Social isolation and loneliness: Undervalued risk factors for disease states and mortality

Associations of social isolation with sleep duration and sleep quality in the elderly: Mediating influence of depression

BACKGROUND

Sleep disorders are common health problems in the elderly. The effect of social isolation on sleep duration and sleep quality remains unclear in the Chinese community-dwelling elderly.

AIM

To explore the associations of social isolation with sleep duration and sleep quality in community-dwelling elderly people.

METHODS

A total of 7762 community-dwelling elderly people aged 60 years and older in Ningbo were recruited from June 2022 to August 2022. Data were collected using a questionnaire. Multivariate logistic regression was used to analyze the associations of social isolation with sleep duration and sleep quality. The KHB mediating effect model was used to test the mediating effect of depression and anxiety on these associations.

RESULTS

Among the participants, 2656 (34.2%) had abnormal sleep duration (< 6 hours or > 8 hours), 1115 (14.4%) had poor sleep quality, and 917 (11.8%) had social isolation. After adjusting for confounding factors, compared with the elderly without social isolation, the odds ratios (95%CI) of abnormal sleep duration and poor sleep quality in the elderly with social isolation were 1.49 (1.29-1.73) and 1.32 (1.09-1.59), respectively. Depression partially mediated the associations of social isolation with sleep duration and sleep quality, accounting for 5.68% and 9.87% of the mediating effect, respectively.

CONCLUSION

Social isolation was found to be associated with sleep duration and sleep quality in community-dwelling elderly people. More attention should be paid to social isolation in the elderly.

"None of us asked to be in this community." Understanding nephrotic syndrome through TikTok: patient and caregiver perspectives

BACKGROUND

TikTok, a popular social media platform, is increasingly used for health information dissemination; however, the accuracy and quality of medical content remain uncertain, including in the context of nephrotic syndrome (NS). This study aims to identify prominent patient and caregiver experiences with NS on TikTok and demonstrate how they may vary.

METHODS

A convenience sample of TikTok videos containing the hashtag "nephrotic syndrome" posted between July 1, 2020, and February 29, 2024, was analyzed. Videos underwent cyclical and inductive coding, followed by content and discourse analysis to identify common themes and narratives.

RESULTS

One hundred twenty-three videos were included in the analysis. 62.6% of videos (N = 77) consisted of caregivers sharing their experiences of their child's disease. Three prominent topics included: (1) navigating healthcare and managing illness, where users shared their disease journeys; (2) emotional and physical wellbeing, where caregivers focused on physical disease signs while patients highlighted the mental health toll of the illness; and (3) education, awareness, and support systems, where users shared feelings of social isolation post-diagnosis. The discourse analysis revealed language portraying patients as "warriors," reflecting the resiliency promoted by TikTok support systems.

CONCLUSIONS

We uncovered a hidden disease burden associated with NS that affects everyday life, reinforcing the importance of the journey and stress patients and caregivers experience outside of the clinician's office. Our findings also highlight that patient priorities may differ from those reported by caregivers, particularly in pediatrics. TikTok may also be an outlet for feelings of isolation and community-building within NS.

Social isolation in the young and middle-aged patients with stroke: role of social support, family resilience and hope

Background

Stroke is the leading cause of death and disability among adults in China. Social isolation in stroke survivors is a major public health concern across the globe. Social isolation is associated with social support, family resilience, and levels of personal hope, but how they interact to predict social isolation in the young and middle-aged stroke survivors remains unclear.

Methods

Using cross-sectional design and convenience sampling method, a survey was conducted among 461 young and middle-aged stroke survivors. Perceived social support scale, General isolation Scale, Chinese version of Family Resilience Assessment Scale and Herth hope index were adopted to assess patients' social, family and personal factors. SPSS 27.0 and AMOS 26.0 were used for descriptive analysis and structural equation modeling of the data.

Results

The young and middle-aged stroke survivors had a high level of social isolation(49.57 ± 5.84). In the mediating effects model, social support could influence social isolation directly (95% CI -0.250, -0.061) or indirectly through family resilience (95% CI -0.136, -0.062) or patient hope level (95% CI -0.078, -0.017). In addition, Family resilience and hope had a significant chain mediating effect between social support and social isolation (95% CI -0.029, -0.006).

Conclusions

Social support can have both direct and indirect effects on social isolation through the mediating factors of family resilience and hope. Clinicians and nurses can develop supportive interventions by taking integration of family and personal hope. On the one hand, resources can be directed to the individual patient, and on the other hand, the utilization of social support can be ensured by increasing family resilience and enhancing the coping capacity of family members and individuals.

