Effects of social isolation on quality of life in elderly adults

Understanding Factors Associated With Sleep Quality in Korean American Older Adults Residing in Subsidized Senior Housing

PURPOSE

Sleep quality is crucial for older adults, yet many experience poor sleep due to physical, mental, and social factors. The current study addresses the research gap on sleep quality among Korean American older adults in senior housing by examining relevant factors.

METHOD

Using data from 314 Korean American residents in Los Angeles senior housing, we conducted descriptive analysis and logistic regression models.

RESULTS

Poor sleep was significantly associated with poor physical health (odds ratio [OR] = 4.89), low energy (OR = 7.92), severe pain (OR = 14.92), multiple chronic conditions (OR = 2.71), and poor mental health (OR = 5.82), including moderate to severe anxiety (OR = 4.71) and depression (OR = 5.11).

CONCLUSION

Findings emphasize the unique sleep needs of Korean American older adults in senior housing and provide insights to improve their well-being. The study also highlights the need for further research using longitudinal designs, broader samples, and comprehensive sleep measures. [Journal of Gerontological Nursing, xx(x), xx-xx.].

Evaluation of a multiplex genomic point-of-care strategy for rapid support of older people with respiratory infection in a geriatric hospital over a full winter season

BACKGROUND

In older patients, it is important to rapidly identify those infected by a significant pathogen in order to implement isolation measures and prescribe appropriate specific treatments when available and indicated. The objective of this study was to evaluate a multiplex genomic point-of-care (POC) strategy detecting four viruses, SARS-CoV-2, influenza virus (IV) A and B and respiratory syncytial virus (RSV), in a geriatric setting located 7 km from the central laboratory of the hospital.

METHODS

This prospective monocentric study was conducted during the 2022-2023 winter season in two geriatric wards of the University Hospital of Saint-Etienne, France. Two automated quantitative reverse transcription polymerase chain reaction (RT-qPCR) tests were compared, the reference test at the central laboratory and the POC test performed by nurses. The main outcome was the saved time to result (TTR) by the clinician with the POC technology. Additional objectives included testing performance, health-economic considerations and healthcare workers' acceptability.

RESULTS

From 69 included infectious episodes, the reference test identified 18 viral infections (7 for SARS-CoV-2, 8 for RSV, 2 for both viruses, 1 for IVA). The POC test yielded similar performance with reference test (overall concordance of 98.55 % for SARS-CoV-2 and RSV). The POC strategy showed a gain of 10.43 ( ± 6.92) hours on TTR and a cumulative time of isolation of 488.27 hours in case of negative result. Further results showed economic savings and a strong acceptability by healthcare workers in favor of the POC strategy.

CONCLUSIONS

This pilot study illustrates the benefits of a genomic POC test to identify current respiratory viral infections in older people within a geriatric setting remote from the central laboratory during a winter season with multiple viral outbreaks.

IBD Is Like a Tree: Reflections From Older Adults With Inflammatory Bowel Disease

BACKGROUND

Despite the growing proportion of older adults with inflammatory bowel disease (IBD), their lived experience is not well understood. IBD literature is generally focused on younger adults, and few studies are qualitative. Older adults may report well-being differently than younger adults, so it is important that we learn about their goals and priorities with a chronic disease.

OBJECTIVE

The study sought to understand the lived experience of older adults with IBD and explore their perceptions and priorities.

METHODS

We conducted in-depth interviews with patients ≥60 years of age with IBD to evaluate the impact and perception of IBD in the context their overall health and life. We used a hybrid inductive-deductive thematic analysis of our transcripts to identify underlying patterns.

RESULTS

We achieved thematic saturation after 22 interviews. We produced 4 major themes: (1) having IBD at an older age, (2) financial ramifications of IBD at an older age, (3) expectations for a meaningful life, and (4) unmet needs. Prominent subthemes included (1) ageism, loss of autonomy, and barriers to healthcare; (2) retirement and insurance issues; (3) redefining quality of life and gratitude; and (4) social isolation and navigating daily life with IBD.

