Daniel Stow, and Barbara Hanratty are with the Institute of Health and Society/Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom. Danielle Collingridge Moore is with the International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
| | - Barbara Hanratty
- Nicole K. Valtorta, Lynn Barron, Daniel Stow, and Barbara Hanratty are with the Institute of Health and Society/Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom. Danielle Collingridge Moore is with the International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
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40
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Robins LM, Hill KD, Finch CF, Clemson L, Haines T. The association between physical activity and social isolation in community-dwelling older adults. Aging Ment Health 2018; 22:175-182. [PMID: 27736192 DOI: 10.1080/13607863.2016.1242116] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Social isolation is an increasing concern in older community-dwelling adults. There is growing need to determine effective interventions addressing social isolation. This study aimed to determine whether a relationship exists between physical activity (recreational and/or household-based) and social isolation. An examination was conducted for whether group- or home-based falls prevention exercise was associated with social isolation. METHODS Cross-sectional analysis of telephone survey data was used to investigate relationships between physical activity, health, age, gender, living arrangements, ethnicity and participation in group- or home-based falls prevention exercise on social isolation. Univariable and multivariable ordered logistic regression analyses were conducted. RESULTS Factors found to be significantly associated with reduced social isolation in multivariable analysis included living with a partner/spouse, reporting better general health, higher levels of household-based physical activity (OR = 1.03, CI = 1.01-1.05) and feeling less downhearted/depressed. Being more socially isolated was associated with symptoms of depression and a diagnosis of congestive heart failure (pseudo R2 = 0.104). DISCUSSION Findings suggest that household-based physical activity is related to social isolation in community-dwelling older adults. Further research is required to determine the nature of this relationship and to investigate the impact of group physical activity interventions on social isolation.
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Affiliation(s)
- Lauren M Robins
- a Faculty of Medicine, Nursing and Health Sciences Department of Physiotherapy , Monash University , Melbourne , Australia.,b Allied Health Research Unit (AHRU), Kingston Centre , Monash Health , Melbourne Australia
| | - Keith D Hill
- c School of Physiotherapy and Exercise Science, Faculty of Health Sciences , Curtin University , Perth , Australia
| | - Caroline F Finch
- d Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) , Federation University , Ballarat , Australia
| | - Lindy Clemson
- e Ageing, Work & Health Research Unit, Faculty of Health Sciences , The University of Sydney , Sydney , Australia
| | - Terry Haines
- b Allied Health Research Unit (AHRU), Kingston Centre , Monash Health , Melbourne Australia.,f Faculty of Medicine, Nursing and Health Sciences, Department of Physiotherapy, Southern Physiotherapy Clinical School , Monash University , Melbourne , Australia
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Abstract
RÉSUMÉAvec le vieillissement de la population canadienne, l’isolement social des personnes âgées constitue une préoccupation croissante et une priorité d’action au niveau national. Bien que les risques individuels de l’isolement social des personnes âgées et les conséquences négatives sur leur santé soient relativement bien connus, les impacts des trajectoires de vie et des expériences collectives sont rarement considérés. Les définitions actuelles et les réponses à cet isolement social se basent sur des programmes qui tendent à privilégier les approches individuelles. Ici nous proposons que la discussion soit élargie afin de considérer les aspects sociaux et culturels de l’isolement social des personnes âgées. En particulier, nous suggérons que les définitions et les approches prennent en compte trois dimensions : les facteurs temporels, les facteurs spatiaux et les liens entre l’isolement social et l’exclusion. Ainsi, nous pensons qu’il serait possible d’élaborer une approche d’intervention plus inclusive face à l’isolement social des personnes âgées, et de développer les capacités en ce sens chez un plus grand nombre d’aînés, en vue de pouvoir répondre, en particulier, aux besoins des personnes âgées les plus vulnérables ou marginalisées.
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Alpert PT. Self-perception of Social Isolation and Loneliness in Older Adults. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2017. [DOI: 10.1177/1084822317728265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There are a large group of older individuals suffering from social isolation and loneliness; in fact, the number of older adults affected is increasing due to the large aging population worldwide. Within the United States, the baby boomers are or will be potentially facing social isolation and loneliness in great numbers. The current research literature in this area is difficult to interpret because the variable used to define social isolation and loneliness varies across disciplines when looking at this problem. Intervention research has also produced mixed findings. This article looks at this public health issue by reviewing some of the research in this area and discussing potential interventions.