Social isolation and loneliness increase the risk of coronary heart disease: Insights from a prospective cohort study

Social isolation and loneliness are associated with an increased risk of various diseases and all-cause mortality. Coronary heart disease (CHD) is the main cause of heart disease deaths worldwide, which affects people's quality of life and longevity. However, the causal relationship between social isolation, loneliness, and CHD remains uncertain. This study aims to explore the potential impacts of social isolation and loneliness on the risk of CHD, thereby helping identify those most susceptible to these conditions. A total of 442,811 individuals (mean and sd of age = 56.24 ± 8.07, 55.8% women, 91.5% white) were included in the study. The UK Biobank cohort study documented 25,120 CHD cases during a mean follow-up of 14.77 years. The relationship between loneliness, social isolation and CHD were first examined using the COX proportional risk model. A two-sample Mendelian randomization (MR) study was then conducted to further the association. We found that the hazard ratio (95% CI) of coronary heart disease (CHD) when comparing the most socially isolated groups to the least was 1.15 (1.05-1.26; P = 0.0017). Additionally, the hazard ratio (95% CI) for comparing the presence of loneliness to its absence was 1.15 (1.10-1.20; P < 0.001).Subgroup analyses showed that the risk of CHD was higher in individuals with low sleep quality who experienced social isolation and in women who experienced loneliness. MR analyses further revealed that individuals who felt lonely (OR = 1.03; 95% CI: 1.01,1.06) and those less involved in sports/social activities (OR = 1.02; 95% CI: 1.00,1.04) had a higher likelihood of developing CHD. MR provided further evidence supporting the causal relationship between social isolation, loneliness and CHD risk. Our findings suggest a significant association between social isolation, loneliness and increased risk of coronary heart disease. These findings suggest that both social isolation and loneliness are critical risk factors for CHD.

Social isolation and loneliness and their association with all-cause mortality. A population-based longitudinal study in Norway: The Tromsø Study 1994-2023

Objectives

Loneliness and social isolation are associated with increased mortality, but few studies have assessed this association over long time in young adults.

Methods

The study sample comprised 9061 women and 8735 men aged 25 to 69 years who participated in the Tromsø4 survey (1994-95, baseline) of the Tromsø Study, Norway. A subset of the study sample also attended the Tromsø5 (2001), Tromsø6 (2007-08), and Tromsø7 (2015-16) surveys. Participants were followed up for all-cause mortality until November 2023; with 1630 women and 2099 men deceased. Information on social isolation (least isolated, modestly isolated, and most isolated) and loneliness (yes, no) were taken from self-administered questionnaires. Sex-specific, time-varying Cox models were employed, updating exposures and covariates from Tromsø5.

Results

Most-isolated versus least-isolated women and men had hazard ratios of 1.37 (95 % confidence interval 1.18-1.59) and 1.41 (1.25-1.60), respectively, after adjustment for covariates. These hazard ratios were higher in younger adults (HR = 1.55 in women and HR = 1.76 in men aged <50 years at baseline), though the age-isolation interaction was not statistically significant in women (P = 0.26), but in men (P = 0.01). For loneliness, the adjusted hazard ratios were 1.51 (1.23-1.87) and 1.46 (1.16-1.84). Over time, 51 % and 47 % of participants remained most isolated at Tromsø5 and Tromsø7, respectively; 25 % of those initially lonely remained so at Tromsø5, while only 2.6 % of those initially non-lonely became lonely at Tromsø5.

Conclusion

Both social isolation and loneliness are strongly associated with all-cause mortality, particularly among younger adults, underscoring their importance as public health concerns.

Social isolation and likelihood of becoming centenarians: evidence from the Chinese longitudinal healthy longevity survey

BACKGROUND

Social isolation, defined as an individual's lack of social connections, is particularly prevalent among older adults. However, its association with health outcomes among the oldest-old population (aged 80 and above) was understudied.

AIMS

To examine the association between social isolation and the likelihood of becoming a centenarian among the oldest-old people in China, aiming to provide novel insights into promoting healthy aging and longevity.

METHODS

Using data from The Chinese Longitudinal Healthy Longevity Survey, conducted in 22 provinces in mainland China since 1998, we performed a community-based, prospective nested case-control study. The primary outcome was survival to the age of 100 by 2018 (the end of follow-up). Information on social isolation and other covariates was collected via a questionnaire at baseline. The degree of social isolation was categorized as low, moderate, and high. Included (n = 5,716) were 1,584 identified centenarians and 4,132 controls (deceased before reaching 100 years), matched by age, sex, and year of entry. A conditional logistic regression model was used to evaluate the association between social isolation and the likelihood of becoming a centenarian, adjusting for demographic factors, lifestyle factors, chronic disease, potential disability, optimistic attitude, and perceived loneliness.

RESULTS

Individuals with the highest social isolation score had lower odds of becoming centenarians (adjusted OR:0.82; 95% CI: 0.68, 0.98), relative to those with the least social isolation (P-value < 0.05), and this association persisted in sensitivity analyses. The association was more pronounced among ever smokers, compared to never smokers (P-value = 0.001). We did not observe significant interactions between social isolation and other covariates (P-value > 0.05 for all).