CONCLUSIONS

Having IBD later in life presents unique challenges. Physicians treating older patients should consider age-sensitive communication, susceptibility to social isolation, and practices for healthy aging in the context of IBD. Patient priorities for further investigation include more representation in the media and educational material tailored for older adults with IBD.

Virtual avatar communication task eliciting pseudo-social isolation and detecting social isolation using non-verbal signal monitoring in older adults

Social isolation and loneliness are two of the main causes of mental health problems or suicide, not only in younger adults but also in older adults. Thus, identifying an effective method to detect social isolation is important in the field of human-machine interaction. However, to the best of our knowledge, no effective method has been developed to elicit pseudosocial isolation tasks to evaluate social isolation detection systems for older adults. This study has two research aims: 1. To develop a virtual avatar conversation cyberball task to evoke pseudosocial isolation in older adults and, 2. to identify non-verbal indicators that replace social isolation in older adults. To achieve these objectives, 22 older men were recruited as participants. They were asked to communicate with two virtual avatars on a monitor and then to rate the follow-up questions provided to evaluate the level of social isolation and emotions; meanwhile, facial expressions and gaze patterns were recorded by a camera and an eye tracker. In the results, the developed virtual avatar conversation cyberball task successfully induced pseudosocial isolation in older adults, and this social isolation was detected by the intensity of inner/outer eyebrow and eyelid movements and the blink frequency.

Social isolation, loneliness, death stress and life satisfaction in older adults: A serial mediation study

This study aims to examine the mediating role of loneliness on the relationship between social isolation and life satisfaction among older adults and tests a mechanism through which social isolation exerts its menacing effects through a sequential model of loneliness and death distress. Data came from 548 community-dwelling older adults in rural settings in Turkey. They completed some demographic information including sex, age and measures of social isolation, loneliness, death distress, and life satisfaction. The results showed that loneliness and death distress exacerbated the negative effects of social isolation on life satisfaction. Loneliness and death distress served as a sequential mediating role in the association between social isolation and life satisfaction. Older adults with higher social isolation experience heightened loneliness and death distress, and worsening levels of life satisfaction. Greater experience of loneliness in sequence with greater levels of death distress mediated the relationship between life satisfaction and social isolation.

Exploring the Experiences of Community-Dwelling Older Adults Participating in Group Interaction Programs: A Qualitative Meta-Synthesis

AIM

To synthesise evidence from qualitative studies on community-dwelling older adults' experiences of social interactions in group interaction programmes.

DESIGN

A systematic review and meta-synthesis based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines.

METHODS

Two independent researchers screened the titles and abstracts of all retrieved studies based on eligibility criteria. Quality appraisal was conducted based on the comprehensive Critical Appraisal Skills Programme checklist. Data were extracted through an adapted Data Extraction Tool from the Joanna Briggs Institute Qualitative Assessment and Instrument. Findings were synthesised through the JBI meta-aggregation approach.

DATA SOURCES

A literature search for peer-reviewed studies was conducted across seven databases from inception to September 2023.

RESULTS

Our review included the experiences of 395 community-dwelling older adults across 25 studies, yielding the overarching theme of 'Navigating relationships and facilitating growth in a supportive community'. Five themes were identified: feeling safe in a familiar environment, bringing people together, establishing meaningful relationships, improving personal well-being and facing socialising challenges.

CONCLUSION

Our findings provided not just theoretical insights but also practical implications. They can serve as a solid foundation for formulating or enhancing similar programmes, directly addressing the pervasive issues of loneliness and social isolation among the ageing population worldwide.

IMPLICATIONS FOR NURSING

This review improves our understanding of the social, emotional and personal benefits for older adults upon engaging in group interaction programmes. The insights into the elements of successful group interaction programmes for older adults, include providing a safe and familiar setting and bringing people together for socialisation. Future interventions should incorporate these elements to promote social interactions and community engagement more effectively to mitigate loneliness among older adults. Finally, the diverse range of programmes explored in this review demonstrates that future programmes can be flexibly formulated to suit different interests.

