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

Development of a Community-Based Integrated Service Model of Health and Social Care for Older Adults Living Alone

The number of elderly people living alone worldwide is increasing, and the responsibility of the state in this context is emerging. This study aimed to develop a community-based integrated service (CBIS) model of health and social care for older adults living alone. The model was designed based on a literature review of previous community care models and per older adults’ health and daily life needs. Thereafter, feedback on the integrated model was taken from older adults living alone by conducting a survey (n = 1023) and focus group interviews, after which the opinions of the Public type Health Management Promotion Council were considered and content validity was confirmed. The model, comprising eight healthcare services and five social care services, was tested on 22 older adults for two weeks to assess its feasibility and preliminary efficiency. Each service included screening, assessment, providing service, evaluation, and quit. Participants rated their overall satisfaction with the services as 9 out of 10. Care navigators reported feeling comforted and discovered their own sense of being while providing the services. We believe that the CBIS model may foster independence among community-dwelling older adults living alone, thereby improving their quality of life through “aging in place”.

Peer Support for Post Intensive Care Syndrome Self-Management (PS-PICS): Study protocol for peer mentor training

AIMS

The primary aim of the Peer Support for Post Intensive Care Syndrome Self-Management (PS-PICS) peer mentor training trial is to determine the feasibility for peer mentor training to connect new ICU survivors with survivors who have made successful recoveries. Secondary aims are to also examine peer mentor eligibility, recruitment and retention rates and assess changes in participant knowledge of Post Intensive Care Syndrome (PICS), reported symptoms and health-related quality of life.

DESIGN

Prospective clinical feasibility trial.

METHODS

This study received funding from the National Institutes of Health funded P30 Center for Excellence (2014-2020). Up to 20 adult patients who have had an ICU stay of 3 days or longer more than 3 months ago will be enrolled into the study. Participants will undergo a 6-week peer mentor training program to learn how to promote healthy self-management behaviours, social connections, and well-being using motivational interviewing (MI). Participants will complete surveys about their recovery at 3 points during the study: prior to training, 6 weeks post-training and 3 months post-training. Survey questions will be used to assess trends in participant social isolation, depression, functional status, and self-management behaviours.

DISCUSSION

Enrollment closes by December 2020. As a feasibility trial, power sufficient for hypothesis testing will not be available. However, study operations and intervention fidelity contribute to future research knowledge and participant characteristics and longitudinal outcomes will yield data on intervention feasibility. This study is the first use of embedding peer-led motivational interviewing training into a peer support intervention for ICU survivors.

IMPACT

Current self-management interventions are limited for ICU survivors and do not sufficiently address barriers to promoting self-management behaviours or improving their health status, well-being and cost of health. This study will provide data to develop and implement interventions for the self-management of PICS-related symptoms and sequelae.

A randomized control trial to test a peer support group approach for reducing social isolation and depression among female Mexican immigrants

BACKGROUND

Female Mexican Immigrants (FMIs) experience high rates of depression compared with other populations. For this population, depression is often exacerbated by social isolation associated with the experience of immigration. Aim 1. To measure whether a culturally situated peer group intervention will reduce depression and stress associated with the experience of immigration. Aim 2. To test whether an intervention using a "women's funds of knowledge" approach results in improved resilience, knowledge and empowerment. Aim 3. To investigate whether a culturally situated peer group intervention using a women's funds of knowledge approach can give participants a sense and experience of social and physical connection ("emplacement") that is lost in the process of immigration.

METHODS

This mixed-methods study will implement "Tertulias" ("conversational gatherings" in Spanish), a peer support group intervention designed to improve health outcomes for FMI participants in Albuquerque, New Mexico. We will document results of the intervention on our primary hypotheses of a decrease in depression, and increases in resilience and social support, as well as on our secondary hypotheses of decreased stress (including testing of hair cortisol as a biomarker for chronic stress), and an increase in social connectedness and positive assessment of knowledge and empowerment.

DISCUSSION

This project will address mental health disparities in an underserved population that experiences high rates of social isolation. Successful completion of this project will demonstrate that health challenges that may appear too complex and too hard to address can be using a multi-level, holistic approach. Our use of hair samples to test for the 3-month average levels of systemic cortisol will contribute to the literature on an emerging biomarker for analyzing chronic stress.

TRIAL REGISTRATION

This study was registered with ClinicalTrials.gov on 2/3/20, Identifier # NCT04254198 .

Social isolation and loneliness as related to progression and reversion of frailty in the Survey of Health Aging Retirement in Europe (SHARE)

BACKGROUND

Frailty was shown to be associated with psychosocial risk factors, but there are few longitudinal data.

METHODS

We used data from waves 5 and 6 of the Survey of Health Aging Retirement in Europe (SHARE) to study the contribution of loneliness and social isolation to transitions towards frailty defined according to Fried criteria in a sample of 27,468 individuals aged ≥60.

RESULTS

At baseline, there were 13,069 (47.6%) robust individuals, 11,430 (41.6%) pre-frail and 2,969 (10.8%) frail. After 2 years, among robust subjects at baseline, 8,706 (61.8%) were still robust, 4,033 (30.8%) were pre-frail and 330 (2.6%) were frail. Among those who were pre-frail, 1,504 (13.2%) progressed to frail and 3,557 (31.1%) became robust. Among frail people, 182 (6.1%) reversed to robust and 1,271 (42.8%) to pre-frail. Average and high levels of loneliness and social isolation were significantly associated with the risk of robust people becoming frail and pre-frail (except robust with high loneliness to become frail), and of pre-frail people to become frail (except with average loneliness). Reversion to robustness was inversely associated with high levels of loneliness.

CONCLUSION

Average levels of loneliness and social isolation should not be considered acceptable and should be actively addressed even in the absence of any health conditions through an available evidence-based intervention.

Psychosocial Needs of Parents Engaged in Treatment for Opioid Use Disorder

Background: Little research has examined the needs of parents with opioid use disorder (OUD) who are receiving medications for OUD (MOUDs), which is striking given growing rates of OUD among parents. Objective: The current study expands the literature by examining psychiatric, psychosocial, and parenting-related functioning, as well as 12-month MOUD treatment retention among parents versus non-parents participating in a buprenorphine program at an academic family medicine residency clinic. Methods: Patients (N = 144; 61 parents) completed measures of psychiatric and psychosocial functioning at the first MOUD visit; parents also completed measures of parental functioning. Results: Parents endorsed less anxiety and loneliness, as well as greater social connection, life satisfaction, and life meaning. Parents were also older, more likely to be female, of a race other than white, married, employed, and had higher incomes. Although parents endorsed high levels of parental self-agency and strong bonds with children, many also reported elevated parental shame. Among parents, higher levels of shame were also associated with higher depression, anxiety, anger, stress, and loneliness. Over 25% of parents reported that a child lived with friends/relatives over 3 months, and 11% noted a child having been removed from the home by child protective services. Finally, parents were more likely to be retained in treatment at 12 months, although this finding was non-significant after controlling for covariates. Conclusions/Importance: These findings illustrate the needs experienced by parents engaged in MOUD treatment, which may prove valuable in informing policy, program development, and treatment approaches for parents with OUD.