CONCLUSIONS

This study highlights the inverse association between social isolation and the likelihood of becoming a centenarian, emphasizing the need for public health initiatives to combat isolation in the older population.

The associations of social isolation with depression and anxiety among adults aged 65 years and older in Ningbo, China

Social isolation was associated with emotional problems (depression and anxiety) among older adults, however, little is known in China. Thus, we conducted a cross-sectional study including 6,664 ≥ 65 years older adults in Ningbo, China. We collected data on social isolation, depression, and anxiety by specific scales. The relationship between social isolation and emotional problems was estimated by multivariate-adjusted logistic regression models. The population-attributable risk percentage (PAR%) was used to explore the contribution of social isolation to emotional problems. Overall, the percentage of participants who had experienced social isolation, depression, and anxiety was 12.67%, 4.83%, and 2.63%. Compared with the elderly without social isolation, the adjusted odds ratios (95% confidence interval) of depression and anxiety with social isolation were 1.77 (1.25-2.51) and 1.66 (1.05-2.63), respectively. The PAR analysis showed that 10.66% of depression and 9.03% of anxiety could be attributable to social isolation. In the gender subgroup, ORs and PAR% were only significantly observed in female participants. In Chinese older adults, social isolation has been linked to depression and anxiety, suggesting the importance of taking effective and feasible interventions to reduce social isolation and emotional problems, especially among females.

Adverse childhood experiences and cognitive function in later life: the sequential mediating roles of education level and adult loneliness

Background

This study assesses the impact of adverse childhood experiences (ACEs) on the cognitive function of older adults. Furthermore, it examines the potential underlying mechanism involving education level and the subjective "feeling of loneliness" (FOL).

Methods

Analyzing a population-based cohort sample from the China Health and Retirement Longitudinal Study database, 8,365 subjects aged 45 or older were interviewed in 2018. Ten ACEs indicators were measured using life history questionnaires assessed at 2014. FOL was assessed using a single item from 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Cognitive function was assessed using a structured questionnaire comprising four dimensions: memory, orientation, computation, and visuospatial abilities.

Results

In the fully adjusted model, which accounted for age, gender, marital status, smoke, drink, rural residence, and education levels of both mothers and fathers, the linear regression analysis indicated that ACEs were inversely associated the lower education level (B = -0.058, 95% CI = -0.090, -0.026, p < 0.001), and ACEs were found to be linked to an elevated risk of FOL (B = 0.072, 95% CI = 0.056, 0.089, p < 0.001). In addition, ACEs was not significantly associated with cognitive function (B = -0.047, 95% CI = -0.108, 0.015, p = 0.136), but FOL was significantly associated with cognitive function (B = -0.483, 95% CI = -0.561, -0.404, p < 0.001). Mediation analysis revealed that education level and FOL sequentially and partially mediated the association between ACEs and the total cognitive score, with a proportion mediated of 52.58%.

Limitations

The evaluation of ACEs exposure was based on binary response options. This method limited our ability to explore various dimensions of adversity, such as ages of occurrence, severity, frequency, duration, and the extent of psychological effects at the time. Furthermore, the assessment of loneliness relied on a single item from the CESD-10, introducing a potential source of measurement error.

Conclusion

Our study unveils a substantial association between ACEs and education level, as well as with FOL and cognitive function in the older adults. Moreover, education level and FOL serve as sequential mediating factors in the relationship between ACEs and cognitive function.

Association between Levels of Loneliness, Laboratory Measurements, and Behavioral Aspects in a Primary Care Setting in Crete, Greece

This paper examines potential associations of loneliness with laboratory data and specific psychosocial and behavioral attitudes. The sample collection took place in an urban Primary Health Care unit between May and July 2023, consecutively, and once exclusion criteria were implemented. Participants were aged between 40 and 75 years. Routine laboratory test results upon study initiation and six months before were used. The University of California, Los Angeles (UCLA), Loneliness Scale (Version 3), blood glucose, serum lipids, Fibrosis-4 index, and Creatinine Clearance (CrCl) were assessed through hierarchical multiple logistic regression analysis. Based on full model (3rd) analysis, those who were engaged in an individual sport or activity or had contacts with more friends presented significantly lower odds for increased loneliness levels (odds ratio (OR): 0.28 [95% confidence interval (CI) 0.09-0.91], p = 0.034 and OR: 0.76 [95%CI 0.66-0.88], p < 0.001, respectively). The consumption of alcohol was associated with increased loneliness (OR: 5.55 [95%CI 1.42-21.63], p = 0.014). Elevated triglyceride levels were linked with moderate or no loneliness (OR: 0.20 [95%CI 0.05-0.83], p = 0.026), while an increased LDL/HDL atherosclerotic index was related to increased subjective loneliness (OR: 4.50 [95%CI 1.12-18.13], p = 0.035). The need for holistic approaches-involving primary care personnel-in understanding and addressing loneliness, recognizing its multifaceted nature as well as the diverse factors that contribute to this issue, is considered challenging.