PATIENT AND PUBLIC CONTRIBUTION

The authors have nothing to report.

PROTOCOL REGISTRATION

The review protocol has been registered on PROSPERO.

Depression, Loneliness and Quality of Life in Institutionalised and Non-Institutionalised Older Adults in Portugal: A Cross-Sectional Study

Our study aims to estimate the prevalence of depressive symptomatology among older adults and to assess their association with loneliness and quality of life according to institutionalisation status in a Portuguese sample.

BACKGROUND

The World Health Organisation estimates that by 2050, the world's population over 60 will number two billion people, which poses complex challenges in terms of maintaining the mental health of older adults. The COVID-19 pandemic has increased the prevalence of depressive symptoms in this population, but the post-pandemic phase has not yet been studied much.

METHODS

A cross-sectional survey was carried out in 2023 among institutionalised and non-institutionalised older adults (total n = 525; institutionalised = 458; non-institutionalised = 67) who were selected by convenience sampling. The Patient Health Questionnaire (PHQ-9) was used to assess the presence of depressive symptoms, the WHOQOL-BREF to assess perceived quality of life and the Loneliness Scale (UCLA) to assess negative feelings of loneliness. Unconditional logistic regression models were fitted to compute crude adjusted odds ratios (ORs) and the respective 95% confidence intervals (95%CIs) for the association between sociodemographic, clinical and psychosocial characteristics and depressive symptomatology, according to institutionalisation status. The final model was adjusted for sex, age, QoL and feelings of loneliness.

RESULTS

Of the 525 participants, 74.6% of the non-institutionalised participants had no or minimal depressive symptoms, while 55.4% of the institutionalised participants fell into this category. Mild to moderately severe depressive symptoms were present in 25.4% of the non-institutionalised participants. 26.9% of the institutionalised participants had mild symptoms, 11.8% had moderate symptoms, 3.9% had moderately severe symptoms, and 2.0% had severe depressive symptoms. Overall, a higher quality of life was associated with lower levels of depressive symptoms. Participants describing feelings of loneliness were more likely also to present depressive symptoms (OR = 78.10; 95%CI 2.90-2106.08 and OR = 3.53; 95%CI 1.72-6.91 for non-institutionalised and institutionalised older adults, respectively), independently of institutionalisation status.

CONCLUSIONS

The prevalence of depressive symptoms is high in older adults, which means that it has not decreased after the increase seen due to the COVID-19 pandemic. A lower perception of quality of life and the presence of negative feelings of loneliness are associated with the presence of depressive symptoms. These conclusions suggest that plans should be developed to intervene in the dimensions of depressive symptoms, perceived quality of life and negative feelings of loneliness.

Age-Related Hearing Loss, Cognitive Decline, and Social Interaction: Testing a Framework

PURPOSE

Aging increases risk for hearing loss, cognitive decline, and social isolation; however, the nature of their interconnection remains unclear. This study examined the interplay between age-related hearing loss, cognitive decline, and social isolation in adults by testing the ability to understand speech in background noise, a challenge frequently reported by many older adults.

METHOD

We analyzed data collected from 128 adults (20-79 years of age, Mage = 51 years) recruited as part of the Aging Brain Cohort at the University of South Carolina repository. The participants underwent testing for hearing, cognition, and social interaction, which included pure-tone audiometry, a words-in-noise (WIN) test, a hearing questionnaire (Speech, Spatial and Qualities of Hearing Scale [SSQ12]), a social questionnaire (Patient-Reported Outcomes Measurement Information System-57 Social), and the Montreal Cognitive Assessment. We used a single pure-tone average (PTA) threshold value and a single WIN threshold value for each participant because there were no differences on average between the left and right ears.

