Social isolation: a predictor of mortality comparable to traditional clinical risk factors

Conceptualizing Biological Aging and Frailty in Orthopaedics: A Framework for Clinical Practice

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Biological aging can best be conceptualized clinically as a combination of 3 components: frailty, comorbidity, and disability.

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Despite advancements in the understanding of senescence, chronological age remains the best estimate of biological age. However, a useful exercise for practitioners is to look beyond chronological age in clinical and surgical decision-making.

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A chronologically aging person does not age biologically at the same rate.

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The best way to understand frailty is to consider it as a physical phenotype.

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Physical optimization should parallel medical optimization before elective surgery.

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The poorer the host (both in terms of bone quality and propensity for healing), the more robust the implant construct must be to minimize reliance on host biology.

Causes, experiences and consequences of the impact of chronic heart failure on the person´s social dimension: A scoping review

Chronic heart failure (CHF) is a progressive and disabling condition that significantly impacts patients' daily lives. One of its effects is decreased opportunities to participate in social life, leading to reduced social interaction, loneliness, social isolation and lack of social support to continue with their daily life activities. This study aimed to explore the causes, experiences, and consequences of the impact of CHF on the social dimension of the person. According to the Arksey & O'Malley method, a scoping review of the literature was conducted to examine existing knowledge in the area, summarise existing evidence and identify gaps in the literature. The search was conducted in the PubMed, CINAHL, PsychINFO, Scopus, and Web of Science databases from January 2010 to November 2021. Twenty-six articles were identified. The reasons why CHF influences the social dimension of the person were multifactorial and related to physical aspects, sociodemographics, lifestyle changes and the feelings experienced by these patients. Social relationships play a key role, and the benefits of good social relationships and the impact of poor or inadequate social support were identified. Furthermore, the influence of alterations in the social dimension on the CHF patient's clinical outcomes was described. This approach will help to detect and better understand the bidirectional influence that exists in each person between social isolation, relationships, and support life experiences, self-care activities, and morbi-mortality rates. These findings have shown the importance of detecting higher-risk groups and systematically assessing factors related to the social dimension in all patients with CHF.

Factors associated with recovery from homelessness among veterans in permanent supportive housing

AIMS

We sought to identify person- and program-level factors distinguishing permanent supportive housing (PSH) residents with higher versus lower social integration; and higher versus lower instrumental functioning.

METHODS

Among 60 PSH residents at Los Angeles' VA, surveys and medical records captured person-level factors. Using a median split, we dichotomized participants with higher versus lower social integration; and higher versus lower instrumental functioning. Recursive partitioning (RP) identified variables that best-differentiated these subgroups. Interviews with 26 participants captured their perceptions on social integration and instrumental functioning.

RESULTS

Using RP, health-related quality of life, psychiatric symptoms and case management frequency best-differentiated the social integration subgroups. Few perceived that PSH affected social integration. RP did not yield a stable model to differentiate the instrumental functioning subgroups; participants perceived that PSH addressed most functional deficits.

CONCLUSIONS

Services that enhance social integration may benefit PSH residents with poor health; existing services may adequately address instrumental functioning.

Marital Status, Living Arrangement, and Cancer Recurrence and Survival in Patients with Stage III Colon Cancer: Findings from CALGB 89803 (Alliance)

BACKGROUND

Limited and conflicting findings have been reported regarding the association between social support and colorectal cancer (CRC) outcomes. We sought to assess the influences of marital status and living arrangement on survival outcomes among patients with stage III colon cancer.

PATIENTS AND METHODS

We conducted a secondary analysis of 1082 patients with stage III colon cancer prospectively followed in the CALGB 89803 randomized adjuvant chemotherapy trial. Marital status and living arrangement were both self-reported at the time of enrollment as, respectively, married, divorced, separated, widowed, or never-married, and living alone, with a spouse or partner, with other family, in a nursing home, or other.

RESULTS

Over a median follow-up of 7.6 years, divorced/separated/widowed patients experienced worse outcomes relative to those married regarding disease free-survival (DFS) (hazards ratio (HR), 1.44 (95% CI, 1.14-1.81); P =.002), recurrence-free survival (RFS) (HR, 1.35 (95% CI, 1.05-1.73); P = .02), and overall survival (OS) (HR, 1.40 (95% CI, 1.08-1.82); P =.01); outcomes were not significantly different for never-married patients. Compared to patients living with a spouse/partner, those living with other family experienced a DFS of 1.47 (95% CI, 1.02-2.11; P = .04), RFS of 1.34 (95% CI, 0.91-1.98; P = .14), and OS of 1.50 (95% CI, 1.00-2.25; P =.05); patients living alone did not experience significantly different outcomes.

CONCLUSION

Among patients with stage III colon cancer who received uniform treatment and follow-up within a nationwide randomized clinical trial, being divorced/separated/widowed and living with other family were significantly associated with greater colon cancer mortality. Interventions enhancing social support services may be clinically relevant for this patient population.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT00003835.

Social isolation, loneliness, and all-cause mortality: A cohort study of 35,254 Chinese older adults

BACKGROUND

Few studies of social isolation, loneliness and associations with all-cause mortality in older adults have been conducted in non-Western countries. The aim of this study was to conduct such an analysis in a nationally representative sample of Chinese older adults.

METHODS

This study used eight waves of data from the Chinese Longitudinal Healthy Longevity Survey from 1998 to 2018 and focused on participants aged ≥60 years. A total of 21,570 people died (61.2%) over a median follow-up of 4.8 years. Social isolation, loneliness, demographic, health and lifestyle factors were measured at baseline. The primary outcome was all-cause mortality. Cox proportional hazard regression models were used to examine the associations of isolation and loneliness with all-cause mortality.

RESULTS

This study included 35,254 participants with mean age of 86.63 ± 11.39 years. Social isolation was significantly associated with an increased mortality (adjusted HR 1.22; 95% CI 1.18-1.25; p < 0.01). The association of loneliness with mortality was nonsignificant after adjustment for health indicators and low psychological well-being (HR 1.01; 95% CI 0.98-1.04; p = 0.69). However, when stratified by age, there was a significant association of loneliness with mortality among participants aged <80 years (HR 1.15; 95% CI 1.05-1.26; p < 0.01).

CONCLUSIONS

Social isolation was associated with an increased all-cause mortality among the older Chinese adults. However, loneliness was associated with an increased mortality only among younger participants. Public health interventions aimed at increasing social connectedness may potentially reduce excess mortality among older adults.

The Concept of Social Health From an Iranian Perspective: A Qualitative Exploration

Objective

As one of the health aspects, social health is less well-known than physical and mental aspects. In order to better understand this aspect and considering the importance of social context in its conceptualizing, the present study was performed aiming at explaining the social health and identification of its various aspects in the perspective of Iranian adults.

Methodology

The present study was conducted in 2021 with a qualitative approach and with the participation of Iranian adults and social health professionals. Data were collected through semi-structured interviews with 36 participants who were selected by purposive sampling. The obtained data were analyzed using qualitative (conventional) content analysis and Granheim and Lundman method in the MAXQDA-2020. Guba and Lincoln criteria were observed to evaluate the quality of research results.