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Hand C, Retrum J, Ware G, Iwasaki P, Moaalii G, Main DS. Understanding Social Isolation Among Urban Aging Adults: Informing Occupation-Based Approaches. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2017; 37:188-198. [PMID: 28856958 DOI: 10.1177/1539449217727119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Socially isolated aging adults are at risk of poor health and well-being. Occupational therapy can help address this issue; however, information is needed to guide such work. National surveys characterize social isolation in populations of aging adults but fail to provide meaningful information at a community level. The objective of this study is to describe multiple dimensions of social isolation and related factors among aging adults in diverse urban neighborhoods. Community-based participatory research involving a door-to-door survey of adults 50 years and older was used. Participants ( N = 161) reported social isolation in terms of small social networks (24%) and wanting more social engagement (43%). Participants aged 50 to 64 years reported the highest levels of isolation in most dimensions. Low income, poor health, lack of transportation, and infrequent information access appeared linked to social isolation. Occupational therapists can address social isolation in similar urban communities through policy and practice that facilitate social engagement and network building.
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Affiliation(s)
- Carri Hand
- 1 University of Western Ontario, London, Canada
| | | | - George Ware
- 3 Taking Neighborhood Health to Heart, Inc., Denver, CO, USA
| | | | - Gabe Moaalii
- 4 Tacoma-Pierce County Health Department, WA, USA
| | - Deborah S Main
- 3 Taking Neighborhood Health to Heart, Inc., Denver, CO, USA.,5 University of Colorado Denver, USA
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Lewis E, Samperi S, Boyd-Skinner C. Telephone follow-up calls for older patients after hospital discharge. Age Ageing 2017; 46:544-546. [PMID: 28104599 DOI: 10.1093/ageing/afw251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 12/23/2016] [Indexed: 11/13/2022] Open
Abstract
Population ageing poses many challenges. Recurrent readmission to hospital by frail older people places a strain on health systems and the individual. Registered nurses with experience in emergency department, ICU and aged care conducted telephone follow-up calls to patients or bereaved family members after an acute hospital admission. During follow-up calls, many patients reported feelings of loneliness and social isolation post-discharge. It was also found that patients may not be aware of support services available in the community. Telephone follow-up calls after discharge is a potentially cost-effective strategy to identify these patients and potentially provide comfort and timely referrals where needed.
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Affiliation(s)
- Ebony Lewis
- The Simpson Centre for Health Services Research, the University of New South Wales, SWS Clinical School and the Ingham Institute for Applied Medical Research, New South Wales, Australia
| | - Sarah Samperi
- The Simpson Centre for Health Services Research, the University of New South Wales, SWS Clinical School and the Ingham Institute for Applied Medical Research, New South Wales, Australia
| | - Christopher Boyd-Skinner
- The Simpson Centre for Health Services Research, the University of New South Wales, SWS Clinical School and the Ingham Institute for Applied Medical Research, New South Wales, Australia
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Courtin E, Knapp M. Social isolation, loneliness and health in old age: a scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:799-812. [PMID: 26712585 DOI: 10.1111/hsc.12311] [Citation(s) in RCA: 626] [Impact Index Per Article: 89.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 05/17/2023]
Abstract
The health and well-being consequences of social isolation and loneliness in old age are increasingly being recognised. The purpose of this scoping review was to take stock of the available evidence and to highlight gaps and areas for future research. We searched nine databases for empirical papers investigating the impact of social isolation and/or loneliness on a range of health outcomes in old age. Our search, conducted between July and September 2013 yielded 11,736 articles, of which 128 items from 15 countries were included in the scoping review. Papers were reviewed, with a focus on the definitions and measurements of the two concepts, associations and causal mechanisms, differences across population groups and interventions. The evidence is largely US-focused, and loneliness is more researched than social isolation. A recent trend is the investigation of the comparative effects of social isolation and loneliness. Depression and cardiovascular health are the most often researched outcomes, followed by well-being. Almost all (but two) studies found a detrimental effect of isolation or loneliness on health. However, causal links and mechanisms are difficult to demonstrate, and further investigation is warranted. We found a paucity of research focusing on at-risk sub-groups and in the area of interventions. Future research should aim to better link the evidence on the risk factors for loneliness and social isolation and the evidence on their impact on health.