Post-Stroke Social Isolation Reduces Cell Proliferation in the Dentate Gyrus and Alters miRNA Profiles in the Aged Female Mice Brain

Social isolation and loneliness are risk factors for stroke. Elderly women are more likely to be isolated. Census data shows that in homeowners over the age of 65, women are much more likely to live alone. However, the underlying mechanisms of the detrimental effects of isolation have not been well studied in older females. In this study, we hypothesized that isolation impairs post-stroke recovery in aged female mice, leading to dysregulated microRNAs (miRNAs) in the brain, including those previously shown to be involved in response to social isolation (SI). Aged C57BL/6 female mice were subjected to a 60-min middle cerebral artery occlusion and were randomly assigned to either single housing (SI) or continued pair housing (PH) immediately after stroke for 15 days. SI immediately after stroke led to significantly more brain tissue loss after stroke and higher mortality. Furthermore, SI significantly delayed motor and sensory recovery and worsened cognitive function, compared to PH. A decrease in cell proliferation was seen in the dentate gyrus of SI mice assessed by bromodeoxyuridine (BrdU) labeling. miRNAome data analysis revealed changes in several miRNAs in the brain, such as miR-297a-3p and miR-200c-3p, which are known to regulate pathways involved in cell proliferation. In conclusion, our data suggest that SI can lead to a poor post-stroke recovery in aged females and dysregulation of miRNAs and reduced hippocampal cell proliferation.

‘She shouldn't cross the line’: experiential effectivity of social guidance trajectories for socially isolated older adults with complex problems

Social isolation of older adults is difficult to break through, and interventions that focus on network development or enhanced social participation are hardly effective, especially when the older adults have been isolated for a long time and have problems in multiple life domains. This study aimed to investigate the needs and subjective experiences of this less-researched group and obtain a deeper understanding of their goals and priorities. The study involved a qualitative study with 25 socially isolated persons who receive assistance from a social worker in an individual guidance trajectory. Data were collected via repeated in-depth interviews with the older adults. By directing the focus towards their subjective experiences, the study gives insight into the ‘experiential effectivity’ of the intervention. It shows what their experienced problems were, and to what degree they benefited from the intervention in this respect. The experience of personal attention and involvement of the social workers represents the most relevant results for them. The participants have no need for network development or engagement in local communities. Yet, the help offered by the social workers produces other results for them, such as solved practical problems, emotional support, more self-sufficiency, a point of contact or a safety net that was not there before. This knowledge can help to improve the quality of intervention for this target group.

Older survivors of cancer in the COVID-19 pandemic: Reflections and recommendations for future care

Purpose

Although the year after cancer treatment is challenging for all cancer survivors, older adults (≥60 years) face additional challenges due to age-related decline and high rates of comorbidity. There is a paucity of research on how health service interruptions from the COVID-19 pandemic have impacted the experience of older cancer survivors. In this study we explore older cancer survivors' reflections on the pandemic and their suggestions for future care delivery when traditionally offered resources are not available.

Methods

We conducted 1:1 telephone interviews with adults 60 years and older previously diagnosed with breast and colorectal cancer and recently (≤12 months) discharged from their cancer care team. We analyzed the data using descriptive thematic analysis.

Results

The mean sample (n = 30) age was 72.1 years (SD 5.8, Range 63–83) of whom 57% identified as female. Participants described personal and societal implications of the pandemic.

that affected their ability to navigate social support, and public and clinical landscapes. These reflections informed their suggestions for future health care delivery, such as how they could have been better prepared to self-manage their post-cancer treatment journey. Participants recommendations were grouped into four sub-themes: 1) enhanced baseline information; 2) facilitate caregiver support and engagement; 3) greater technology integration; and 4) sustained use and public appreciation of personal protective equipment.

Conclusion

Older cancer survivors appreciate the needed shift to virtual appointments and services during the COVID-19 pandemic. Specific strategies to bolster older adults existing strengths and improve their readiness to engage in these measures are critical.

Influence of Psychosocial Variables on the Health of People Living in Housing Exclusion

The aim of this study was to analyze the influence of some personal characteristics, health variables, and social support on the self-rated health of people in housing exclusion in Spain. For that purpose, we used the FOESSA Survey of Social Integration and Needs database, with a final sample of 1574 households. Being more educated and reporting a good life satisfaction stood out as the main factors preventing worse health status. Furthermore, results showed that being female, experiencing poverty-related food insecurity, not having health insurance, experiencing widowhood or partner bereavement, and having caring responsibilities for others or having a disabled person in the household are associated with increased reporting of regular or poor health. On the other hand, being young, having a diagnosed/long-term illness, and a big household size are preventive factors for good health. These results allowed identifying risk and prevention factors to inform interventions to improve the health of those living in housing exclusion. Promoting better education levels, social support, and overall life satisfaction could be important to improve health in this population. Developing social support policies for caring responsibilities and food insecurity must be a priority to improve the health of people living in housing exclusion.

Complex mental health needs in older people living with frailty

Frailty describes a state of health whereby people develop multiple or cumulative deficits in physiological systems over the life course, leading to vulnerability and being less able to respond to acute and/or physiological stressors, which at times may be relatively minor. Mental health should be an important consideration in the assessment and management of frailty in older people. This article provides an overview and clinical perspective on the evidence relating to frailty and mental health assessment and management.

Expectant Fathers' Social Determinants of Health in Early Pregnancy

This cross-sectional, descriptive study examined unmet social and economic needs and health information requests of low-income, expecting fathers who participated in the First 1000 Days program. The First 1000 Days is a systems-level intervention aiming to prevent obesity among low-income mothers and infants across 3 community health centers in Greater Boston, MA, USA. Fathers who attended their partner's first prenatal care visit were invited to complete a program survey during early pregnancy. Among 131 fathers surveyed, 45% were white, 21% were Hispanic/Latino, 55% were foreign-born, and 69% reported an annual income under $50 000. Fathers reported elevated levels of food insecurity (18%) and 33% were unaware of someone that could provide a $50 loan; however, over 85% of fathers knew someone that could provide non-financial social support. Fathers requested information about pregnancy, birth preparation, and fatherhood. Findings support addressing fathers' unmet needs during pregnancy and providing father-specific perinatal information.

A Longitudinal Epigenetic Aging and Leukocyte Analysis of Simulated Space Travel: The Mars-500 Mission

Astronauts undertaking long-duration space missions may be vulnerable to unique stressors that can impact human aging. Nevertheless, few studies have examined the relationship of mission duration with DNA-methylation-based biomarkers of aging in astronauts. Using data from the six participants of the Mars-500 mission, a high-fidelity 520-day ground simulation experiment, we tested relationships of mission duration with five longitudinally measured blood DNA-methylation-based metrics: DNAmGrimAge, DNAmPhenoAge, DNA-methylation-based estimator of telomere length (DNAmTL), mitotic divisions (epigenetic mitotic clock [epiTOC2]), and pace of aging (PoA). We provide evidence that, relative to baseline, mission duration was associated with significant decreases in epigenetic aging. However, only decreases in DNAmPhenoAge remained significant 7 days post-mission. We also observed significant changes in estimated proportions of plasmablasts, CD4T, CD8 naive, and natural killer (NK) cells. Only decreases in NK cells remained significant post-mission. If confirmed more broadly, these findings contribute insights to improve the understanding of the biological aging implications for individuals experiencing long-duration space travel.