Results

Using data analysis, 3 main categories and 17 subcategories were obtained, including: (1) Conceptual scope of social health (social health as social capital, social health as mental health, social health as moral health), (2) Characteristics of social health (biologic, continual, acquired, evolutionary, relative), and (3) Social health dimensions (openness to interactions, social adaptability, social dutifulness, social self-esteem, mutual trust, communicational capability, social optimism, enjoying social support, public-oriented personality).

Conclusion

Since social health has a conceptual scope, it is important to try to strengthen and reproduce the dimensions of social health and at the same time use planning, policymaking and appropriate interventions to improve and to promote the dimensions of social health.

Psychological Predictors of Self-reported COVID-19 Outcomes: Results From a Prospective Cohort Study

BACKGROUND

Previous research has shown that psychological factors, such as stress and social support, are associated with greater susceptibility to viral respiratory illnesses and more severe symptoms. During the COVID-19 pandemic there has been a well-documented deterioration in psychological well-being and increased social isolation. This raises questions as to whether those experiencing psychological adversity during the pandemic are more at risk of contracting and/or experiencing COVID-19 symptoms.

PURPOSE

To examine the relationship between psychological factors and the risk of COVID-19 self-reported infection and the symptomatic experience of SARS-CoV-2 (indicated by the number and severity of symptoms).

METHODS

As part of a longitudinal prospective observational cohort study, 1,087 adults completed validated measures of psychological well-being during April 2020 and self-reported incidence of COVID-19 infection and symptom experience across the pandemic through to December 2020. Regression models were used to explore these relationships controlling for demographic and occupational factors.

RESULTS

Greater psychological distress during the early phase of the pandemic was significantly associated with subsequent self-reported SARS-CoV-2 infection as well as the experience of a greater number and more severe symptoms.

CONCLUSIONS

COVID-19 infection and symptoms may be more common among those experiencing elevated psychological distress. Further research to elucidate the mechanisms underlying these associations is needed.

[Pre-post evaluation of an intergenerational program to improve wellbeing in older adults and age stereotypes in primary and secondary students: CRENCO project]

OBJECTIVE

The present study aims to evaluate the effectiveness of the CRENCO project which was carried out during the COVID-19 pandemic including intergenerational activities shared by students from primary and secondary education and users of two centers for older adults and a day hospital in Catalonia. The effectiveness was assessed in terms of well-being in older adults and on negative stereotypes about the elderly in primary and secondary students.

METHODS

Three interventions were carried out in which 32 older persons (9 users of centers for older adults and 23 of a day hospital), 99 primary students and 56 secondary students participated. Participants answered a questionnaire before and after the interventions. Through multilevel linear models for repeated measures, changes in feelings of loneliness, social support, anxiety and depressive symptoms, self-reported health and health-related quality of life were evaluated in older people. In primary and secondary students, changes in age stereotypes were evaluated.

RESULTS

Health-related quality of life and self-reported health improved statistically after the interventions in older persons. Users of the day hospital also reported an improvement in social support. Primary school students improved their age stereotypes; no statistically significant changes were detected in secondary students.

CONCLUSION

The results of the present study contribute to underlining the importance of intergenerational programs such as the one proposed by CRENCO, capable of improving well-being and providing a more realistic vision of the older adults. Our results suggest that these programs should be implemented during childhood in order to prevent the proliferation of ageist stereotypes in later life stages.

Associations of face-to-face and non-face-to-face social isolation with all-cause and cause-specific mortality: 13-year follow-up of the Guangzhou Biobank Cohort study

BACKGROUND

Although social isolation has been associated with a higher mortality risk, little is known about the potential different impacts of face-to-face and non-face-to-face isolation on mortality. We examined the prospective associations of four types of social isolation, including face-to-face isolation with co-inhabitants and non-co-inhabitants, non-face-to-face isolation, and club/organization isolation, with all-cause and cause-specific mortality separately.

METHODS

This prospective cohort study included 30,430 adults in Guangzhou Biobank Cohort Study (GBCS), who were recruited during 2003-2008 and followed up till Dec 2019.

RESULTS

During an average of 13.2 years of follow-up, 4933 deaths occurred during 396,466 person-years. Participants who lived alone had higher risks of all-cause (adjusted hazard ratio (AHR) 1.24; 95% confidence interval (CI) 1.04-1.49) and cardiovascular disease (CVD) (1.61; 1.20-2.03) mortality than those who had ≥ 3 co-habitant contact after adjustment for thirteen potential confounders. Compared with those who had ≥ 1 time/month non-co-inhabitant contact, those without such contact had higher risks of all-cause (1.60; 1.20-2.00) and CVD (1.91; 1.20-2.62) mortality. The corresponding AHR (95% CI) in participants without telephone/mail contact were 1.27 (1.14-1.42) for all-cause, 1.30 (1.08-1.56) for CVD, and 1.37 (1.12-1.67) for other-cause mortality. However, no association of club/organization contact with the above mortality and no association of all four types of isolation with cancer mortality were found.

CONCLUSIONS

In this cohort study, face-to-face and non-face-to-face isolation were both positively associated with all-cause, CVD-, and other-cause (but not cancer) mortality. Our finding suggests a need to promote non-face-to-face contact among middle-aged and older adults.

Social Anxiety as a Consequence of Non-consensually Disseminated Sexually Explicit Media Victimization

The purpose of this qualitative study was to explore consequences of the non-consensual dissemination of sexually explicit media (NCDSEM) for survivors, with an emphasis on how NCDSEM may impact social relationships and social anxiety. One-on-one telephone interviews with (N = 17) self-identified survivors of NCDSEM were conducted between May and December 2019. Interviews were analyzed using a flexible coding methodology. There were five main ways in which participants described consequences of NCDSEM: (a) fear of going out in public, (b) fear of engaging in relationships, (c) fear of applying to jobs, (d) fear of seeking help, and (e) influencing depression and feelings of anxiety. These findings suggest that, for some people, NCDSEM victimization may influence whether and how they subsequently socialize with other people.

The Impact of the COVID-19 Pandemic on Patients from a Bariatric Program: A Qualitative Analysis of Their Perceptions of Health and Well-Being

Introduction: The study was conducted to explore the perceptions of patients from a bariatric program who have undergone or will undergo bariatric surgery during the ongoing COVID-19 pandemic, specifically as related to their struggles with health issues and their psychological well-being. Materials and Methods: We conducted semi-structured, in-depth interviews with nineteen pre- or post-bariatric patients to generate data on their perceptions of COVID-19. Consistent with the methods of constructivist grounded theory, we collected and analyzed data iteratively through a constant comparative process for data coding and develop themes in the transcripts. Results: We identified themes to summarize the pandemic-associated experiences of our cohort as follows: their life structure before COVID-19, the turning point with changes and adaptations, and the impact of isolation on psychological well-being. We identified grief due to loss of social contacts as well as physical and psychological health impairment as consequences of pandemic-related lifestyle changes. Most participants were not aware of overweight and obesity being major risk factors for worse outcomes of COVID-19. We developed a theme-based theory on patients’ perceptions and fears regarding the pandemic as they live through phases of grief. Discussion: Most participants shared critical perceptions about their own somatic and psychological health. These findings may inform recommendations and strategies for both patients and healthcare professionals to manage the challenges potentially presented by this vulnerable patient group in the context of the COVID-19 pandemic.