RESULTS

Poorer hearing was significantly associated with cognitive decline, through both PTA and WIN thresholds, with a stronger association observed for WIN threshold. Adults with poorer hearing also exhibited greater social isolation, as evidenced by their WIN threshold and SSQ12 score, although not through PTA. This connection was more pronounced with the WIN threshold than with the SSQ12 score. Cognition was not related to social isolation, suggesting that social isolation is affected more by the ability to understand words in noise than by cognition in a nondemented population.

CONCLUSIONS

Understanding speech in challenging auditory environments rather than mere threshold detection is strongly linked to social isolation and cognitive decline. Thus, inclusion of a word-recognition-in-noise test and a social isolation survey in clinical settings is warranted.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26237060.

Recovering from physical trauma in late life, a struggle to recapture autonomy: A grounded theory study

AIM

The study aimed to explore the experiences of care and recovery among older patients treated for physical trauma.

DESIGN

A qualitative study with a constructivist grounded theory design.

METHODS

Fifteen in-depth interviews with older adults recovering from physical trauma were conducted and analysed between 2019 and 2023, in accordance with grounded theory methodology.

RESULTS

The findings show that for older patients who suffered physical trauma, the core category was the strive to recapture autonomy. This was achieved by means of Adaptation, Reflection and Interactions, which constitute the three main categories. Recovery involves facing and navigating various new life challenges, such as increased dependency on others, managing difficult symptoms and adapting in various ways to everyday life. The recovery process was influenced by fear, hope and the attitude towards new challenges.

CONCLUSION

Older adults being cared for after a traumatic event have a difficult path to recovery ahead of them. Dealing with increased unwanted dependency on others was a main concern for the participants. Undertreated symptoms can lead to undesired isolation, delayed recovery and further increase unwanted dependency. On the other hand, hope, which was defined as having a positive approach to life and longing for the future, was a strong accelerating factor in the recovery process.

IMPACT

As a result of this study, we have established that older patients experience the initial period after trauma as difficult and that support in the initial phase can be helpful when returning home. As healthcare services are under increasing pressure because of an ageing population, this study contributes by addressing an understudied population and clarifying their concerns.

REPORTING METHOD

Reporting adheres to the COREQ (COnsolidated criteria for REporting Qualitative research) Checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public involvement.

Association between the COVID-19 pandemic and mental health in very old people in Sweden

BACKGROUND

During the COVID-19 pandemic, Sweden implemented social distancing measures to reduce infection rates. However, the recommendation meant to protect individuals particularly at risk may have had negative consequences. The aim of this study was to investigate the impact of the COVID-19 pandemic on very old Swedish peoples' mental health and factors associated with a decline in mental health.

METHODS

We conducted a cross-sectional study among previous participants of the SilverMONICA (MONItoring of Trends and Determinants of CArdiovascular disease) study. Of 394 eligible participants, 257 (65.2%) agreed to participate. Of these, 250 individuals reported mental health impact from COVID-19. Structured telephone interviews were carried out during the spring of 2021. Data were analysed using the χ2 test, t-test, and binary logistic regression.

RESULTS

Of 250 individuals (mean age: 85.5 ± 3.3 years, 54.0% women), 75 (30.0%) reported a negative impact on mental health, while 175 (70.0%) reported either a positive impact (n = 4) or no impact at all (n = 171). In the binary logistic regression model, factors associated with a decline in mental health included loneliness (odds ratio [95% confidence interval]) (3.87 [1.83-8.17]) and difficulty adhering to social distancing recommendations (5.10 [1.92-13.53]). High morale was associated with positive or no impact on mental health (0.37 [0.17-0.82]).

CONCLUSIONS

A high percentage of very old people reported a negative impact on mental health from the COVID-19 pandemic, primarily from loneliness and difficulty adhering to social distancing measures, while high morale seemed to be a protective factor.

Social isolation, depression, nutritional status and quality of life during COVID-19 among Chinese community-dwelling older adults: a cross-sectional study

OBJECTIVE

This survey investigated the relationship between social isolation, depression, nutritional status and quality of life among community-dwelling older adults during COVID-19.