Long-duration space travel is marked by a unique combination of stressors known to impact human aging. Using data from six participants of the Mars-500 mission, a high-fidelity 520-day ground simulation experiment, Nwanaji-Enwerem et al. report significant associations of mission duration with decreased biological aging measured via blood DNA methylation.

The Perceptions of People with Dementia and Key Stakeholders Regarding the Use and Impact of the Social Robot MARIO

People with dementia often experience loneliness and social isolation. This can result in increased cognitive decline which, in turn, has a negative impact on quality of life. This paper explores the use of the social robot, MARIO, with older people living with dementia as a way of addressing these issues. A descriptive qualitative study was conducted to explore the perceptions and experiences of the use and impact of MARIO. The research took place in the UK, Italy and Ireland. Semi-structured interviews were held in each location with people with dementia (n = 38), relatives/carers (n = 28), formal carers (n = 28) and managers (n = 13). The data was analyzed using qualitative content analysis. The findings revealed that despite challenges in relation to voice recognition and the practicalities of conducting research involving robots in real-life settings, most participants were positive about MARIO. Through the robot's user-led design and personalized applications, MARIO provided a point of interest, social activities, and cognitive engagement increased. However, some formal carers and managers voiced concern that robots might replace care staff.

Lockdown During COVID-19 and the Increase of Frailty in People With Neurological Conditions

Governments around the globe have introduced quarantine, lockdown, and mandatory isolation to slow the transmission of COVID-19. These public health and policy measures aim to protect the public and vulnerable people. This perspective paper argues that the impacts of lockdown (such as social disconnection, reduced exercise, and fewer physiotherapy treatments) may be amplified for people with neurological conditions with subsequent increases in frailty. The paper outlines why this may occur, and explores how adverse impacts for these vulnerable populations may be minimized through strategies such as telehealth, exercise programs, and health policies.

Patient-reported psychosocial needs and psychological distress predict survival in geriatric oncology patients

OBJECTIVES

Little is known about how psychosocial factors and distress affect older patients with cancer and their survival. The study goals were to: 1) observe the prevalence of anxiety (ANX) and depression (DEP) symptoms at diagnosis in patients aged ≥65 years, 2) observe the association between social isolation (isolation) and distress, and 3) evaluate the impact on overall survival (OS).

MATERIALS AND METHODS

A retrospective cohort study was completed for all patients ≥65 years (N = 25,382) referred to the provincial cancer care program in British Columbia, Canada from 2011 to 2016. Patients who completed the Psychosocial Screen for Cancer within 6 months of diagnosis were included. Baseline and disease characteristics were collected retrospectively.

RESULTS

Subclinical/clinical levels of ANX and DEP were found in 32% and 23%, respectively. Thirty-six percent of patients reported at least one indicator for isolation. Factors associated with distress at presentation included female, age 65-69, lung cancer, metastatic disease, and presence of any risk indicator for isolation (p-values <0.001). Patients with any risk indicator for isolation had higher rates of subclinical/clinical levels of ANX and DEP. On multivariate analysis including age, sex and stage, hazard ratio (HR) for death was increased with ANX (1.30), DEP (1.51) and isolation (1.12) (p < 0.001).

CONCLUSIONS

Older adults with cancer with symptoms of distress are more likely to be female, aged 65-69, socially isolated, have metastatic disease or have lung cancer. ANX, DEP, and isolation are independent negative prognostic variables for OS. This vulnerable population should receive psychological support to improve outcomes.

Social isolation alters behavior, the gut-immune-brain axis, and neurochemical circuits in male and female prairie voles

The absence of social support, or social isolation, can be stressful, leading to a suite of physical and psychological health issues. Growing evidence suggests that disruption of the gut-immune-brain axis plays a crucial role in the negative outcomes seen from social isolation stress. However, the mechanisms remain largely unknown. The socially monogamous prairie vole (Microtus ochrogaster) has been validated as a useful model for studying negative effects of social isolation on the brain and behaviors, yet how the gut microbiome and central immune system are altered in isolated prairie voles are still unknown. Here, we utilized this social rodent to examine how social isolation stress alters the gut-immune-brain axis and relevant behaviors. Adult male and female prairie voles (n = 48 per sex) experienced social isolation or were cohoused with a same-sex cagemate (control) for six weeks. Thereafter, their social and anxiety-like behaviors, neuronal circuit activation, neurochemical expression, and microgliosis in key brain regions, as well as gut microbiome alterations from the isolation treatment were examined. Social isolation increased anxiety-like behaviors and impaired social affiliation. Isolation also resulted in sex- and brain region-specific alterations in neuronal activation, neurochemical expression, and microgliosis. Further, social isolation resulted in alterations to the gut microbiome that were correlated with key brain and behavioral measures. Our data suggest that social isolation alters the gut-immune-brain axis in a sex-dependent manner and that gut microbes, central glial cells, and neurochemical systems may play a critical, integrative role in mediating negative outcomes from social isolation.

Social Adversity, Sleep Characteristics, and Elevated Blood Pressure Among Young Adult Black Females

Purpose: We examined whether sleep characteristics and adverse social exposures were associated with elevated blood pressure (BP) in young adult black women.

Methods: This is a cross-sectional analysis of existing data from 581 black females who participated in the National Longitudinal Study of Adolescent to Adult Health (Add Health). Adverse social exposures included child abuse, discrimination, perceived stress, social isolation, and subjective social status. Self-reported sleep characteristics were measures of duration, latency, continuity, and snoring. Logistic regression was used to evaluate the influence of social exposures and sleep characteristics on BP.

Results: Among the women (mean age=29.1 years), 32.4% had elevated BP (≥130 systolic or ≥80 diastolic). In adjusted analysis, poor sleep continuity (adjusted odds ratio [aOR]=1.70, 95% confidence interval [CI]=1.07–2.70) and discrimination (aOR=1.61, 95% CI=1.00–2.58) were associated with higher odds of elevated BP, while more social isolation (aOR=0.69, 95% CI=0.48–0.99) was associated with lower odds of elevated BP.

Conclusion: Poor sleep continuity and experiencing discrimination may represent key risk factors for hypertension in young black females. Unexpectedly, being more isolated was associated with lower BP. Future research should examine how to adapt current paradigms and measures of social connectedness, isolation, and stress to better elucidate the impact of these factors on the long-term health of young black females.

Assessment of Value of Neighborhood Socioeconomic Status in Models That Use Electronic Health Record Data to Predict Health Care Use Rates and Mortality

Importance

Prediction models are widely used in health care as a way of risk stratifying populations for targeted intervention. Most risk stratification has been done using a small number of predictors from insurance claims. However, the utility of diverse nonclinical predictors, such as neighborhood socioeconomic contexts, remains unknown.

Objective

To assess the value of using neighborhood socioeconomic predictors in the context of 1-year risk prediction for mortality and 6 different health care use outcomes in a large integrated care system.