The COVID-19 Pandemic Related Lived Experiences of Individuals With a Spinal Cord Injury/Disease

Introduction

COVID-19 related restrictions and recommendations have impacted everyone. Those living with a disability, such as individuals with a spinal cord injury (SCI), may have had pandemic related changes made yet more challenging by societal failures to accommodate their mobility, physical abilities, and health care needs. To better understand participants experiences we drew upon Heidegger's phenomenology and the mobilities paradigm. The objective of this study was to explore COVID-19 pandemic related lived-experiences of individuals with an SCI.

Materials and Methods

This study used an interpretive phenomenological methodology. Semi-structured interviews were the primary means of data collection. These were conducting in May and June of 2020, roughly 2–3 months into the pandemic. Transcript data were analyzed using a phenomenological methodology.

Results

We interviewed 22 participants with SCI, the mean age was 54 years, and nine were females. We identified three themes: (1) Experiencing changes to mobility and daily life described how new rules had impacted everyday life and usual routines, particularly in regard to mobility. (2) Struggling with new challenges explored some of the negative experiences of the pandemic. (3) Being resilient in the face of a new normal conveyed the resilience participants exhibited despite challenges.

Conclusion

Although our findings indicate some positive changes and highlight the strengths that many individuals with SCI have, they also accentuate issues with ableism within the medical system. Certain changes were made primarily because people without disabilities needed them, and several COVID-19 changes were made without consulting individuals with disabilities. With physical movement restricted, our findings emphasize the importance of the movement of information and a need for increased dialogue with people in the SCI community about their ongoing pandemic related needs.

Lockdown strictness and mental health effects among older populations in Europe

This paper investigates whether lockdown policies aggravated mental health problems of older populations (50 and over) in Europe during the first COVID-19 wave. Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE COVID-19 questionnaire) and from the Oxford COVID-19 Government Response Tracker for 17 countries, we estimate the causal effect of lockdown policies on mental health by combining cross-country variability in the strictness of the policies with cross-individual variability in face-to-face contacts prior to the pandemic. We find that lockdown policies worsened insomnia, anxiety, and depression by 5, 7.2 and 5.1 percentage points, respectively. This effect was stronger for women and those aged between 50 and 65. Interestingly, lockdown policies notably damaged the mental health of healthy populations. We close with a discussion of lockdown policies targeted at individuals above 65 and/or with pre-existing conditions.

A Mixed Methods Study of Hearing Loss, Communication, and Social Engagement in a Group Care Setting for Older Adults

PURPOSE

The purpose of this study is to characterize the communication needs of older adults in group care environments and understand the factors that foster engaged communication.

METHOD

This mixed methods study provides an in-depth analysis of communication and engagement for older adults at two Program for All-inclusive Care for the Elderly (PACE) sites. Seventy-two PACE participants (M _age = 74 years) completed a hearing test, cognitive screener (MOST^™), the Institute of Medicine (IOM) Measures of Social and Behavioral Determinants of Health Questionnaire, and the UCLA Loneliness Scale. Using maximum variation sampling based on hearing status and UCLA Loneliness scores, 19 participants were invited to do (and 11 participants completed) one-on-one semi-structured interviews. In addition, 35 staff members participated in 5 focus groups. Field observations were interspersed throughout the data collection period.

RESULTS

Results suggest that communication challenges such as hearing loss, cognitive decline, and social isolation are highly prevalent in this convenience sample. Sixty-seven percent have at least a mild hearing loss in the better hearing ear. Eighty-two percent scored in the "very" or "most isolated" range of the IOM Measures of Social and Behavioral Determinants of Health questionnaire. The mean score on the MOST^™ cognitive screener was 17.6, which is below the dementia screening cutoff score of 18 points. A thematic analysis of the qualitative data suggests that the PACE programs support socialization and engagement. A conceptual framework was developed by integrating quantitative and qualitative findings to recognize what contributes to meaningful interactions or engaged communication.

CONCLUSION

Identifying communication challenges can enhance the benefits individuals can experience at care facilities and lessen the burden of the staff members trying to provide safe and effective care. In order to maximize the potential benefit of attending group-based day centers, the communication challenges and motivations of older adults need to be addressed.

The Relationship Between Social Isolation and Mortality Among Adults Aged 50 and Older in a 12-year Follow-Up Analysis in Mexico

Social relationships have a complex nature shaped mainly by two dimensions: structure and function. Previous research raised the importance of considering both features simultaneously given that they may operate differently. However, research on social relationships and mortality mainly refers to European and U.S. populations. This study examines structural and functional features of social relationships to understand social isolation among adults aged 50 and older in Mexico. In addition, we analyze that association with mortality, using panel data from a 12-year follow-up from the Mexican Health and Aging Study (2003-2015). Results reveal that structural and functional features of social relationships are intertwined, and social isolation was shaped by two aspects that we label lack of socialization and being alone and feeling lonely. After controlling for a series of sociodemographic and health variables, Cox proportional hazard regression models indicate that both aspects significantly increase mortality among older adults in Mexico.

Social barriers influence inflammatory bowel disease (IBD) outcomes and disproportionally affect Hispanics and non-Hispanic Blacks with IBD

BACKGROUND

The impact of social determinants of health in inflammatory bowel disease (IBD) remains understudied. We evaluated the impact of social barriers on IBD outcomes within a diverse cohort of patients.

METHODS

We performed a cross-sectional study on adult IBD patients and assessed known social determinants of health. We calculated the total prevalence of these barriers in the sample as a whole and within each ethnic group. We summed the number of barriers present for each individual to create a cumulative social barrier score (SBS), and we evaluated the relationship of each barrier and of the cumulative SBS with IBD outcomes, including disease activity and depressive symptoms.

RESULTS

A total of 316 patients were included in the study. Disparities in the prevalence of social barriers emerged by ethnicity: non-Hispanic Blacks reported the greatest number of social barriers, followed by Hispanic patients. Prevalent social barriers included financial strains (38.4%), such as food insecurity, medical care delays (~30%), and low educational attainment (26.8%). Social barriers associated with poor IBD outcomes included low educational attainment, poor health literacy, and financial insecurity. High SBS was associated with greater depressive symptoms [odds ratio (OR) 1.94, 95% confidence interval (CI) 1.21-2.9, p = 0.001] and lower reported use of medications. Greater ulcerative colitis (UC) disease activity was observed in patients with greater SBS. No associations were identified between SBS and IBD surgeries, hospitalizations, or disease location.

CONCLUSION

Our study identifies social barriers that may impact IBD care and are disproportionately higher in non-Hispanic Blacks and Hispanics in the United States. Future studies should focus on implementing interventions to reduce these barriers and improve delivery of care.

