Performance of an Abbreviated Lubben Social Network Scale (LSNS-6) among Three Ethnic Groups of Older Asian Americans

Prognostic Value of Objective Social Isolation and Loneliness in Older Patients With Heart Failure: Subanalysis of FRAGILE-HF and Kitasato Cohort

BACKGROUND

Social factors encompass a broad spectrum of nonmedical factors, including objective (social isolation [SI]) and perceived (loneliness) conditions. Although social factors have attracted considerable research attention, information regarding their impact on patients with heart failure is scarce. We aimed to investigate the prognostic impact of objective SI and loneliness in older patients with heart failure.

METHODS AND RESULTS

This study was conducted using the FRAGILE-HF (Prevalence and Prognostic Value of Physical and Social Frailty in Geriatric Patients Hospitalized for Heart Failure; derivation cohort) and Kitasato cohorts (validation cohort), which included hospitalized patients with heart failure aged ≥65 years. Objective SI and loneliness were defined using the Japanese version of Lubben Social Network Scale-6 and diagnosed when the total score for objective and perceived questions on the Lubben Social Network Scale-6 was below the median in the FRAGILE-HF. The primary outcome was 1-year death. Overall, 1232 and 405 patients in the FRAGILE-HF and Kitasato cohorts, respectively, were analyzed. Objective SI and loneliness were observed in 57.8% and 51.4% of patients in the FRAGILE-HF and 55.4% and 46.2% of those in the Kitasato cohort, respectively. During the 1-year follow-up, 149 and 31 patients died in the FRAGILE-HF and Kitasato cohorts, respectively. Cox proportional hazard analysis revealed that objective SI, but not loneliness, was significantly associated with 1-year death after adjustment for conventional risk factors in the FRAGILE-HF. These findings were consistent with the validation cohort.

CONCLUSIONS

Objective SI assessed using the Lubben Social Network Scale-6 may be a prognostic indicator in older patients with heart failure. Given the lack of established SI assessment methods in this population, further research is required to refine such methods.

Social Networks as a Key Health Determinant in Acute Illness Recovery: A Lesson from the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic highlighted the importance of considering social determinants of health in health outcomes. Within this spectrum of determinants, social networks garnered attention as the pandemic highlighted the negative effects of social isolation in the context of social distancing measures. Post-pandemic, examining the role social networks play in COVID-19 recovery can help guide patient care and shape future health policies. This study aimed to investigate the relationship between social networks and self-rated health change, as well as physical function, in patients recovering from COVID-19 pneumonia.

METHODS

This was a retrospective cohort study utilizing clinical data from two New York City hospitals and a 9-month follow-up survey of COVID-19 pneumonia survivors. We evaluated a composite Social Network Score from the 6-item Lubben Social Network Scale and its association with two outcomes: 1) self-rated health change and 2) physical function.

RESULTS

A total of 208 patients were included in this study. A one-point increase in the Social Network Score was associated with greater odds of both improved or similar self-rated health change (odds ratio [OR] 1.07, 95% CI 1.02 - 1.12, p = 0.01), as well as unimpaired physical function (OR 1.08, 95% CI 1.03 - 1.14, p < 0.01).

CONCLUSION

This study emphasized the importance of social networks as a social determinant of health among patients recovering from COVID-19 hospitalization. Targeted interventions to enhance social networks may benefit not only COVID-19 patients but also individuals recovering from other acute illnesses.

Findings from a Peer-Facilitated, Social Isolation Intervention in the Veterans Health Administration Healthcare System: A Mixed-Methods, Pilot Feasibility Study

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.

The psychometric properties of the Lubben Social Network Scale (LSNS-6) and its associations with well-being indicators in Hong Kong older adults

OBJECTIVE

Social networks play a vital role in facilitating late-life health and well-being. The current research sought to examine the psychometric properties of the abbreviated Lubben Social Network Scale (LSNS-6) among community-dwelling Hong Kong Chinese older adults and to explore the association between social network and well-being indicators such as life satisfaction, functional social support, loneliness and anxiety.

METHODS

We administered the LSNS-6 scale to 324 older adults (mean = 71.70, SD = 8.58, range: 58-95). We performed confirmatory factor analysis (CFA) to confirm the construct validity. Cronbach's alpha was chosen for internal consistency estimation. Correlational analysis was performed between LSNS-6 scale and other measures to ascertain the convergent validity.