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Affiliation(s)
- Emilie Courtin
- London School of Economics and Political Science, Personal Social Services Research Unit, London, UK
| | - Martin Knapp
- London School of Economics and Political Science, Personal Social Services Research Unit, London, UK
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Banbury A, Chamberlain D, Nancarrow S, Dart J, Gray L, Parkinson L. Can videoconferencing affect older people's engagement and perception of their social support in long-term conditions management: a social network analysis from the Telehealth Literacy Project. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:938-950. [PMID: 27573127 DOI: 10.1111/hsc.12382] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 06/06/2023]
Abstract
Social support is a key component in managing long-term conditions. As people age in their homes, there is a greater risk of social isolation, which can be ameliorated by informal support networks. This study examined the relationship between changes in social support networks for older people living in a regional area following weekly videoconference groups delivered to the home. Between February and June 2014, we delivered 44 weekly group meetings via videoconference to participants in a regional town in Australia. The meetings provided participants with education and an opportunity to discuss health issues and connect with others in similar circumstances. An uncontrolled, pre-post-test methodology was employed. A social network tool was completed by 45 (87%) participants either pre- or post-intervention, of which 24 (46%) participants completed the tool pre- and post-intervention. In addition, 14 semi-structured interviews and 4 focus groups were conducted. Following the intervention, participants identified increased membership of their social networks, although they did not identify individuals from the weekly videoconference groups. The most important social support networks remained the same pre- and post-intervention namely, health professionals, close family and partners. However, post-intervention participants identified friends and wider family as more important to managing their chronic condition compared to pre-intervention. Participants derived social support, in particular, companionship, emotional and informational support as well as feeling more engaged with life, from the weekly videoconference meetings. Videoconference education groups delivered into the home can provide social support and enhance self-management for older people with chronic conditions. They provide the opportunity to develop a virtual social support network containing new and diverse social connections.
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Affiliation(s)
- Annie Banbury
- Human Health and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Daniel Chamberlain
- School of Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Susan Nancarrow
- School of Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Jared Dart
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Len Gray
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Lynne Parkinson
- Human Health and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
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Sixsmith J, Fang ML, Woolrych R, Canham SL, Battersby L, Sixsmith A. Ageing well in the right place: partnership working with older people. ACTA ACUST UNITED AC 2017. [DOI: 10.1108/wwop-01-2017-0001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The provision of home and community supports can enable people to successfully age-in-place by improving physical and mental health, supporting social participation and enhancing independence, autonomy and choice. One challenge concerns the integration of place-based supports available as older people transition into affordable housing. Sustainable solutions need to be developed and implemented with the full involvement of communities, service organizations and older people themselves. Partnership building is an important component of this process. The purpose of this paper is to detail the intricacies of developing partnerships with low-income older people, local service providers and nonprofit housing associations in the context of a Canadian housing development.
Design/methodology/approach
A community-based participatory approach was used to inform the data collection and partnership building process. The partnership building process progressed through a series of democratized committee meetings based on the principles of appreciative inquiry, four collaboration cafés with nonprofit housing providers and four community mapping workshops with low-income older people. Data collection also involved 25 interviews and 15 photovoice sessions with the housing tenants. The common aims of partnership and data collection were to understand the challenges and opportunities experienced by older people, service providers and nonprofit housing providers; identify the perspectives of service providers and nonprofit housing providers for the provision and delivery of senior-friendly services and resources; and determine actions that can be undertaken to better meet the needs of service providers and nonprofit housing providers in order to help them serve older people better.
Findings
The partnership prioritized the generation of a shared vision together with shared values, interests and the goal of co-creating meaningful housing solutions for older people transitioning into affordable housing. Input from interviews and photovoice sessions with older people provided material to inform decision making in support of ageing well in the right place. Attention to issues of power dynamics and knowledge generation and feedback mechanisms enable all fields of expertise to be taken into account, including the experiential expertise of older residents. This resulted in functional, physical, psychological and social aspects of ageing in place to inform the new build housing complex.
Research limitations/implications
The time and effort required to conduct democratized partnerships slowed the decision-making process.
Originality/value
The findings confirm that the drive toward community partnerships is a necessary process in supporting older people to age well in the right place. This requires sound mechanisms to include the voice of older people themselves alongside other relevant stakeholders. Ageing well in a housing complex requires meaningful placemaking to include the functional, physical, psychological and social aspects of older people’s everyday life in respect to both home and community.
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Smith-Carrier T, Sinha SK, Nowaczynski M, Akhtar S, Seddon G, Pham TNT. It 'makes you feel more like a person than a patient': patients' experiences receiving home-based primary care (HBPC) in Ontario, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:723-733. [PMID: 27287281 DOI: 10.1111/hsc.12362] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/28/2016] [Indexed: 06/06/2023]
Abstract
The lack of effective systems to appropriately manage the health and social care of frail older adults - especially among those who become homebound - is becoming all the more apparent. Home-based primary care (HBPC) is increasingly being promoted as a promising model that takes into account the accessibility needs of frail older adults, ensuring that they receive more appropriate primary and community care. There remains a paucity of literature exploring patients' experiences with HBPC programmes. The purpose of this study was to explore the experiences of patients accessing HBPC delivered by interprofessional teams, and their perspectives on the facilitators and barriers to this model of care in Ontario, Canada. Using certain grounded theory principles, we conducted an inductive qualitative content analysis of in-depth patient interviews (n = 26) undertaken in the winter of 2013 across seven programme sites exploring the lived experiences and perspectives of participants receiving HBPC. Themes emerged in relation to patients' perceptions regarding the preference for and necessity of HBPC, the promotion of better patient care afforded by the model in comparison to office-based care, and the benefits of and barriers to HBPC service provision. Underlying patterns also surfaced related to patients' feelings and emotions about their quality of life and satisfaction with HBPC services. We argue that HBPC is well positioned to serve frail homebound older adults, ensuring that patients receive appropriate primary and community care - which the office-based alternative provides little guarantee - and that they will be cared for, pointing to a model that may not only lead to greater patient satisfaction but also likely contributes to bettering the quality of life of a highly vulnerable population.