The association between social network index, atrial fibrillation, and mortality in the Framingham Heart Study

Social isolation might be considered as a marker of poor health and higher mortality. The aim of our analysis was to assess the association of social network index (SNI) with incident AF and death. We selected participants aged ≥ 55 years without prevalent AF from the Framingham Heart Study. We evaluated the association between social isolation measured by the Berkman-Syme Social Network Index (SNI), incident AF, and mortality without diagnosed AF. We assessed the risk factor-adjusted associations between SNI (the sum of 4 components: marriage status, close friends/relatives, religious service attendance, social group participation), incident AF, and mortality without AF by using Fine-Gray competing risk regression models. We secondarily examined the outcome of all-cause mortality. We included 3454 participants (mean age 67 ± 10 years, 58% female). During 11.8 ± 5.2 mean years of follow-up, there were 686 incident AF cases and 965 mortality without AF events. Individuals with fewer connections had lower rates of incident AF (P = 0.04) but higher rates of mortality without AF (P = 0.03). Among SNI components, only social group participation was associated with higher incident AF (subdistribution hazards ratio [sHR] 1.35, 95% CI 1.16-1.57, P = 0.0001). For mortality without AF, social group participation (sHR = 0.81, 95% CI 0.71-0.93, P = 0.002) and regular religious service attendance sHR = 0.76, 95% CI 0.67-0.87, P < 0.0001) were associated with lower risk of death. Social isolation was associated with a higher rate of mortality without diagnosed AF. In contrast to our hypothesis, we observed that poor social connectedness was associated with a lower rate of incident AF. This finding should be interpreted cautiously since there were very few participants in the lowest social connectedness group. Additionally, the seemingly protective effect of social isolation on AF incidence may be simply an artifact of the strong association between social isolation and increased mortality rate in combination with the large number of deaths as compared to AF events in our study. Further study is warranted.

Social Isolation and Incident Heart Failure Hospitalization in Older Women: Women's Health Initiative Study Findings

Background The association of social isolation or lack of social network ties in older adults is unknown. This knowledge gap is important since the risk of heart failure (HF) and social isolation increase with age. The study examines whether social isolation is associated with incident HF in older women, and examines depressive symptoms as a potential mediator and age and race and ethnicity as effect modifiers. Methods and Results This study included 44 174 postmenopausal women of diverse race and ethnicity from the WHI (Women's Health Initiative) study who underwent annual assessment for HF adjudication from baseline enrollment (1993-1998) through 2018. We conducted a mediation analysis to examine depressive symptoms as a potential mediator and further examined effect modification by age and race and ethnicity. Incident HF requiring hospitalization was the main outcome. Social isolation was a composite variable based on marital/partner status, religious ties, and community ties. Depressive symptoms were assessed using CES-D (Center for Epidemiology Studies-Depression). Over a median follow-up of 15.0 years, we analyzed data from 36 457 women, and 2364 (6.5%) incident HF cases occurred; 2510 (6.9%) participants were socially isolated. In multivariable analyses adjusted for sociodemographic, behavioral, clinical, and general health/functioning; socially isolated women had a higher risk of incident HF than nonisolated women (HR, 1.23; 95% CI, 1.08-1.41). Adding depressive symptoms in the model did not change this association (HR, 1.22; 95% CI, 1.07-1.40). Neither race and ethnicity nor age moderated the association between social isolation and incident HF. Conclusions Socially isolated older women are at increased risk for developing HF, independent of traditional HF risk factors. Registration URL: http://www.clinicaltrials.gov; Unique identifier: NCT00000611.

Significantly Increased Risk of All-Cause Mortality Among Type 2 Diabetes Patients Living Alone

Background

There is a lack of studies evaluating the association between living status and subsequent outcomes in patients with type 2 diabetes (T2DM).

Objectives

This study aimed to assess the association between living alone and the risk of all-cause mortality in T2DM patients.

Methods

We performed a secondary analysis in patients with long-lasting T2DM from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. The primary outcome was all-cause mortality. Multivariable Cox proportional hazard models was used to analyze and compare the hazard ratios (HRs) in patients living alone and with one or more adults.

Results

This study included 10,249 patients with T2DM. Of these, 2,078 (20.28%) were living alone and 8,171 (79.72%) lived with one or more adults. Over a median total follow-up of 8.8 years, 1,958 patients developed the primary endpoint. The all-cause mortality rates in patients living alone or living with one or more adults were 23.24 and 18.05%, respectively. Cox proportional hazard analysis showed that T2DM patients living alone had significantly higher rate of all-cause mortality than those living with others (HR, 1.34; 95% confidence interval [CI], 1.20–1.48; p < 0.001). After multivariable adjustment, living alone was an independent risk factor for all-cause mortality in patients with T2DM (adjusted HR, 1.27; 95% CI, 1.14–1.41; p < 0.001). Furthermore, the risks of both congestive heart failure (CHF) and fatal coronary heart disease (CHD) among 4,050 propensity score-matched patients were higher for patients living alone (respectively HR, 1.37; 95% CI, 1.08–1.74; p = 0.010; and HR, 1.16; 95% CI, 1.00–1.34; p = 0.047).

Conclusions

The risk of all-cause mortality was significantly higher in T2DM patients living alone than in those living with one or more adults.

Global Prevalence, Risk Factors, and Outcomes of Depression After Liver Transplant: A Systematic Review and Meta-analysis

Background and aims

With existing literature focusing on general quality of life, the magnitude and impact of depression among recipients after liver transplantation (LT) is unclear. Hence, we aim to evaluate the prevalence, risk factors, and outcomes for recipient-related depression after LT.

Methods

Medline and Embase were searched. Single-arm analysis was pooled using the generalized linear mixed model, and logistic regression was performed to analyze risk factors. Pairwise comparative meta-analysis in odds ratio was conducted for binary outcomes.

Results

Of 1069 abstracts, 189 articles underwent full-text review before the inclusion of 48 articles. Pooled depression rate among 5170 recipients was 24.52% (confidence interval [CI]: 19.46%-30.41%). Depression was most prevalent in Asia compared with other geographical regions. Younger age at transplantation (P = .019) and university education (P = .051) were protective against depression. However, those transplanted for alcoholic liver disease (odds ratio: 1.14, CI: 1.10-1.18, P ≤ 0.001) were more likely to be depressed. Depression resulted in increased odds of mortality (odds ratio: 1.82, CI: 1.08-3.07, P = .04), graft loss (P = .03), and graft rejection (P = .01).

Conclusion

Depression is highly prevalent after LT and may be associated with increased mortality and poorer graft outcomes. More emphasis is needed on the screening of depression among higher risk recipients.

Who wants more social contacts? A cross-sectional study of people with psychotic disorders in England

Many people with psychosis have few social contacts which can significantly reduce quality of life. While the symptoms of psychosis are thought to contribute to social isolation, they could also lead to the perception that patients are uninterested in increasing their social contacts or in socialisation interventions. Hence, those who most need support to reduce isolation may be less likely to receive it. Despite this, studies have yet to identify the characteristics of patients who do and do not want to increase their social contacts. A cross-sectional study was conducted with 548 participants with psychosis in community mental health teams across England, covering urban and rural areas. Logistic regression analysis was used to determine predictors of wanting to vs. not wanting to increase social contacts. Content analysis was used to explore reasons. The majority (68%) of participants reported a desire for more social contacts, which was significantly associated with lower quality of life. While people with lower quality of life were more likely to express a desire for more contacts, they were less likely to feel confident in increasing them. Reasons for not wanting to increase contacts were related either to perceived barriers or to feeling content with current circumstances. It may be concluded that people with psychosis who have a lower quality of life and little confidence in socialising have a greater desire for more social contacts. Hence, contrary to traditional beliefs, they are likely to be motivated to engage with support to reduce isolation if it is offered.

Pro-active monitoring and social interventions at community level mitigate the impact of coronavirus (COVID-19) epidemic on older adults’ mortality in Italy: A retrospective cohort analysis

Background

The COVID-19 epidemic in Italy has severely affected people aged more than 80, especially socially isolated. Aim of this paper is to assess whether a social and health program reduced mortality associated to the epidemic.