RESULTS

The two-factor model of LSNS-6 indicated an adequate fit. The goodness-of-fit index values for the model were χ2 /df = 2.61, CFI = 0.98, RSMEA = 0.07, SRMR = 0.05. The internal consistency of the scale was α = 0.75. It also demonstrated good construct validity in measuring the social network and acceptable convergent validity to other measures.

CONCLUSIONS

The LSNS-6, according to current findings, can be a valid reference to the social network of Hong Kong older adults, enabling researchers and clinicians to investigate and develop further corresponding remedies for those in need.

A systematic review of reviews on the psychometric properties of measures of older persons' ability to build and maintain social relationships

BACKGROUND

Within the scope of the World Health Organisation's (WHO) world report on ageing and health and how healthy ageing was conceptualised, the WHO has been working with academia towards producing reviews of the psychometric properties of instruments that measure different domains of functional ability. This study aimed to conduct a review of reviews to examine existing and validated instruments measuring the ability of older persons to build and maintain social relationships and to evaluate the psychometric properties of these instruments.

METHODS

We searched for studies published in the English, Spanish and Portuguese languages. No restrictions were placed on the year of publication. The following databases were searched: PubMed, Embase, Psyinfo and Cumulated Index to Nursing and Allied Health Literature. Titles and abstracts were screened and selected articles were screened and reviewed independently by two reviewers.

RESULTS

A total of 3,879 records were retrieved, of which 39 records were retrieved for full-text analysis. None of the reviews met the inclusion criteria, thus resulting in an empty review.

CONCLUSIONS

Considering the current definition of older persons' functional ability to build and maintain social relationships, this review did not identify instruments that can measure both constructs simultaneously. We suggest the development of an instrument that simultaneously assesses the ability of older persons to build and maintain relationships.

Social isolation during the COVID-19 pandemic in Spain: a population study

Since March of 2020, billions of people worldwide have been asked to limit their social contacts in an effort to contain the spread of the SARS-CoV-2 virus. However, little research has been carried out to date on the impact of such social distancing measures on the social isolation levels of the population. In this paper, we study the impact of the pandemic on the social isolation of the Spanish population, by means of 32,359 answers to a citizen survey collected over a period of 7 months. We uncover (1) a significant increase in the prevalence of social isolation in the population, reaching almost 26%; (2) gender and age differences, with the largest prevalence of isolation among middle-aged individuals; (3) a strong relationship between economic impact and social isolation; and (4) differences in social isolation, depending on the number of COVID-19 protection measures and on the perception of coronavirus infection risk by our participants. Our research sheds quantitative light on the sociological impact of the pandemic, and enables us to identify key factors in the interplay between the deployment of non-pharmaceutical interventions to contain the spread of an infectious disease and a population’s levels of social isolation.

Prevalence and correlates of disability among urban-rural older adults in Southwest China: a large, population-based study

Background

As one of the challenges of aging, older adults with disabilities are often overlooked in remote areas of many developing countries, including southwest China. Similar populations would undoubtedly benefit from a representative, high-quality survey of large samples, which would also enrich global disability data. This study aims to assess the prevalence of disability and associated factors among urban and rural older adults in a typical representative region.

Method

A large-scale baseline survey was conducted between March and September 2020 using face-to-face interviews with a multistage stratified random sample of 16,536 participants aged ≥ 60 years. Disability was assessed using the BI scale, with a score of 100 representing normal status, 65–95 as mild disability, 45–60 as moderate disability, and 0–40 as severe disability. The prevalence of disability was estimated by demographics and health characteristics, and their associations were explored by robust Poisson regression analysis.

Results

The prevalence of disability among older adults was 19.4%, and the prevalence of mild, moderate, and severe disability was 16.8%, 1.5%, and 1.1%, respectively. All variables, including older age, residence in a rural area, higher number of hospitalizations, comorbidities, poor self-rated health, falls, cognitive impairment, mental impairment, and alienation from friends and relatives, were shown to be associated with a higher adjusted prevalence of disability. Only formal education can reduce the risk of disability.