Association between illness perception and social alienation among maintenance hemodialysis patients: The mediating role of fear of progression

PURPOSE

This study aimed to investigate the mediating role of fear of progression on illness perception and social alienation among maintenance hemodialysis (MHD) patients.

BACKGROUND

MHD is frequently accompanied by increased pain and complications such as itchy skin, chronic fatigue, and muscle spasms. Cardiovascular disease rates are also elevated among MHD patients, which can heighten their anxiety regarding prognosis and treatment discomfort. This chronic fear may severely impact social functioning, leading patients to withdraw from interpersonal interactions and experience heightened helplessness and loneliness. Further investigation is necessary to understand the factors behind the high level of social alienation in MHD patients and their underlying mechanisms.

DESIGN

A cross-sectional study guided by the STROBE.

METHODS

A convenience sample of 230 MHD patients were enrolled from January to May 2023. Data including demographic and clinical characteristics, illness perception, fear of progression, and social alienation were collected. Descriptive analysis and Pearson correlations were conducted using IBM SPSS version 25.0. The mediating effect was analyzed using Model 4 of the PROCESS macro for SPSS, with the Bootstrap method employed to assess its significance.

RESULTS

The score of social alienation in MHD patients was high, with illness perception and fear of progression both significantly correlated with social alienation. In the mediating effects model, illness perception can predict social alienation in MHD patients, and fear of progression use plays a part in mediating the process by which illness perception affects social alienation. The Kappa Squared (κ2) value of 21.9%, suggests a medium effect size.

CONCLUSIONS

Illness perception directly predicts social alienation in MHD patients and exerts an indirect effect through the mediating role of fear of progression. Suggests that healthcare professionals should concentrate on MHD patients with high negative illness perceptions to alleviate their fear of progression, thereby decreasing the level of social alienation and enhancing their integration into society.

Factors associated with perceived social isolation among veterans with spinal cord injury and disorders: Cross sectional survey

CONTEXT/OBJECTIVE

Examine demographics, injury characteristics, objective measures of social isolation and health factors that are associated with perceived social isolation (PSI) among Veterans with spinal cord injury and disorders (SCI/D).

DESIGN

Cross-sectional survey.

SETTING

The Veterans Health Administrations (VHA) SCI/D system of care.

PARTICIPANTS

Veterans with SCI/D who have used the VHA health care system.

INTERVENTION

Not applicable.

OUTCOMES MEASURES

We assessed unadjusted associations of high PSI (above population mean) vs low (normative/below population mean), and multivariable logistic regression for independent associations with PSI.

RESULTS

Out of 1942 Veterans with SCI/D, 421 completed the survey (22% response rate). Over half (56%) had PSI mean scores higher than the general population. Among the objective measures, having a smaller social network size was associated with increased odds of high PSI (OR 3.59, P < .0001); additionally, for health factors, having depression (OR 3.98, P < 0.0001), anxiety (OR 2.29, P = 0.009), and post-traumatic stress (OR 2.56, P = 0.003) in the previous 6 months, and having 4 or more chronically occurring secondary conditions (OR 1.78, P = 0.045) was associated with increased odds of high PSI. The most commonly identified contributors to feelings of PSI included mobility concerns (63%), having a SCI/D (61%), and concerns about being a burden on others (57%).

CONCLUSIONS

Factors such as social network size may be used to identify individuals with SCI/D at risk for PSI. Additionally, by identifying mental health problems, presence of multiple chronically occurring secondary conditions, and Veteran-identified contributors of PSI, we can target these factors in a patient-centered interventions to identify and reduce PSI.

Conservative Management in End-Stage Kidney Disease between the Dialysis Myth and Neglected Evidence-Based Medicine

In the last few decades, the aging of the general population has significantly increased the number of elderly patients with end-stage kidney disease (ESKD) who require renal replacement therapy. ESKD elders are often frail and highly comorbid with social issues and seem to not benefit from dialysis in terms of survival and quality of life. Conservative management (CM) could represent a valid treatment option, allowing them to live for months to years with a modest impact on their habits. Despite these possible advantages, CM remains underused due to the myth of dialysis as the only effective treatment option for all ESKD patients regardless of its impact on quality of life and survival. Both CM and dialysis remain valid alternatives in the management of ESKD. However, assessing comorbidities, disabilities, and social context should drive the choice of the best possible treatment for ESKD, while in elderly patients with short life expectancies, referring them to palliative care seems the most reasonable choice.