Methods

An observational retrospective cohort analysis of deaths recorded among >80 years in three Italian cities has been carried out to compare death rate of the general population and “Long Live the Elderly!” (LLE) program. Parametric and non-parametric tests have been performed to assess differences of means between the two populations. A multivariable analysis to assess the impact of covariates on weekly mortality has been carried out by setting up a linear mixed model.

Results

The total number of services delivered to the LLE population (including phone calls and home visits) was 34,528, 1 every 20 day per person on average, one every 15 days during March and April. From January to April 2019, the same population received one service every 41 days on average, without differences between January-February and March-April. The January-April 2020 cumulative crude death rate was 34.8‰ (9,718 deaths out of 279,249 individuals; CI95%: 34.1–35.5) and 28.9‰ (166 deaths out of 5,727 individuals; CI95%:24.7–33.7) for the general population and the LLE sample respectively. The general population weekly death rate increased after the 11^th calendar week that was not the case among the LLE program participants (p<0.001). The Standardized Mortality Ratio was 0.83; (CI95%: 0.71–0.97). Mortality adjusted for age, gender, COVID-19 weekly incidence and prevalence of people living in nursing homes was lower in the LLE program than in the general population (p<0.001).

Conclusions

LLE program is likely to limit mortality associated with COVID-19. Further studies are needed to establish whether it is due to the impact of social care that allows a better clients’ adherence to the recommendations of physical distancing or to an improved surveillance of older adults that prevents negative outcomes associated with COVID-19.

Social Connection as a Public Health Issue: The Evidence and a Systemic Framework for Prioritizing the "Social" in Social Determinants of Health

There is growing interest in and renewed support for prioritizing social factors in public health both in the USA and globally. While there are multiple widely recognized social determinants of health, indicators of social connectedness (e.g., social capital, social support, social isolation, loneliness) are often noticeably absent from the discourse. This article provides an organizing framework for conceptualizing social connection and summarizes the cumulative evidence supporting its relevance for health, including epidemiological associations, pathways, and biological mechanisms. This evidence points to several implications for prioritizing social connection within solutions across sectors, where public health work, initiatives, and research play a key role in addressing gaps. Therefore, this review proposes a systemic framework for cross-sector action to identify missed opportunities and guide future investigation, intervention, practice, and policy on promoting social connection and health for all. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Educational Differences in Self-Rated Health Trends Among Middle-Aged and Older Adults Living Alone, 1972-2018

Objectives: This study examines educational differences in living alone and in self-rated health trends among middle-aged and older adults. Methods: We used logistic regression to analyze data from the 1972-2018 National Health Interview Survey (n = 795,239 aged 40-64; n = 357,974 aged 65-84). Results: Between 1972-1974 and 2015-2018, living alone became more prevalent, particularly among men and at lower levels of education. Self-rated health trends varied by living arrangement and education. We found self-rated health declines among middle-aged adults having no college degree and living alone, but trends in self-rated health were mostly stable or even improved among middle-aged adults living with others. Among older adults, self-rated health improved over time, but for the least-educated older Americans living alone, the probability of reporting fair or poor health increased between 1972-1974 and 2015-2018. Discussion: The findings suggest growing disparities by social class, in living arrangements and in self-rated health.

Neighbourhood characteristics and social isolation of people with psychosis: a multi-site cross-sectional study

PURPOSE

People with psychosis are vulnerable to social isolation, which is associated with worse clinical outcomes. In general populations, people living in areas with higher population density have more social contacts, while those living in more socially deprived and fragmented areas are less satisfied with their relationships. We assessed whether and how neighbourhood factors are associated with social contacts and satisfaction with friendships for people with psychosis.

METHODS

We carried out a cross-sectional study including people with psychosis aged 18-65 years in urban and rural sites in England. Population density and social deprivation and fragmentation indexes were described within Lower Level Super Output Areas (LSOA). Their associations with participants' social contacts and satisfaction with friendships were tested with negative binomial and ordinal regression models, respectively.

RESULTS

We surveyed 511 participants with psychotic disorders. They had a median of two social contacts in the previous week (interquartile range [IQR] = 1-4), and rated satisfaction with friendships as 5 out of 7 (Manchester Short Assessment of Quality of Life; IQR = 4-6). Higher population density was associated with fewer social contacts (Z-standardised relative risk [RR] = 0.88; 95% CI = 0.79-0.99, p = 0.03), but not with satisfaction with friendships (RR = 1.08; 95% CI = 0.93-1.26, p = 0.31). No associations were found for social contacts or satisfaction with friendships with social deprivation or fragmentation indexes.

CONCLUSIONS

Clinicians in urban areas should be aware that their patients with psychosis are more socially isolated when more people live around them, and this could impact their clinical outcomes. These findings may inform housing programmes.

The Impact of COVID-19 on Older Adults: Results from an Annual Survey

Objectives

Assess well-being among older adults through secondary analysis measured during an annual survey in 2018, 2019, and 2020, to determine trends from before and during the COVID-19 pandemic.

Methods

Mailed surveys sent annually included measures related to various psychosocial factors.

Main findings

Response rates were 29% in 2018, 25% in 2019, and 24% in 2020. Most respondents reported average or high resilience (89% 2018-2020), high purpose (64% in 2018 and 2019, 63% in 2020), moderate optimism (46% in 2019, 44% in 2020) and low stress (88% in 2019 and 2020). Reported loneliness increased 13% from 2018 to 2020. In 2020, only 45% reported high comfort with technology, decreasing with age (>75).

Principal conclusion

Psychosocial well-being of respondents were doing well despite changes related to COVID-19. However, increased loneliness may negatively impact long-term health outcomes; thus, a focus on technology options to stay socially connected and access healthcare are needed.

Mediation analysis of social isolation and mortality by health behaviors

Social isolation associated with greater risk for mortality is well documented, however, it is unclear whether and the extent to which social isolation influences mortality through health behaviors. We therefore assessed the mediation between social isolation and mortality by health behaviors. 15,000 adults ages 18-89 years in the Third National Health and Nutrition Examination Survey in the US (NHANES III) (1988-1994) were followed through 2015. The outcomes of overall and cause-specific mortality were assessed by linking with the National Death Index. Social isolation was based on a modified Social Network Index. Mediation analyses were conducted under the counterfactual framework. Compared with participants who were not socially isolated, those who were isolated had significantly increased risk for overall mortality (HR = 1.33, 95% CI: 1.15-1.54), cardiovascular disease (CVD)-specific mortality (HR = 1.28, 95% CI: 1.01-1.62) and mortality from causes other than CVD or cancer (HR = 1.53, 95% CI: 1.22-1.90). Social isolation was not independently associated with risk for cancer-specific mortality. The association between social isolation and cancer-specific mortality was largely (74%) mediated by health behaviors, including smoking, physical activity and quality of diet. The associations between social isolation and CVD or other specific mortality were partly (about one-fifth) explained by unhealthy behaviors. In conclusion, the extent to which social isolation and mortality was mediated by healthy behaviors varies by causes of death. Given mounting evidence that social isolation is increasing in society, it is important to add social isolation to the list of public health concerns in addition to conventional risk factors.

