Risk factors for social isolation in post-hospitalized older adults

Social isolation and loneliness in non-communicable chronic diseases: Impact of COVID-19 pandemic, population aging and technological progress

AIMS

Social isolation and loneliness have increasingly emerged as closely linked to onset and progression of non-communicable chronic diseases (NCDs). The aim of this review is to highlight the importance of addressing social isolation in the prevention and management of NCDs such as obesity, type 2 diabetes, and cardiovascular diseases in order to hinder their development and improve their outcomes.

DATA SYNTHESIS

Social isolation and loneliness affect a significant portion of the older adult population, due to decrease in social interactions, chronic illnesses and sensory impairments. However, many other vulnerable populations may experience social isolation because of psychiatric or disabling health conditions, substances abuse, low socioeconomic status, unemployment and belonging to ethnic or marginalized minorities. The unprecedented COVID-19-related social distancing can be taken as a proof-of-concept of the detrimental role of poor interactions in NCDs prevention and management not only at individual level but also in a public health perspective. Indeed, social isolation has been linked to unhealthy lifestyle choices, disrupted sleep quality, low utilization of healthcare, preventive services and adherence to treatments. Underlying mechanisms like inflammation and stress responses may also play a role in the association between social isolation and worse NCDs outcomes.

CONCLUSIONS

Social isolation negatively impacts on the development, progression and management of NCDs. Effective interventions for social isolation should address both societal factors and healthcare-related needs. To counteract the detrimental effects of social distancing during COVID-19 pandemic, the use of telemedicine was implemented. However, telemedicine is not always available, and legislative and age-related barriers persist.

Examining the Role of Third Sector Organization Volunteers in Facilitating Hospital-to-Home Transitions for Older Adults - a Collective Case Study

Introduction

With increasing attention to models of transitional support delivered through multisectoral approaches, third-sector organizations (TSOs) have supported community reintegration and independent living post-hospitalization. This study aimed to identify the core elements of these types of programs, the facilitators, and barriers to service implementation and to understand the perspectives of providers and recipients of their experiences with the programs.

Methods and Analysis

A collective case study collected data from two UK-based 'Home from Hospital' programs. An inductive thematic analysis generated rich descriptions of each program, and analytical activities generated insights across the cases.

Results

Programs provided a range of personalized support for older adults and addressed many post-discharge needs, including well-being assessments, support for instrumental activities of daily living, psychosocial support, and other individualized services directed by the needs and preferences of the service user. Results suggest that these programs can act as a 'safety net' and promote independent living. Skilled volunteers can positively impact older adults' experience returning home.

Conclusions

When the programs under study are considered in tandem with existing evidence, it facilitates a discussion of how TSO services could be made available more widely to support older adults in their transition experiences.

Predictive Strategies to Reduce the Risk of Rehospitalization with a Focus on Frail Older Adults: A Narrative Review

Frailty is a geriatric syndrome that has physical, cognitive, psychological, social, and environmental components and is characterized by a decrease in physiological reserves. Frailty is associated with several adverse health outcomes such as an increase in rehospitalization rates, falls, delirium, incontinence, dependency on daily living activities, morbidity, and mortality. Older adults may become frailer with each hospitalization; thus, it is beneficial to develop and implement preventive strategies. The present review aims to highlight the epidemiological importance of frailty in rehospitalization and to compile predictive strategies and related interventions to prevent hospitalizations. Firstly, it is important to identify pre-frail and frail older adults using an instrument with high validity and reliability, which can be a practically applicable screening tool. Comprehensive geriatric assessment-based care is an important strategy known to reduce morbidity, mortality, and rehospitalization in older adults and aims to meet the needs of frail patients with a multidisciplinary approach and intervention that includes physiological, psychological, and social domains. Moreover, effective multimorbidity management, physical activity, nutritional support, preventing cognitive frailty, avoiding polypharmacy and anticholinergic drug burden, immunization, social support, and reducing the caregiver burden are other recommended predictive strategies to prevent post-discharge rehospitalization in frail older adults.

Social Disconnectedness and Loneliness: Do Self-Perceptions of Aging Play a Role?