Design, Setting, and Participants

Diagnostic study using data from all adults age 18 years or older who had Kaiser Foundation Health Plan membership and/or use in the Kaiser Permantente Northern California: a multisite, integrated health care delivery system between January 1, 2013, and June 30, 2014. Data were recorded before the index date for each patient to predict their use and mortality in a 1-year post period using a test-train split for model training and evaluation. Analyses were conducted in fall of 2019.

Main Outcomes and Measures

One-year encounter counts (doctor office, virtual, emergency department, elective hospitalizations, and nonelective), total costs, and mortality.

Results

A total of 2 951 588 patients met inclusion criteria (mean [SD] age, 47.2 [17.4] years; 47.8% were female). The mean (SD) Neighborhood Deprivation Index was -0.32 (0.84). The areas under the receiver operator curve ranged from 0.71 for emergency department use (using the LASSO method and electronic health record predictors) to 0.94 for mortality (using the random forest method and electronic health record predictors). Neighborhood socioeconomic status predictors did not meaningfully increase the predictive performance of the models for any outcome.

Conclusions and Relevance

In this study, neighborhood socioeconomic predictors did not improve risk estimates compared with what is obtainable using standard claims data regardless of model used.

Patient-Reported Social and Behavioral Determinants of Health and Estimated Risk of Hospitalization in High-Risk Veterans Affairs Patients

IMPORTANCE

Despite recognition of the association between individual social and behavioral determinants of health (SDH) and patient outcomes, little is known regarding the value of SDH in explaining variation in outcomes for high-risk patients.

OBJECTIVE

To describe SDH factors among veterans who are at high risk for hospitalization, and to determine whether adding patient-reported SDH measures to electronic health record (EHR) measures improves estimation of 90-day and 180-day all-cause hospital admission.

DESIGN, SETTING, AND PARTICIPANTS

A survey was mailed between April 16 and June 29, 2018, to a nationally representative sample of 10 000 Veterans Affairs (VA) patients whose 1-year risk of hospitalization or death was in the 75th percentile or higher based on a VA EHR-derived risk score. The survey included multiple SDH measures, such as resilience, social support, health literacy, smoking status, transportation barriers, and recent life stressors.

MAIN OUTCOMES AND MEASURES

The EHR-based characteristics of survey respondents and nonrespondents were compared using standardized differences. Estimation of 90-day and 180-day hospital admission risk was assessed for 3 logistic regression models: (1) a base model of all prespecified EHR-based covariates, (2) a restricted model of EHR-based covariates chosen via forward selection based on minimizing Akaike information criterion (AIC), and (3) a model of EHR- and survey-based covariates chosen via forward selection based on AIC minimization.

RESULTS

In total, 4685 individuals (response rate 46.9%) responded to the survey. Respondents were comparable to nonrespondents in most characteristics, but survey respondents were older (eg, >80 years old, 881 [18.8%] vs 800 [15.1%]), comprised a higher percentage of men (4391 [93.7%] vs 4794 [90.2%]), and were composed of more White non-Hispanic individuals (3366 [71.8%] vs 3259 [61.3%]). Based on AIC, the regression model with survey-based covariates and EHR-based covariates better estimated hospital admission at 90 days (AIC, 1947.7) and 180 days (AIC, 2951.9) than restricted models with only EHR-based covariates (AIC, 1980.2 at 90 days; AIC, 2981.9 at 180 days). This result was due to inclusion of self-reported measures such as marital or partner status, health-related locus of control, resilience, smoking status, health literacy, and medication insecurity.

CONCLUSIONS AND RELEVANCE

Augmenting EHR data with patient-reported social information improved estimation of 90-day and 180-day hospitalization risk, highlighting specific SDH factors that might identify individuals who are at high risk for hospitalization.

The trajectory of loneliness in response to COVID-19

Social distancing and "stay-at-home" orders are essential to contain the coronavirus outbreak (COVID-19), but there is concern that these measures will increase feelings of loneliness, particularly in vulnerable groups. The present study examined change in loneliness in response to the social restriction measures taken to control the coronavirus spread. A nationwide sample of American adults (N = 1,545; 45% women; ages 18 to 98, M = 53.68, SD = 15.63) was assessed on three occasions: in late January/early February 2020 (before the outbreak), in late March (during the President's initial "15 Days to Slow the Spread" campaign), and in late April (during the "stay-at-home" policies of most states). Contrary to expectations, there were no significant mean-level changes in loneliness across the three assessments (d = .04, p > .05). In fact, respondents perceived increased support from others over the follow-up period (d = .19, p < .01). Older adults reported less loneliness overall compared to younger age groups but had an increase in loneliness during the acute phase of the outbreak (d = .14, p < .05). Their loneliness, however, leveled off after the issuance of stay-at-home orders. Individuals living alone and those with at least one chronic condition reported feeling lonelier at baseline but did not increase in loneliness during the implementation of social distancing measures. Despite some detrimental impact on vulnerable individuals, in the present sample, there was no large increase in loneliness but remarkable resilience in response to COVID-19. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

How do cat owners, dog owners and individuals without pets differ in terms of psychosocial outcomes among individuals in old age without a partner?

Objectives: The purpose of this study was to identify whether cat owners, dog owners and individuals without pets differ in terms of depressive symptoms, loneliness and social isolation among individuals in old age without a partner.Method: For this study, data were used from a nationally representative sample of non-institutionalized older individuals (German Ageing Survey). We focused on older adults (>65 years) who did not have a partner. The outcome measures were quantified using validated scales. Multiple linear regressions were used.Results: Among the n = 1,160 individuals aged 65 years and over without a partner, 952 individuals (82.1%) did not own a pet. Moreover, 145 individuals (12.5%) owned one or more cat/s and 63 individuals (5.4%) owned one or more dog/s. Multiple linear regressions showed that dog owners were less socially isolated than individuals without pets. There were no differences between cat owners and individuals without pets in the outcome measures. While there were no differences observed in men, female dog owners were less socially isolated and less lonely than women without pets.Conclusion: Our study revealed an association between owning a dog and social isolation (total sample) as well as loneliness (total sample and women). Future research should focus on elucidating the underlying mechanisms. In addition, longitudinal studies are required to deepen our understanding of this association.

For the Greater Good? The Devastating Ripple Effects of the Covid-19 Crisis

As the crisis around Covid-19 evolves, it becomes clear that there are numerous negative side-effects of the lockdown strategies implemented by many countries. Currently, more evidence becomes available that the lockdowns may have more negative effects than positive effects. For instance, many measures taken in a lockdown aimed at protecting human life may compromise the immune system, and purpose in life, especially of vulnerable groups. This leads to the paradoxical situation of compromising the immune system and physical and mental health of many people, including the ones we aim to protect. Also, it is expected that hundreds of millions of people will die from hunger and postponed medical treatments. Other side effects include financial insecurity of billions of people, physical and mental health problems, and increased inequalities. The economic and health repercussions of the crisis will be falling disproportionately on young workers, low-income families and women, and thus exacerbate existing inequalities. As the virus outbreak and media coverage spread fear and anxiety, superstition, cognitive dissonance reduction and conspiracy theories are ways to find meaning and reduce anxiety. These behavioral aspects may play a role in the continuance of lockdown decisions. Based on theories regarding agnotology (i.e., the ways ignorance or doubt about certain topics is created by means of withholding or presenting information in a certain way), social influence, superstition and stress and coping, I seek to explain the social and behavioral aspects of human behavior in times of crises. Both the Covid-19 crisis itself as well as the resulting economic and (mental) health crisis are global problems that may require global solutions. I present a model of drivers and outcomes of lockdown behaviors and offer suggestions and a tool to counteract the negative psychological effects by means of online life crafting therapeutic writing interventions.