Spotlight on non-motor symptoms and Covid-19

The Coronavirus Disease 2019 (Covid-19) pandemic has profoundly affected the quality of life (QoL) and health of the general population globally over the past 2 years, with a clear impact on people with Parkinson's Disease (PwP, PD). Non-motor symptoms have been widely acknowledged to hold a vital part in the clinical spectrum of PD, and, although often underrecognized, they significantly contribute to patients' and their caregivers' QoL. Up to now, there have been numerous reports of newly emerging or acutely deteriorating non-motor symptoms in PwP who had been infected by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), while some of these symptoms, like fatigue, pain, depression, anxiety and cognitive impairment, have also been identified as part of the long-COVID syndrome due to their persistent nature. The subjacent mechanisms, mediating the appearance or progression of non-motor symptoms in the context of Covid-19, although probably multifactorial in origin, remain largely unknown. Such mechanisms might be, at least partly, related solely to the viral infection per se or the lifestyle changes imposed during the pandemic, as many of the non-motor symptoms seem to be prevalent even among Covid-19 patients without PD. Here, we summarize the available evidence and implications of Covid-19 in non-motor PD symptoms in the acute and chronic, if applicable, phase of the infection, with a special reference on studies of PwP.

Prevalence and outcomes of Covid-19 in Parkinson's disease: Acute settings and hospital

The global explosion of COVID-19 necessitated the rapid dissemination of information regarding SARS-CoV-2. Hence, COVID-19 prevalence and outcome data in Parkinson's disease patients were disseminated at a time when we only had part of the picture. In this chapter we firstly discuss the current literature on the prevalence of COVID-19 in people with PD. We then discuss outcomes from COVID-19 in people with PD, specifically risk of hospitalization and mortality. Finally, we discuss specific contributing and confounding factors which may put PD patients at higher or lower risk from COVID-19.

Rate of Social Isolation by Geographic Location Among Older Adults: AAA LongROAD Study

Introduction: Social isolation is a modifiable risk factor for negative health outcomes among older adults. This work assessed the relationship between geography (i.e., urban vs. non-urban residence) and social isolation in a cohort of older drivers.

Methods: The AAA LongROAD cohort with 2,989 older adult drivers from across the country were included. Social isolation was measured at baseline and at two subsequent annual follow-ups using PROMIS v2.0 Social Isolation 4a. The effect of geographic location with social isolation was assessed through with multivariable regression using a generalized estimating equation model.

Results: The rate of social isolation in urban areas was 21% lower (adjusted RR 0.79, 95% CI 0.46, 1.36) compared to non-urban areas after adjusting for covariates, though not significant.

Discussion: Social isolation is a predictor of poor health outcomes and geographic considerations have been lacking in the literature. The panel data in this analysis provides more evidence for causality though the under-representation of non-urban areas potentially reduces the power for the results.

Conclusions: It is important to understand the needs and risk of social isolation in various geographic settings to ensure resources and interventions are appropriately modified for a greater public health impact.

Social Isolation Is Associated With Rapid Kidney Function Decline and the Development of Chronic Kidney Diseases in Middle-Aged and Elderly Adults: Findings From the China Health and Retirement Longitudinal Study (CHARLS)

Background: There is limited evidence on the relationship between social isolation and renal outcomes. To address this gap, this study estimated the prospective relationship of social isolation with rapid kidney function decline and the development of chronic kidney disease (CKD) in middle-aged and elderly Chinese with normal kidney function. Methods: We analyzed data from 3,031 participants aged ≥ 45 years with baseline estimated glomerular filtration rates (eGFR) ≥ 60 ml/min/1.73 m². All data were obtained from the 2011 and 2015 waves of the Chinese Longitudinal Study of Health and Retirement (CHARLS). eGFR was estimated based on a combination of serum creatinine and cystatin C. The primary outcome was rapid decline in renal function, as defined by an eGFR decrease of > 5 ml/min/1.73 m² per year, while the secondary outcome was the development of CKD, as defined by an eGFR decrease to a level < 60 ml/min/1.73 m². Results: During the follow-up of 4 years, 258 (8.5%) participants experienced a rapid decline in renal function, while 87 (2.9%) developed CKD. In the fully adjusted model, high social isolation was significantly related to an increased risk of experiencing a rapid decline in renal function (OR 1.805, 95% CI 1.310-2.487) and CKD onset (OR 1.842, 95% CI 1.084-3.129). Among the five components of social isolation, being unmarried, not participating in social activities, and living alone independently predicted declined renal function. Conclusions: Social isolation is significantly associated with the risk of rapid eGFR decline and CKD onset in middle-aged and older adults with normal kidney function in China.

Identifying patients with psychosocial problems in general practice: a scoping review protocol

INTRODUCTION

Psychosocial problems (PSPs) are common issues associated with negative health outcomes. Since general practitioners are the first point of contact for any health-related concern, understanding their options to recognise patients with PSPs plays an important role as it is essential for early intervention and can prevent serious conditions. The objective of our scoping review is to map published evidence on the usage of instruments to identify patients with PSPs in general practice.

METHODS AND ANALYSIS

We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist and the Joanna Briggs Institute Reviewer's Manual on scoping reviews. A systematic search of four electronic databases (Medline (Ovid), Web of Science Core Collection, PsycInfo, Cochrane Library) will be conducted for quantitative and qualitative studies published in English, Spanish, French and German. Main study characteristics as well as information on identification instruments will be extracted and visualised in structured tables to map the available evidence. The protocol has been registered with Open Science Framework, https://osfio/c2m6z.

ETHICS AND DISSEMINATION

This study does not require ethical approval as we will not collect personal data. Dissemination will consist of publications, presentations and other knowledge translation activities.

A Framework for Evaluating Social Determinants of Health Screening and Referrals for Assistance

Introduction/Objectives:

Many health systems screen patients for social determinants of health and refer patients with social needs to community service organizations for assistance. We developed a framework based on sequential steps to evaluate this process.

Methods:

We reviewed efforts by The MetroHealth System in Cleveland, Ohio and identified 6 sequential steps: patient screened, has social needs, consents to referral to a service organization, referral placed, referral accepted, and referral outcome. Referral outcomes were categorized as resolved (organization provided requested service or patient self-resolved problem), or unresolved (patient unable to be contacted or declined assistance). We then determined the numbers of patients with food insecurity who completed each step, how completion differed by patient characteristics and service organization, and reasons for failure to complete specific steps.

Results:

We used the framework to evaluate screening and assistance steps among 5741 patients who attended a COVID-19 vaccine clinic from February 15-March 31, 2021 and were followed through April 30, 2021. The percentage of patients who completed each step ranged from 17-98%. Step completion differed by patient age, patient race, and clinic. Of 360 referrals accepted by community organizations, 98 (27%) were resolved. The most common reasons for unresolved referrals were inability of service organization to contact patients (151), no reason stated (71), and patients declined service (30).

Conclusions:

A framework based on sequential steps may be used to evaluate social determinants of health screening and assistance programs. Further work is needed to address reasons for failure to complete steps, to include patient perspectives, and to determine long-term outcomes.