OBJECTIVES

Research suggests that self-perceptions of aging (SPA) have effects on physical, mental, cognitive, and emotional well-being among older adults. Few studies have examined the effects of SPA on social well-being. This study investigates the association of SPA with trajectories of social disconnectedness and loneliness in older Americans and explores mechanisms linking SPA and the 2 forms of social isolation.

METHODS

We conducted Latent Growth Curve Modeling and path analysis using 3-wave data spanning 8 years (2008/2010-2016/2018) from the Health and Retirement Study. The sample included respondents aged 65 and older (N = 3,597) at baseline (2008/2010). SPA was measured by the Attitudes Toward Own Aging Scale. Social disconnectedness was an index including 6 indicators of social networks and social engagement. Loneliness was measured using the 11-item UCLA Loneliness Scale.

RESULTS

Older adults with more negative SPA at baseline were more lonely but had slower rates of increase in loneliness during the 8-year study period. More negative SPA also predicted greater social disconnectedness but was not significantly related to the rate of change in social disconnectedness over time. The effects of SPA on social disconnectedness were primarily indirect through loneliness, whereas SPA had direct effects on loneliness. Overall, SPA had a stronger association with loneliness than with social disconnectedness.

DISCUSSION

The results suggest that older adults with negative SPA are at risk of loneliness which then leads to social disconnectedness. Asking about SPA during individual assessment with older adults may help to discern issues with loneliness.

Housing Unit Type and Perceived Social Isolation Among Senior Housing Community Residents

BACKGROUND AND OBJECTIVES

Social isolation, and its associated health implications, is an important issue for older adults in the United States. To date, there has been limited study of the pathways that connect these two factors. The present study expands on previous models by linking factors related to the built environment-in the form of housing unit type-to perceived social isolation among those living independently in dedicated senior housing.

RESEARCH DESIGN AND METHODS

The causal inference technique of inverse probability weighting with regression adjustment was employed to assess the impact of living in a townhome-style unit, as opposed to in an apartment building, on self-reported perceived social isolation (N = 1,160).

RESULTS

Individuals who lived in townhome-style housing reported 10.4% lower probability of experiencing social isolation as a result of living in a townhome-style unit as opposed to an apartment building-style unit.

DISCUSSION AND IMPLICATIONS

The findings provide evidence for the conceptual model that characteristics specific to a given housing unit type may create conditions that exacerbate or buffer individuals from experiencing social isolation. This, in turn, has important implications for the targeting of interventions for social isolation. Policy considerations related to the type of affordable senior housing being built should also be informed by these findings. Additionally, future research should better explicate the role of housing unit type on mental and emotional health outcomes.

Rurality and atrial fibrillation: a pathway to virtual engagement and clinical trial recruitment in response to COVID-19

Study Objective

To summarize trial adaptation from in-clinic to virtual design in response to the SARS-2 coronavirus-2 (COVID-19).

Design

A clinical trial of a mobile health intervention to improve chronic disease self-management for rural individuals with atrial fibrillation (AF). The trial has a 4-month intervention - accessible regardless of health or digital literacy - to enhance AF medication adherence and patient experience with 8- and 12-month assessments of sustainability.

Setting

Rural, western Pennsylvania.

Participants

Rural individuals with AF receiving oral anticoagulation for stroke prevention.

Interventions

Enrolled participants underwent a telephone-based orientation, provided verbal consent, and were randomized using a digital platform. They received a smartphone with intervention or control applications and a curriculum on usage tailored for study arm. Participants received study assessments by mail with telephone-based administration and contact for the 12-month trial.

Main Outcome Measures

Successful adaptation to virtual engagement and recruitment.

Results

The study enrolled 18 participants during in-clinic recruitment (January-March 2020). From 5/1/2020 to 5/6/2021 the study team enrolled 130 individuals (median age 72.4 years, range 40.8-92.2; 49.2% women, 63.1% without college degree, and 45.4% with limited health literacy. Retention of participants enrolled using virtual methods during the 4-month intervention phase is 92%.

Conclusions

We report a virtual trial of a mobile health intervention for rural individuals with AF. Our successful implementation suggests promise for engaging geographically isolated rural individuals, potential to enhance digital health access, and advance rural health equity.