The additive impact of multiple psychosocial protective factors on selected health outcomes among older adults

Our objective was to investigate the additive properties of five psychosocial protective factors: purpose-in-life, resilience, optimism, internal locus of control and social connections. Self-reported psychological (depression, stress) and physical (health status, functionality) health outcomes and measured healthcare utilization and expenditures were included. The study sample was identified from adults age ≥65 who completed a health survey during May-June 2019 (N = 3,577). Each of the five protective factors was dichotomized as high/low (1/0) and counted with equal weighting. The protective factors were additive such that significant improvements in psychological and physical health outcomes were evident across factor subgroups: as the number of factors increased, health outcomes improved. The magnitude of the improvements was greatest between 0 and 1 factor. In addition, a significant linear trend for reduced healthcare expenditures ($1,356 reduction per factor added) was evident. Interventions promoting at least one protective factor would be beneficial for older adult populations.

Association of the First 1,000 Days Systems-Change Intervention on Maternal Gestational Weight Gain

OBJECTIVE

To examine the associations of a clinical and public health systems-change intervention on the prevalence of excess gestational weight gain among high-risk, low-income women.

METHODS

In a quasi-experimental trial, we compared the prevalence of excess gestational weight gain among women before (n=643) and after (n=928) implementation of the First 1,000 Days program in two community health centers in Massachusetts. First 1,000 Days is a systematic program starting in early pregnancy and lasting through the first 24 months of childhood to prevent obesity among mother-child pairs. The program includes enhanced gestational weight gain tracking and counseling, screening for adverse health behaviors and sociocontextual factors, patient navigation and educational materials to support behavior change and social needs, and individualized health coaching for women at high risk for excess gestational weight gain based on their prepregnancy body mass index (BMI) or excess first-trimester weight gain. The primary outcome was gestational weight gain greater than the 2009 Institute of Medicine (now known as the National Academy of Medicine) guidelines according to prepregnancy BMI.

RESULTS

Among 1,571 women in the analytic sample, mean (SD) age was 30.0 (5.9) years and prepregnancy BMI was 28.1 (6.1); 65.8% of women started pregnancy with BMIs of 25 or higher, and 53.2% were Hispanic. We observed a lower prevalence (55.8-46.4%; unadjusted odds ratio [OR] 0.69, 95% CI 0.49-0.97), similar to results in a multivariable analysis (adjusted OR 0.69, 95% CI 0.49-0.99), of excess gestational weight gain among women with prepregnancy BMIs between 25 and 29.9. Among women who were overweight at the start of pregnancy, the lowest odds of excess gestational weight gain were observed among those with the most interaction with the program's components. Program enrollment was not associated with reduced excess gestational weight gain among women with prepregnancy BMIs of 30 or higher.

CONCLUSIONS

Implementation of a systems-change intervention was associated with modest reduction in excess gestational weight gain among women who were overweight but not obese at the start of pregnancy.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT03191591.

Differences in Self-Esteem Between Cat Owners, Dog Owners, and Individuals Without Pets

Introduction: Pet ownership may provide an additional source of social support and may contribute to the owner's self-esteem. Self-esteem is considered a basic human need and is associated with psychological conditions such as depressive symptoms. To date, there is limited knowledge on the association between keeping a pet and self-esteem.

Objectives: The aim of this study was to determine whether cat owners, dog owners, and individuals without pets differ in terms of self-esteem (total sample and stratified by sex).

Methods: Data were taken from the German Aging Survey (wave 5; nationally representative sample of individuals residing in private households ≥40 years). In this survey, the widely used and well-established Rosenberg scale was used to quantify self-esteem. Socioeconomic, lifestyle, and health-related factors were adjusted for in the regression analysis (n = 5,485).

Results: Multiple linear regressions showed that dog owners reported higher self-esteem scores compared to individuals without pets (β = 0.04, p < 0.05). Similarly, male dog owners reported higher self-esteem scores compared to men without pets (β = 0.07, p < 0.01). In contrast, female cat owners reported lower self-esteem scores compared to women without pets (β = −0.07, p < 0.01).

Conclusion: Study findings showed a link between owning a cat and lower self-esteem (women), as well as between owning a dog and higher self-esteem (total sample; men). Future studies should concentrate on investigating the underlying mechanisms. Furthermore, longitudinal studies are needed to better understand the link between animal ownership and self-esteem.

Social networks and health in later life: a state of the literature

Late life is a period frequently marked by decline in personal health and heightened need for social support. Consequently, the social networks in which individuals are embedded assume an increasingly central role in the health and wellbeing of older adults. In the present article, I review the state of the literature on social networks and health in later life. By drawing on insights from the sociology of ageing and the life course, I address new developments and current challenges within the field. Chief among these developments and challenges is the recognition that the ageing process does not occur in a vacuum. Rather, individuals are consistently exposed to numerous changes to their social lives which have strong implications for current and future health outcomes. Upon highlighting the latest innovations within the field of networks and health, I conclude with useful directions for future research.

Should patients with obesity be more afraid of COVID-19?

COVID-19 crisis has lasted since the late 2019 to the present day. The severity of the disease is positively correlated with several factors, such as age and coexisting diseases. Furthermore, obesity is increasingly considered as a yet another risk factor, particularly, because it has been observed that people suffering from excessive body weight may experience a more severe course of COVID-19 infection. On the basis of current research, in our nonsystematic review, we have investigated the extent to which obesity can affect the SARS-CoV-2 course and identify the potential mechanisms of the disease. We have also described the role of proper nutrition, physical activity and other aspects relevant to the management of obesity.

Emerging infectious disease and the challenges of social distancing in human and non-human animals

The 'social distancing' that occurred in response to the COVID-19 pandemic in humans provides a powerful illustration of the intimate relationship between infectious disease and social behaviour in animals. Indeed, directly transmitted pathogens have long been considered a major cost of group living in humans and other social animals, as well as a driver of the evolution of group size and social behaviour. As the risk and frequency of emerging infectious diseases rise, the ability of social taxa to respond appropriately to changing infectious disease pressures could mean the difference between persistence and extinction. Here, we examine changes in the social behaviour of humans and wildlife in response to infectious diseases and compare these responses to theoretical expectations. We consider constraints on altering social behaviour in the face of emerging diseases, including the lack of behavioural plasticity, environmental limitations and conflicting pressures from the many benefits of group living. We also explore the ways that social animals can minimize the costs of disease-induced changes to sociality and the unique advantages that humans may have in maintaining the benefits of sociality despite social distancing.