Social Isolation and All-Cause and Heart Disease Mortality Among Working-Age Adults in the United States: The 1998-2014 NHIS-NDI Record Linkage Study

Purpose: Living alone, an indicator of social isolation, has been increasing in the United States; 28% of households in 2019 were one-person households, compared with 13% in 1960. The working-age population is particularly vulnerable to adverse social conditions such as low social support. Although previous research has shown that social isolation and loneliness lead to poorer health and decreased longevity, few studies have focused on the working-age population and heart disease mortality in the United States using longitudinal data. Methods: This study examines social isolation as a risk factor for all-cause and heart disease mortality among U.S. adults aged 18-64 years using the pooled 1998-2014 data from the National Health Interview Survey (NHIS) linked to National Death Index (NDI) (n=388,973). Cox proportional hazards regression was used to model survival time as a function of social isolation, measured by "living alone," and sociodemographic, behavioral, and health characteristics. Results: In Cox regression models with 17 years of mortality follow-up, the age-adjusted all-cause mortality risk was 45% higher (hazard ratio [HR]=1.45; 95% confidence interval [CI]=1.40-1.50) and the heart disease mortality risk was 83% higher (HR=1.83; 95% CI=1.67-2.00) among adults aged 18-64 years living alone at the baseline, compared with adults living with others. In the full model, the relative risk associated with social isolation was 16% higher (HR=1.16; 95% CI=1.11-1.20) for all-cause mortality and 33% higher (HR=1.33; 95% CI=1.21-1.47) for heart disease mortality after controlling for sociodemographic, behavioral-risk, and health status characteristics. Conclusion: In this national study, adults experiencing social isolation had statistically significantly higher relative risks of all-cause and heart disease mortality in the United States than adults living with others.

The Housing Needs of Sexual and Gender Minority Older Adults: Implications for Policy and Practice

This study identifies the interconnected needs and concerns of sexual and gender minority (SGM) older adults, with a particular focus on housing, healthcare, transportation, and social support. Data were gathered through seven groups with a sample of SGM-identified adults age 55 and over (N = 50) and analyzed using thematic analysis. The participants seek affordable and inclusive housing options. They identified that access to transportation is paramount in maintaining social support and accessing healthcare. Findings underscore the need for strategies to serve the housing needs of low-income SGM-identified older adults in a nondiscriminatory way, train housing providers in culturally responsive care, meet transportation needs, and provide SGM-inclusive community-based services that reduce isolation.

Do Loneliness and Social Isolation Predict Mortality Because of Hazardous Drinking?

Introduction: Subjective feelings of loneliness and objective social isolation have been consistently connected with ill-health and mortality, though little work has empirically examined the mechanisms explaining the adverse effects. This study examines whether alcohol consumption explains the connection of loneliness and social isolation on mortality in different age and gender groups. Methods: The sample comprised a representative 1994 Finnish sample (n = 8,650) matched with 22-year follow-up mortality data. A multigroup path analysis with discrete survival time analyses was conducted. Results: There were unique differences in the associations between loneliness, social isolation, alcohol consumption, and mortality based on age and gender groups. Loneliness and particularly social isolation predicted mortality partly through subjective intoxication for women under 40 and men 40–65. Discussion: Loneliness and social isolation are associated with mortality, partly through subjective intoxication. Interventions targeted at reducing loneliness and social isolation may help address underlying causes of excess alcohol consumption and mortality.

The association between social needs and chronic conditions in a large, urban primary care population

There is consensus that social needs influence health outcomes, but less is known about the relationships between certain needs and chronic health conditions in large, diverse populations. This study sought to understand the association between social needs and specific chronic conditions using social needs screening and clinical data from Electronic Health Records. Between April 2018-December 2019, 33,550 adult (≥18y) patients completed a 10-item social needs screener during primary care visits in Bronx and Westchester counties, NY. Generalized linear models were used to estimate prevalence ratios for eight outcomes by number and type of needs with analyses completed in Summer 2020. There was a positive, cumulative association between social needs and each of the outcomes. The relationship was strongest for elevated PHQ-2, depression, alcohol/drug use disorder, and smoking. Those with ≥3 social needs were 3.90 times more likely to have an elevated PHQ-2 than those without needs (95% CI: 3.66, 4.16). Challenges with healthcare transportation was associated with each condition and was the most strongly associated need with half of conditions in the fully-adjusted models. For example, those with transportation needs were 84% more likely to have an alcohol/drug use disorder diagnosis (95% CI: 1.59, 2.13) and 41% more likely to smoke (95% CI: 1.25, 1.58). Specific social needs may influence clinical issues in distinct ways. These findings suggest that health systems need to develop strategies that address unmet social need in order to optimize health outcomes, particularly in communities with a dual burden of poverty and chronic disease.

Integrated multi-omics approach identified molecular mechanism and pathogenetic processes of COVID-19 that affect patient with Parkinson's disorder

The novel coronavirus named SARS-CoV-2 has emerged at the end of 2019, which causes coronavirus disease (COVID-2019). Recent case reports of COVID-19 patients have revealed the onset of Parkinson's disease (PD) symptoms in patients who do not have a family history of the PD. However, till recently, no genetic impact or mechanisms that may induce Parkinsonism in COVID-19 patients or after COVID-19 have been found.. This study aimed to detect the commonly dysregulated genes, transcriptional regulators, and pathways between PD and COVID-19. We integrated genome-wide transcriptomic datasets from peripheral blood mononuclear cells (PBMC) samples from COVID-19 and PD and associated pathways. Our study revealed 81 upregulated and 48 downregulated differentially expressed genes (DEGs) shared between PD and COVID-19. These dysregulated genes were involved in key pathways "mitochondrion structure organization", "cell activation in immune response", and "signalling by interleukins". Our analysis showed RELA, TP53 and SP1 TFs that may regulate the upregulated DEGs. We have discovered key dysregulated genes and characterized the biological processes of commonly dysregulated in COVID-19 and PD, which could be used for the design of personalized treatment of PD following COVID-19.

Exploring the Social Impacts of the COVID-19 Pandemic on People Living with HIV (PLHIV): A Scoping Review

Understanding the clinical impact of COVID-19 has been central to emerging research in the HIV field, but in focusing on the biomedical, researchers must not overlook the socially embedded nature of HIV and the potential social impacts of this new pandemic on PLHIV. We conducted a scoping review to explore emerging research examining the social impacts of COVID-19 on PLHIV in OECD countries over the first 12 months of the pandemic. Twenty articles were identified and included for review. Key themes included: impacts on HIV care access/telehealth; stress and mental health; social isolation and loneliness; food insecurity; changes to sexual behaviour; changes to substance use; impacts on income, education and employment; and racial and social inequality. Results from this review can help guide research into areas where it is needed to help minimise the negative social impacts of the COVID-19 pandemic.

Social determinants of atrial fibrillation

Atrial fibrillation affects almost 60 million adults worldwide. Atrial fibrillation is associated with a high risk of cardiovascular morbidity and death as well as with social, psychological and economic burdens on patients and their families. Social determinants - such as race and ethnicity, financial resources, social support, access to health care, rurality and residential environment, local language proficiency and health literacy - have prominent roles in the evaluation, treatment and management of atrial fibrillation. Addressing the social determinants of health provides a crucial opportunity to reduce the substantial clinical and non-clinical complications associated with atrial fibrillation. In this Review, we summarize the contributions of social determinants to the patient experience and outcomes associated with this common condition. We emphasize the relevance of social determinants and their important intersection with atrial fibrillation treatment and outcomes. In closing, we identify gaps in the literature and propose future directions for the investigation of social determinants and atrial fibrillation.