DESIGN

This was a cross-sectional survey study.

SETTING

Communities in Pudong New Area, Shanghai, China that have contracted with Renji Hospital, affiliated with Shanghai Jiao Tong University School of Medicine.

PARTICIPANTS

From May to July 2022, 406 community-dwelling older adults were selected by convenience sampling in Shanghai, China.

PRIMARY AND SECONDARY OUTCOME MEASURES

The Lubben Social Network Scale, Geriatric Depression Scale, 36-item Short Form Health Survey Scale and risk assessment of malnutrition were used in older adults. Mediation models were constructed to determine the mediating role of depression and nutritional status on social isolation and quality of life among older adults.

RESULTS

The prevalence of social isolation among older adults in the community was 44.3%. The total social isolation score in community-dwelling older adults was positively associated with the total malnutrition risk and quality of life scores, and negatively associated with depression (p<0.01). Logistic regression demonstrated that living alone, loss of families or friends during COVID-19 and depression were risk factors for social isolation among community-dwelling older adults (p<0.05). Social isolation could directly affect the quality of life (β=0.306). In addition, depression (β=0.334) and nutritional status (β=0.058) had a significant mediating effect on the relationship between social isolation and quality of life.

CONCLUSIONS

Our findings showed that the prevalence of social isolation among older adults increased during COVID-19. Depression and nutritional status played parallel mediating roles on the effect of social isolation on quality of life. Community workers and healthcare providers should develop intervention plans to improve the status of social isolation in older adults, eliminating existing and ongoing adverse effects.

The relationship between social isolation, social support, and loneliness with cardiovascular disease and shared risk factors: A narrative review

BACKGROUND

Cardiovascular disease (CVD) is the greatest contributor to global morbidity and mortality. Poor social health plays a critical role in CVD incidence. Additionally, the relationship between social health and CVD may be mediated through CVD risk factors. However, the underlying mechanisms between social health and CVD are poorly understood. Certain social health constructs (social isolation, low social support and loneliness) have complicated the characterisation of a causal relationship between social health and CVD.

AIM

To provide an overview of the relationship between social health and CVD (and its shared risk factors).

METHOD

In this narrative review, we examined published literature on the relationship between three social health constructs (social isolation, social support, and loneliness) and CVD. Evidence was synthesised in a narrative format, focusing on the potential ways in which social health affects CVD, including shared risk factors.

RESULTS

The current literature highlights an established relationship between social health and CVD with a likelihood for bi-directionality. However, there is speculation and varied evidence regarding how these relationships may be mediated through CVD risk factors.

CONCLUSIONS

Social health can be considered an established risk factor for CVD. However, the potential bi-directional pathways of social health with CVD risk factors are less established. Further research is needed to understand whether targeting certain constructs of social health may directly improve the management of CVD risk factors. Given the health and economic burdens of poor social health and CVD, improvements to addressing or preventing these interrelated health conditions would have societal benefits.

The Role of Autopsy and Post-Mortem Investigations in Falling Traumas in the Hospital Environment

Falls in a hospital setting are a global public health problem. Despite the production of sensors and various preventive tools to reduce the risk, falls remain a dangerous event with a significant impact on the morbidity and mortality of patients. Despite numerous prevention strategies, falling in the hospital are not always investigated and the autopsy is not always performed in these cases, so it is often not known whether the death is related to the fall or to other causes, inevitably affecting the assessment of any profiles of medical liability for health personnel or for the hospital in the accident. We describe three cases of falls that occurred in different hospitals, in which the autopsy allowed to diagnose with certainty the extent of the trauma and to reconstruct its dynamics. Along with the circumstantial and documentary analyses, deficiencies both in the trauma diagnostics and in the application of the safety measures on the patients were showed. Together with the description of our cases, we propose the post-mortem investigations of these events, both for judicial and risk management purposes.