2019 Novel Coronavirus Disease, Crisis, and Isolation

The highly contagious 2019 novel coronavirus disease (COVID-19) outbreak has not only impacted health systems, economies, and governments, it has also rapidly grown into a global health crisis, which is now threatening the lives of millions of people globally. While, on one hand, medical institutions are critically attempting to find a cure, on the other hand, governments have introduced striking measures and policies to curtail the rapid spread of the disease. Although COVID-19 has achieved pandemic status and is predominantly viewed as a biomedical issue, it is argued that it should also be treated as a psychological crisis. This paper also reviews the literature to examine and comment on the detrimental effects of isolation, which has been enforced as one of the primary preventative measures to manage the spread of COVID-19. This paper further outlines key recommendations that should be addressed across different levels to buffer against the known adverse effects of isolation, which is especially relevant for the current COVID-19 situation, where a large proportion of the global population is isolated, confined, and/or quarantined.

COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options

The novel coronavirus disease (COVID-19) outbreak, caused by SARS-CoV-2, represents the greatest medical challenge in decades. We provide a comprehensive review of the clinical course of COVID-19, its comorbidities, and mechanistic considerations for future therapies. While COVID-19 primarily affects the lungs, causing interstitial pneumonitis and severe acute respiratory distress syndrome (ARDS), it also affects multiple organs, particularly the cardiovascular system. Risk of severe infection and mortality increase with advancing age and male sex. Mortality is increased by comorbidities: cardiovascular disease, hypertension, diabetes, chronic pulmonary disease, and cancer. The most common complications include arrhythmia (atrial fibrillation, ventricular tachyarrhythmia, and ventricular fibrillation), cardiac injury [elevated highly sensitive troponin I (hs-cTnI) and creatine kinase (CK) levels], fulminant myocarditis, heart failure, pulmonary embolism, and disseminated intravascular coagulation (DIC). Mechanistically, SARS-CoV-2, following proteolytic cleavage of its S protein by a serine protease, binds to the transmembrane angiotensin-converting enzyme 2 (ACE2) -a homologue of ACE-to enter type 2 pneumocytes, macrophages, perivascular pericytes, and cardiomyocytes. This may lead to myocardial dysfunction and damage, endothelial dysfunction, microvascular dysfunction, plaque instability, and myocardial infarction (MI). While ACE2 is essential for viral invasion, there is no evidence that ACE inhibitors or angiotensin receptor blockers (ARBs) worsen prognosis. Hence, patients should not discontinue their use. Moreover, renin-angiotensin-aldosterone system (RAAS) inhibitors might be beneficial in COVID-19. Initial immune and inflammatory responses induce a severe cytokine storm [interleukin (IL)-6, IL-7, IL-22, IL-17, etc.] during the rapid progression phase of COVID-19. Early evaluation and continued monitoring of cardiac damage (cTnI and NT-proBNP) and coagulation (D-dimer) after hospitalization may identify patients with cardiac injury and predict COVID-19 complications. Preventive measures (social distancing and social isolation) also increase cardiovascular risk. Cardiovascular considerations of therapies currently used, including remdesivir, chloroquine, hydroxychloroquine, tocilizumab, ribavirin, interferons, and lopinavir/ritonavir, as well as experimental therapies, such as human recombinant ACE2 (rhACE2), are discussed.

Combatting Social Isolation Among Older Adults in a Time of Physical Distancing: The COVID-19 Social Connectivity Paradox

Social isolation is an important public health issue that has gained recognition during the COVID-19 pandemic because of the risks posed to older adults based on physical distancing. The primary purposes of this article are to provide an overview of the complex interconnectedness between social isolation, loneliness, and depression while introducing the COVID-19 Connectivity Paradox, a new concept used to describe the conflicting risk/harm continuum resulting from recommended physical distancing. In this context, examples will be provided for practical and feasible community-based models to improve social connectivity during COVID-19 by adjusting the processes and modalities used to deliver programs and services to older adults through the aging social services network. The COVID-19 pandemic has highlighted the need for clinical and community-based organizations to unite and form inter-sectorial partnerships to maintain the provision of services and programs for engaging and supporting older adults during this difficult time of physical distancing and shelter-in-place and stay-at-home orders. The aging social services network provides a vital infrastructure for reaching older underserved and/or marginalized persons across the U.S. to reduce social isolation. Capitalizing on existing practices in the field, older adults can achieve distanced connectivity to mitigate social isolation risk while remaining at safe physical distances from others.

You've got a friend in me: sociable robots for older adults in an age of global pandemics

Social isolation and loneliness are ongoing threats to health made worse by the coronavirus disease 2019 (COVID-19) pandemic. During the pandemic, half the globe's population have been placed under strict physical distancing orders and many long-term care facilities serving older adults went into lockdown mode, restricting access to all visitors, including family members. Before the pandemic emerged, a 2020 National Academy of Sciences, Engineering and Medicine report warned of the underappreciated adverse effects of social isolation and loneliness on health, especially among older populations. Social isolation and loneliness predict all-cause mortality at rates that rival clinical risk factors, such as obesity and smoking; they are associated with greater incidence of psychological, cognitive, and physical morbidities. This paper sets forth a proposal to design robots to function as companions and friends for socially isolated and lonely older people during pandemic emergencies and in aging societies more generally. "The proposal" section presents and defends the proposal. The "Replies to objections" section answers objections based on coercive design, replacement of humans with robots, privacy incursions, and counterfeit companionship. The "Conclusion" section submits that sociable robots offer a promising avenue for addressing social isolation and loneliness during pandemics and hold promise for aging societies more broadly.

The effectiveness of interventions for reducing subjective and objective social isolation among people with mental health problems: a systematic review

PURPOSE

Subjective and objective social isolation are important factors contributing to both physical and mental health problems, including premature mortality and depression. This systematic review evaluated the current evidence for the effectiveness of interventions to improve subjective and/or objective social isolation for people with mental health problems. Primary outcomes of interest included loneliness, perceived social support, and objective social isolation.

METHODS

Three databases were searched for relevant randomised controlled trials (RCTs). Studies were included if they evaluated interventions for people with mental health problems and had objective and/or subjective social isolation (including loneliness) as their primary outcome, or as one of a number of outcomes with none identified as primary.

RESULTS

In total, 30 RCTs met the review's inclusion criteria: 15 included subjective social isolation as an outcome and 11 included objective social isolation. The remaining four evaluated both outcomes. There was considerable variability between trials in types of intervention and participants' characteristics. Significant results were reported in a minority of trials, but methodological limitations, such as small sample size, restricted conclusions from many studies.

CONCLUSION

The evidence is not yet strong enough to make specific recommendations for practice. Preliminary evidence suggests that promising interventions may include cognitive modification for subjective social isolation, and interventions with mixed strategies and supported socialisation for objective social isolation. We highlight the need for more thorough, theory-driven intervention development and for well-designed and adequately powered RCTs.

Best practices for stress measurement: How to measure psychological stress in health research

Despite the strong evidence linking psychological stress to disease risk, health researchers often fail to include psychological stress in models of health. One reason for this is the incorrect perception that the construct of psychological stress is too vague and broad to accurately measure. This article describes best practices in stress measurement, detailing which dimensions of stressor exposures and stress responses to capture, and how. We describe when to use psychological versus physiological indicators of stress. It is crucial that researchers across disciplines utilize the latest methods for measuring and describing psychological stress in order to build a cumulative science.