Social connectedness among parents raising children in low-income communities: An integrative review

Social isolation has been linked to numerous health risks, including depression and mortality. Parents raising children in low‐income and under‐resourced communities are at an increased risk for experiencing social isolation and its negative effects. Social connectedness (SC), one's sense of belongingness and connection to other people, or a community, has been linked to reduced social isolation and improved health outcomes in the general population, yet little is known about the impact SC has on parents with low incomes. This integrative review aims to describe the current state of the science surrounding SC in parents with low incomes, summarize how SC is being defined and measured, evaluate the quality of the science, and identify gaps in the literature to guide future research. Five electronic databases were searched, yielding 15 articles for inclusion. Empirical studies meeting the following criteria were included: population focused on parents who have low incomes or live in low‐income communities and have dependent children, outcomes were parent‐centered, SC was a study variable or a qualitative finding, and publication date was before March 2021. Findings emphasize SC as a promising construct that may be protective in the health and well‐being of parents and children living in low‐income communities. However, a lack of consensus on definitions and measures of SC makes it difficult to build a strong science base for understanding these potential benefits. Future research should focus on understanding the mechanisms by which SC works to benefit parents and their children.

Social Dysfunction in Psychosis Is More Than a Matter of Misperception: Advances From the Study of Metacognition

Many with psychosis experience substantial difficulties forming and maintaining social bonds leading to persistent social alienation and a lack of a sense of membership in a larger community. While it is clear that social impairments in psychosis cannot be fully explained by symptoms or other traditional features of psychosis, the antecedents of disturbances in social function remain poorly understood. One recent model has proposed that deficits in social cognition may be a root cause of social dysfunction. In this model social relationships become untenable among persons diagnosed with psychosis when deficits in social cognition result in inaccurate ideas of what others feel, think or desire. While there is evidence to support the influence of social cognition upon social function, there are substantial limitations to this point of view. Many with psychosis have social impairments but not significant deficits in social cognition. First person and clinical accounts of the phenomenology of psychosis also do not suggest that persons with psychosis commonly experience making mistakes when trying to understand others. They report instead that intersubjectivity, or the formation of an intimate shared understanding of thoughts and emotions with others, has become extraordinarily difficult. In this paper we explore how research in metacognition in psychosis can transcend these limitations and address some of the ways in which intersubjectivity and more broadly social function is compromised in psychosis. Specifically, research will be reviewed on the relationship between social cognitive abilities and social function in psychosis, including measurement strategies and limits to its explanatory power, in particular with regard to challenges to intersubjectivity. Next, we present research on the integrated model of metacognition in psychosis and its relation to social function. We then discuss how this model might go beyond social cognitive models of social dysfunction in psychosis by describing how compromises in intersubjectivity occur as metacognitive deficits leave persons without an integrated sense of others' purposes, relative positions in the world, possibilities and personal complexities. We suggest that while social cognitive deficits may leave persons with inaccurate ideas about others, metacognitive deficits leave persons ill equipped to make broader sense of the situations in which people interact and this is what leaves them without a holistic sense of the other and what makes it difficult to know others, share experiences, and sustain relationships. The potential of developing clinical interventions focused on metacognition for promoting social recovery will finally be explored.

Aging, Social Distancing, and COVID-19 Risk: Who is more Vulnerable and Why?

Perceived social support represents an important predictor of healthy aging. The global COVID-19 pandemic has dramatically changed the face of social relationships and revealed elderly to be particularly vulnerable to the effects of social isolation. Social distancing may represent a double-edged sword for older adults, protecting them against COVID-19 infection while also sacrificing personal interaction and attention at a critical time. Here, we consider the moderating role of social relationships as a potential influence on stress resilience, allostatic load, and vulnerability to infection and adverse health outcomes in the elderly population. Understanding the mechanisms how social support enhances resilience to stress and promotes mental and physical health into old age will enable new preventive strategies. Targeted social interventions may provide effective relief from the impact of COVID-19-related isolation and loneliness. In this regard, a pandemic may also offer a window of opportunity for raising awareness and mobilizing resources for new strategies that help build resilience in our aging population and future generations.

The Association of Psychological Well-Being With Sensory and Cognitive Function and Neuronal Health in Aging Adults

OBJECTIVES

Psychological well-being (PWB) may be a potential modifiable risk factor of age-related diseases. We aimed to determine associations of PWB with sensorineural and cognitive function and neuronal health in middle-aged adults.

METHODS

This study included 2039 Beaver Dam Offspring Study participants. We assessed PWB, hearing, visual acuity, contrast sensitivity impairment, olfactory impairment, cognition, and retinal (macular ganglion cell inner-plexiform layer, mGCIPL) thickness. Age-sex-education-adjusted multivariable linear, logistic regression, and generalized estimating equation models were used and then further adjusted for health-related confounders.

RESULTS

Individuals with higher PWB had better hearing functions, visual acuity, and thicker mGCIPL and reduced odds for hearing, contrast sensitivity and olfactory impairment in age-sex-education-adjusted models. Effects on mGCIPL and visual and olfactory measures decreased with adjustment. Higher PWB was associated with better cognition, better combined sensorineural-cognitive function, and decreased cognitive impairment.

DISCUSSION

Psychological well-being was associated with sensorineural-cognitive health indicating a potential of PWB interventions for healthy aging.

Reaching people with disabilities to learn about their experiences of social connection and loneliness

BACKGROUND

People with disabilities experience higher rates of social isolation and loneliness than people without disabilities, but there is limited information about how these conditions are manifested in people with specific types of disabilities.

OBJECTIVES

Using data collected as part of the second administration of the National Survey on Health and Disability (n = 2,132), our objectives were to determine if disability type and recruitment method added explanatory power to observed levels of social connectedness, after controlling for socio-demographic and environmental indicators.

METHODS

We used hierarchical regression to evaluate how socio-demographic, disability, environmental, and recruitment type explained four outcome variables for different dimensions of social connectedness, including satisfaction with social activity, quantity of social connections, quality of social connections, and loneliness.

RESULTS

Across all models, employment status (not employed), having mental illness/psychiatric disability, lack of transportation for social needs, and recruitment type (MTurk) significantly predicted lower levels of social connectedness.

CONCLUSIONS

The study provides evidence that using alternative methods, such as MTurk, to complement conventional recruitment strategies can improve understanding of social isolation and feelings of loneliness among people with disabilities, particularly those with mental illnesses and/or psychiatric disorders who are less likely to be accessed through group affiliations, but who are at greater risk for experiencing social isolation and feelings of loneliness.

The Intersection of Pain Outcomes and Social Isolation Among African Americans

There is increasing evidence suggesting the influence social isolation has on health outcomes and mental well-being. Chronic medical conditions, such as pain, have been shown to impact social relationships and isolation among majority populations, but there is little evidence documenting this relationship among African Americans. To address this lack of scholarly work, the current study aimed to examine subjective and objective social isolation, pain interference with daily life, and problems with pain in a sample of African American adults 18 + years of age. Taken from the National Survey of American Life: Coping with Stress in the 21st Century (NSAL), results showed that participants who were objectively isolated from family only were more likely to have a chronic health problem that was associated with increased pain. Data further showed that those reporting subjective isolation from both family and friends experienced greater interference from pain than those who were not isolated from family and friends. Findings from this study acknowledge a larger issue that addresses the impact social isolation has on health, quality of life, and general well-being. Recognizing the influence of such may allow systems to acknowledge the determinants that perpetuate social isolation, while still recognizing the needs of marginalized groups.