Conclusion

The prevalence of disability among older adults is high in both urban and rural settings in southwest China, and a number of important factors associated with disability have been identified. In addition to increased attention to the health status of older adults, further research on scientific management and effective disability interventions is needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03193-2.

Virtual Intergenerational Reverse-Mentoring Program Reduces Loneliness among Older Adults: Results from a Pilot Evaluation

Social isolation and loneliness can create negative health outcomes for older adults. Informed by social capital and intergroup contact theories, our goal was to reduce these social problems using an intergenerational reverse-mentoring program. During fall 2020, we implemented an adapted, fully online version of Cyber-Seniors that encouraged undergraduate students to provide technology mentoring to local older adults in a seven-county area in rural Appalachia. We recruited gerontology students through the university and local older adults through local aging organizations. We collected data through pre-and post-tests that included validated measures (Lubben Social Network Scale-6 and UCLA 3-item loneliness scale) and open-ended questions about the program. Thirty-one students and nine older adults completed the pre-survey; twenty students and eight older adults completed the post-survey. We made comparisons using t-tests and considered p < 0.20 to indicate meaningful differences given the anticipated small sample size in this pilot project. Isolation did not change among older adults but increased among students in the family domain (p = 0.14) between baseline and follow-up. Loneliness improved between the pre- and post-tests among older adults (mean: 5.6 (SD = 2.2) to 4.1 (SD = 1.3), p = 0.17) but not among students (mean: 5.0 (SD = 1.5) to 5.2 (SD = 1.7), p = 0.73). In open-ended responses, older adults described learning new ways to interact with friends and family as a result of the program. This program was acceptable and suggested effectiveness in an important health-related domain (loneliness). While larger studies are needed to fully test the program’s impact, this pilot evaluation suggests that reverse mentoring programs can be implemented virtually and may improve social outcomes.

Loneliness as a Mediator in the Association Between Social Isolation and Psychological Distress: A Cross-Sectional Study With Older Korean Immigrants in the United States

The present study explored the role of loneliness in the association between social isolation and psychological distress, using a cross-sectional sample of older Korean immigrants in the U.S. Considering structural (unmarried and living alone) and relational (isolation from family and friends) social isolation, we hypothesized that (1) both types of social isolation would be associated with loneliness and psychological distress and (2) their effect on psychological distress would be mediated through loneliness. Data came from the Study of Older Korean Americans (SOKA), a multisite survey of Korean immigrants aged 60 and older (n = 2,150). The multivariate analyses demonstrated that older individuals with structural and relational isolation reported higher levels of loneliness and psychological distress. Loneliness was found to mediate the effect of both types of social isolation on psychological distress. The intervening role of loneliness suggests strategies to alleviate the mental health consequences of social isolation in older immigrants.

A comprehensive overview of social network measures for older adults: A systematic review

OBJECTIVES

The size and type of older adults' social networks is associated with health, mental and social outcomes. Investigators within many disciplines are now measuring social networks, but it is not always clear what they are assessing, or which measures may best meet their objectives. To undertake a systematic review to identify (i) social network measures used for older adults, (ii) variety of social network dimensions and (iii) how measures have developed over time.

MATERIALS AND METHODS

The MEDLINE, EMBASE, CINAHL, PsycInfo and Cochrane Library databases were systematically searched to identify social network instruments, followed by categorization of the domains into quantitative, qualitative and alter domains.

RESULTS

A total of 229 studies and 21 social network measures were included, with 11 quantitative dimensions (e.g., size, frequency), 5 qualitative dimensions (e.g., support satisfaction, emotional bond) and 7 alter members (e.g., family, neighbours) of social networks identified. Measures commonly clustered on quantifiable network size (n = 19), availability of supportive networks (n = 14) and presence of family ties (n = 21). The period between 1985 and 1995 produced the greatest number of newly developed social network measures (n = 10) with a stronger focus on qualitative features.

DISCUSSION AND IMPLICATIONS

This review provides researchers with an organized summary of measures and dimensions for consideration when appraising social connections in older adults. This can enable better study design through providing information that makes explicit inevitable trade-offs between survey length, comprehensiveness of dimension coverage, and utilization of the measure for researchers. PROSPERO Registration number: CRD42016043089.