Financial Conflicts of Interest are of Higher Ethical Priority than "Intellectual" Conflicts of Interest

The primary claim of this paper is that intellectual conflicts of interest (COIs) exist but are of lower ethical priority than COIs flowing from relationships between health professionals and commercial industry characterized by financial exchange. The paper begins by defining intellectual COIs and framing them in the context of scholarship on non-financial COIs. However, the paper explains that the crucial distinction is not between financial and non-financial COIs but is rather between motivations for bias that flow from relationships and those that do not. While commitments to particular ideas or perspectives can cause all manner of cognitive bias, that fact does not justify denying the enormous power that relationships featuring pecuniary gain have on professional behaviour in term of care, policy, or both. Sufficient reason exists to take both intellectual COIs and financial COIs seriously, but this paper demonstrates why the latter is of higher ethical priority. Multiple reasons will be provided, but the primary rationale grounding the claim is that intellectual COIs may provide reasons to suspect cognitive bias but they do not typically involve a loss of trust in a social role. The same cannot be said for COIs flowing from relationships between health professionals and commercial industries involving financial exchange. The paper then assumes arguendo that the primary rationale is mistaken and proceeds to show why the claims that intellectual COIs are more significant than relationship-based COIs are dubious on their own merits. The final section of the paper summarizes and concludes.

Social isolation from family and friends and mental health among African Americans and Black Caribbeans

Social isolation is a significant social problem in the United States that many health and welfare organizations have begun to acknowledge and address. Unfortunately, extremely little research focuses on social isolation among ethnic minority populations. This study investigated the association between social isolation from family and friends and the mental health of African Americans and Black Caribbeans. Using data from the National Survey of American Life (2001-2003), we explore 2 indicators of mental health: depressive symptoms (CES-D) and serious psychological distress (Kessler 6). The negative binomial regression analysis examined both objective isolation (infrequent contact) and subjective isolation (lack of emotional closeness) from family and friends. Overall study findings indicated that infrequent contact (objective social isolation) and diminished emotional closeness (subjective social isolation) from family and friends were associated with higher levels of depressive symptoms and serious psychological distress for both African Americans and Black Caribbeans. The addition of subjective social isolation to regression models attenuated the association between objective social isolation and depressive symptoms for both groups. However, the addition of subjective social isolation attenuated the association between serious psychological distress for African Americans but not for Black Caribbeans. These findings contribute to the very limited, but growing body of research on the negative association between social isolation and the mental and physical health of ethnic minorities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Social Risks Among Primary Care Patients in a Large Urban Health System

INTRODUCTION

Health systems are increasingly interested in addressing the social determinants of health via social risk screening. The objective of this study is to understand the variability in the number and types of social risks overall and in population subgroups among primary care patients routinely screened in a large urban health system.

METHODS

Between April and December 2018, a total of 24,633 primary care patients completed a 10-item screener across 19 ambulatory sites within a health system in the Bronx, NY. The prevalence of any social risk and specific social risks was estimated overall and for population subgroups. Wald tests were used to determine statistically significant differences by subgroup. Data were analyzed in winter/spring 2019.

RESULTS

Twenty percent of patients presented with at least 1 social risk. The most frequently reported risks included housing quality (6.5%) and food insecurity (6.1%). Middle-aged (30-59 years) respondents (24.7%, 95% CI=23.6%, 25.7%) compared with those aged 18-29 years (17.7%, 95% CI=16.4%, 19.2%, p<0.001), and Medicaid patients (24.8%, 95% CI=24.0%, 25.5%) compared with commercially insured patients (11.8%, 95% CI=11.1%, 12.5%, p<0.001), were more likely to report social risks. The strongest predictor of housing quality risk was residing in public housing (15.1%, 95% CI=13.8%, 16.6%) compared with those not in public housing (5.6%, 95% CI=5.3%, 5.9%, p<0.001). Housing quality was the most frequently reported risk for children (aged <18 years) and older adults (aged ≥70 years), whereas, for middle-aged respondents (30-69 years), it was food insecurity.

CONCLUSIONS

There are important differences in the prevalence of overall and individual social risks by subgroup. These findings should be considered to inform clinical care and social risk screening and interventions.

Association of social relationships with incident cardiovascular events and all-cause mortality

Objective

To examine how different aspects of social relationships are associated with incident cardiovascular events and all-cause mortality.

Methods

In 4139 participants from the population-based Heinz Nixdorf Recall study without previous cardiovascular disease (mean (SD) age 59.1 (7.7) years, 46.7% men), the association of self-reported instrumental, emotional and financial support and social integration at baseline with incident fatal and non-fatal cardiovascular events and all-cause mortality during 13.4-year follow-up was assessed in five different multivariable Cox proportional hazards regression models: minimally adjusted model (adjusting for age, sex, social integration or social support, respectively); biological model (minimally adjusted+systolic blood pressure, low-density and high-density lipoprotein cholesterol, glycated haemoglobin, body mass index, antihypertensive medication, lipid-lowering medication and antidiabetic medication); health behaviour model (minimally adjusted+alcohol consumption, smoking and physical activity); socioeconomic model (minimally adjusted+income, education and employment); and depression model (minimally adjusted+depression, antidepressants and anxiolytics).

Results

339 cardiovascular events and 530 deaths occurred during follow-up. Lack of financial support was associated with an increased cardiovascular event risk (minimally adjusted HR=1.30(95% CI 1.01 to 1.67)). Lack of social integration (social isolation) was associated with increased mortality (minimally adjusted HR=1.47 (95% CI 1.09 to 1.97)). Effect estimates did not decrease to a relevant extent in any regression model.

Conclusions

Perceiving a lack of financial support is associated with a higher cardiovascular event incidence, and being socially isolated is associated with increased all-cause mortality. Future studies should investigate how persons with deficient social relationships could benefit from targeted interventions.

Isolement social et solitude : les nouveaux géants gériatriques

Objectif

Examiner les problèmes de l’isolement social, de la solitude et de la vulnérabilité sociale chez les adultes plus âgés, de même que les risques qui leur sont associés, et aider les professionnels des soins primaires à identifier les patients à risque et à recommander des interventions efficaces.

Sources de l’information

Une recherche documentaire a été effectuée dans PubMed et PsycINFO en se servant des expressions aged, social isolation, loneliness, screening et interventions, de même que des mots clés associés pour trouver des articles pertinents en anglais. Les références des articles cernés ont aussi fait l’objet d’une recherche manuelle. Une recension distincte dans la littérature grise à l’aide de Google a aussi été faite pour trouver des documents de politiques et du matériel de transfert des connaissances provenant d’organisations appropriées. La recherche portait sur les articles publiés durant les 10 années précédant juin 2019.

Message principal

L’isolement social, la solitude et la vulnérabilité sociale sont très fréquents chez les adultes plus âgés; ils sont liés à une morbidité et à une mortalité considérables, et sont comparables à des facteurs de risque établis comme le tabagisme, la consommation d’alcool, l’obésité et la fragilité. De nombreuses interventions pour lutter contre la solitude et l’isolement social ont fait l’objet d’études : la facilitation sociale (y compris avec la technologie), l’exercice, les psychothérapies, les services sociaux et de santé, la zoothérapie, les programmes d’amitié, les loisirs et le perfectionnement des compétences. Par ailleurs, les données scientifiques actuelles sur leur efficacité sont limitées. Les besoins des populations mal desservies et marginalisées, y compris les nouveaux immigrants, les adultes plus âgés s’identifiant comme LGBTQ+ (lesbienne, gai, bisexuel, transgenre, queer ou en questionnement, et les communautés connexes), les personnes âgées autochtones et les aînés qui vivent dans la pauvreté, de même que les besoins des bénéficiaires de soins de longue durée et des aidants plus âgés, doivent être évalués de manière plus approfondie.