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Affiliation(s)
- Tracy Smith-Carrier
- School of Social Work, King's University College at Western University, London, Ontario, Canada
| | - Samir K Sinha
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Johns Hopkins University School of Medicine, Balitmore, Maryland, USA
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mark Nowaczynski
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- House Calls: Interdisciplinary Healthcare for Homebound Seniors, SPRINT Senior Care, Toronto, Ontario, Canada
| | - Sabrina Akhtar
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Home-Based Care Program, Toronto Western Family Health Team, Toronto, Ontario, Canada
| | - Gayle Seddon
- Toronto Central Community Care Access Centre, Toronto, Ontario, Canada
| | - Thuy-Nga Tia Pham
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- South East Toronto Family Health Team, Toronto, Ontario, Canada
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Lowthian JA, Lennox A, Curtis A, Dale J, Browning C, Smit DV, Wilson G, O'Brien D, Rosewarne C, Boyd L, Garner C, Cameron P. HOspitals and patients WoRking in Unity (HOW R U?): protocol for a prospective feasibility study of telephone peer support to improve older patients' quality of life after emergency department discharge. BMJ Open 2016; 6:e013179. [PMID: 27913561 PMCID: PMC5168602 DOI: 10.1136/bmjopen-2016-013179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 11/10/2016] [Accepted: 11/14/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Older people presenting to an emergency department (ED) have a higher likelihood of social isolation, loneliness and depression; which are all associated with negative health outcomes and increased health service use, including higher rates of ED attendance. The HOW R U? study aims to ascertain the feasibility and acceptability of a postdischarge telephone support programme for older ED patients following discharge. The intervention, which aims to improve quality of life, will be delivered by hospital-based volunteers. METHODS AND ANALYSIS A multicentre prospective uncontrolled feasibility study will enrol 50 community-dwelling patients aged ≥70 years with symptoms of loneliness or depression who are discharged home within 72 hours from the ED or acute medical ward. Participants will receive weekly supportive telephone calls over a 3-month period from a volunteer-peer. Feasibility will be assessed in terms of recruitment, acceptability of the intervention to participants and level of retention in the programme. Changes in level of loneliness (UCLA-3 item Loneliness Scale), mood (Geriatric Depression Scale-5 item) and health-related quality of life (EQ-5D-5L and EQ-VAS) will also be measured postintervention (3 months). ETHICS AND DISSEMINATION Research ethics and governance committee approval has been granted for this study by each participating centre (reference: 432/15 and 12-09-11-15). Study findings will inform the design and conduct of a future multicentre randomised controlled trial of a postdischarge volunteer-peer telephone support programme to improve social isolation, loneliness or depressive symptoms in older patients. Results will be disseminated through peer-reviewed journal publication, and conference and seminar presentation. TRIAL REGISTRATION NUMBER ACTRN12615000715572, Pre-results.
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Affiliation(s)
- Judy A Lowthian
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alyse Lennox
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrea Curtis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Colette Browning
- RDNS Institute, RDNS, Melbourne, Victoria, Australia
- International Institute for Primary Health Care Research, Shenzhen, China
- School of Primary Health Care, Monash University, Melbourne, Victoria, Australia
| | - De Villiers Smit
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Gillian Wilson
- Volunteer Services, Alfred Health, Melbourne, Victoria, Australia
| | - Debra O'Brien
- Emergency Department, Cabrini Health, Malvern, Victoria, Australia
| | - Cate Rosewarne
- Volunteer Services, Cabrini Health, Malvern, Victoria, Australia
| | - Lee Boyd
- Nursing Services, Cabrini Institute, Cabrini Health, Malvern, Victoria, Australia
| | - Cath Garner
- Department of Mission and Strategy, Cabrini Health, Malvern, Victoria,
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
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Levin KA, Crighton EM. Reshaping Care for Older People: Trends in emergency admissions to hospital during a period of simultaneous interventions in Glasgow City, April 2011–March 2015. Maturitas 2016; 94:92-97. [DOI: 10.1016/j.maturitas.2016.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 08/22/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
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