The Impact of an Internet Use Promotion Programme on Communication, Internet Use, and the Extent of Social Networks among Low-Income Older Adults

We examined whether an internet use promotion intervention influences low-income older adults’ communication modes, internet use, and social networks using existing data collected for an intervention. Participants living in public senior housing facilities in the United States (n = 77) completed surveys before and after a 12-week computer and internet training. The six-item Lubben Social Network Scale (LSNS-6) was used to measure the extent of older adults’ social networks. The primary mode of communication shifted from more traditional means to internet-based communications (p < .0005 in a Fisher’s exact test). The frequency of internet use significantly increased (p < .00005 in a one-sided Sign test). Overall, the LSNS-6 score increased by 4.1 points (p < .00005 in a Welch’s t-test). The LSNS-6 score increase was significantly larger among African Americans than Whites, controlling for gender (p < .05 in negative binomial regression). Moderate (p < .005) and frequent internet users (p < .05) had higher LSNS-6 scores than rare internet users at posttest when gender and race were controlled for in linear regression. Comparatively more improvement in the extent of social networks among African Americans suggests greater benefits of such interventions for population groups of disadvantaged backgrounds. Larger social networks among moderate and frequent internet users than rare users suggest positive impacts of internet communications on social networks.

Health risks posed by social and linguistic isolation in older Korean Americans

OBJECTIVES

Inspired by the notion of double jeopardy positing the dual disadvantage in the coexistence of different sources of vulnerability, the present study examined health risks posed by social and linguistic isolation in older Korean Americans.

DESIGN

A cross-sectional study, using a four-cell classification to compare isolation types (no isolation, social isolation only, linguistic isolation only, and dual isolation) and to examine their impacts on physical (self-rated health), mental (mental distress), and cognitive (cognitive performance) health.

SETTING AND PARTICIPANTS

Data are from the Study of Older Korean Americans survey of Korean immigrants aged 60 or older (n = 2032), conducted in five states in the United States (California, New York, Texas, Hawaii, and Florida).

MEASUREMENT

Social isolation was indexed by the Lubben Social Network Scale-6; linguistic isolation, by a question on English-speaking ability. Physical, mental, and cognitive health were indicated by a single-item self-rating of health, the Kessler Psychological Distress Scale 6, and the Mini-Mental State Examination, respectively.

RESULTS

The dual-isolation group exhibited notable sociodemographic and health disadvantages. The odds of having fair/poor health, mental distress, and cognitive impairment were 2.21-3.17 times higher in the dual-isolation group than in the no-isolation group.

CONCLUSION

Our findings confirm that both social relationships and language proficiency are key elements for older immigrants' social connectedness and integration, the deprivation of which puts them at heightened risk in multiple dimensions of health.

Cognitive health risks posed by social isolation and loneliness in older Korean Americans

BACKGROUND

This study examines associations among social isolation, loneliness, and cognitive health risks in older Korean Americans, focusing on the mediating role of loneliness in the relationship between social isolation and objective and subjective measures of cognitive impairment.

METHODS

Data are from 2061 participants in the Study of Older Korean Americans, a multi-state survey of Korean immigrants age 60 and older (Mage = 73.2, SD = 7.93). Social isolation was indexed with the Lubben Social Network Scale- 6; loneliness, with the short-form UCLA Loneliness Scale. Objective and subjective measures of cognitive impairment included the Mini-Mental State Examination and a single-item self-rating of cognitive health.

RESULTS

In the logistic regression model for objective cognitive impairment, social isolation was significantly associated, but loneliness was not. In the model for subjective cognitive impairment, both social isolation and loneliness were significant factors. However, the effect of social isolation became non-significant when loneliness was considered, suggesting a potential mediating role of loneliness. The subsequent mediation analysis confirmed that the indirect effect of social isolation on subjective cognitive impairment through loneliness was significant (B = .20, SE = .03, 95% CI = .12, .28).

CONCLUSION

Our analyses provide evidence for the proposed mediating effect of loneliness in the relationship between social isolation and subjective cognitive impairment. Intervention efforts should focus on reducing feelings of loneliness experienced by older immigrants, possibly by engaging them in socially meaningful and cognitively stimulating activities.