Conclusion

L’isolement social, la solitude et la vulnérabilité sociale sont des problèmes fréquents chez les adultes plus âgés, et ils ont des répercussions importantes sur la santé. Les médecins de famille sont bien placés pour identifier les aînés esseulés ou socialement isolés et enclencher l’amorce des services voulus.

Social Isolation's Influence on Loneliness among Older Adults

Social isolation and loneliness are significant risks to health among older adults. Previous studies have found a significant association between social isolation and loneliness; however, few studies examined the association between social isolation and loneliness in a multivariate context and how specific types of social isolation influence loneliness. This study fills this gap by examining social isolation's overall influence on loneliness and how specific social isolation indicators influence loneliness. Data comes from 2014 Wave of the Health and Retirement Study, a nationally representative study of adults aged 50 and older. Social isolation was operationalized using seven indicators as social isolation from: 1) adult children, 2) other family members, 3) friends, 4) living alone, 5) being unmarried, and 6) not participating in social groups or 7) religious activities. Loneliness was operationalized by the Hughes 3-item loneliness scale. Loneliness was regressed on social isolation and key socio-demographic factors. Results found when social isolation indicators were combined into an index, every unit increase in overall social isolation was associated with an increase in loneliness. Furthermore older adults who were isolated from other family members and from friends, lived alone, were single, and did not participate in social groups or religious activities reported greater loneliness. Study findings demonstrate that greater overall social isolation and specific social isolation indicators are associated with greater loneliness. Clinical practice with older adults can be enhanced by understanding the connections between social isolation and loneliness and which forms of social isolation are more meaningful for perceived loneliness.

Perceived social isolation and cognitive functioning. Longitudinal findings based on the German Ageing Survey

OBJECTIVES

There is a lack of longitudinal studies, which are both based on nationally representative samples and use standardized instruments to quantify social isolation. Thus, the purpose of this study was to determine the link between perceived social isolation and cognitive functioning longitudinally.

METHODS/DESIGN

Longitudinal data with n = 6420 from 2014 (wave 5) to 2017 (wave 6) were drawn from the German Ageing Survey (nationally representative sample of individuals aged 40 years and over). Perceived social isolation was assessed using a scale by Bude and Lantermann. Cognitive functioning was quantified using the established digit symbol test. To reduce the problem of unobserved heterogeneity, linear fixed effects regressions were used.

RESULTS

Regressions showed that increases in perceived social isolation were associated with decreases in cognitive functioning. With regard to covariates, decreases in cognitive functioning were associated with increases in aging and worsening self-rated health, whereas changes in marital status, employment status, income, physical functioning, and physical illnesses were not associated with the outcome measure.

CONCLUSIONS

Based on a nationally representative sample and exploiting the panel data structure, the study findings extend current knowledge by showing that increasing perceived social isolation contributes to decreases in cognitive functioning among individuals aged 40 years and over longitudinally. Future longitudinal studies based on panel data methods are required to validate the study findings.

Reducing Isolation and Loneliness Through Membership in a Fitness Program for Older Adults: Implications for Health

Objectives: To explore the effects of membership in a fitness program for older adults on social isolation, loneliness, and health. Method: Using survey responses from SilverSneakers members and matched nonmembers, regression path analysis was used to examine the influence of SilverSneakers membership on physical activity, social isolation, loneliness, and health, and the interrelationships among these concepts. Results: SilverSneakers membership directly increased physical activity and self-rated health, directly decreased social isolation, and indirectly decreased loneliness. Decreased social isolation and loneliness were associated with better self-rated health: social isolation and loneliness had independent direct effects on health, while social isolation also had an indirect effect on health mediated through loneliness. Discussion: Members of SilverSneakers experienced better health through increased physical activity, reduced social isolation, and reduced loneliness. Future research should explore independent effects of social isolation and loneliness on health and the mechanisms by which membership reduces social isolation and loneliness.

Social isolation and loneliness: the new geriatric giants: Approach for primary care

OBJECTIVE

To review the problems of social isolation, loneliness, and social vulnerability in older adults and the associated risks, and to help primary care providers identify patients at risk and recommend effective interventions.

SOURCES OF INFORMATION

PubMed and PsycINFO searches were conducted using the terms aged, social isolation, loneliness, screening, and interventions and associated key words for relevant English-language articles. References of identified articles were also hand searched. A separate search of the gray literature using Google was conducted to find policy documents and knowledge translation materials from relevant organizations. The search covered relevant articles from the 10 years before June 2019.

MAIN MESSAGE

Social isolation, loneliness, and social vulnerability are very common in older adults and are associated with considerable morbidity and mortality, comparable to established risk factors such as smoking, alcohol consumption, obesity, and frailty. Numerous interventions addressing loneliness and social isolation have been studied: social facilitation (including technology), exercise, psychological therapies, health and social services, animal therapy, befriending, and leisure and skill development. However, current evidence of effectiveness is limited. A patient-centred approach is essential to the selection of interventions. The needs of underserviced and marginalized populations, including new immigrants, older adults identifying as LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning, and related communities), Indigenous seniors, and seniors living in poverty, as well as the needs of long-term care residents and older caregivers, require further evaluation.

CONCLUSION

Social isolation, loneliness, and social vulnerability are common problems in older adults and have important health consequences. Family physicians are uniquely positioned to identify lonely and socially isolated older adults and to initiate services.

Risk factors for social isolation in post-hospitalized older adults

INTRODUCTION

Social isolation in older adults is associated with high rates of adverse health outcomes. Older adults who have had a recent significant health event are likely to be at risk of social isolation following hospitalization. This study aims to identify risk factors amongst older adults at hospital discharge that are associated with social isolation at three months post-hospitalization.

METHODS

Older adults were surveyed at hospital discharge and three months post-hospitalization. Baseline data including demographics, self-reported quality of life, physical activity and capacity levels, lifestyle factors, symptoms of depression and anxiety were collected at discharge. Social isolation was measured using the Friendship Scale at the three-month follow-up. Regression analyses were used to examine the relationship between baseline characteristics and social isolation at three months post-hospitalization.

RESULTS

Older adults (n = 311) participated in the baseline survey, of whom 241 (78 %) completed the three-month survey. Higher depressive and anxiety symptoms at hospital discharge, comorbidity of cancer, history of cigarette smoking, prior access to community and respite service, and arrangement for shopping assistance post-discharge were factors independently associated with an increased risk of social isolation at three months post-hospitalization.

DISCUSSION

This study identified risk factors for social isolation that are unique to older post-hospitalized adults. These findings can help clinicians identify individuals at risk of social isolation and to target interventions that address these risk factors for the prevention of social isolation in older adults after hospitalization.